They are not an issue in Northern Ireland, perhaps because we have had them for at least 25 years. They were built during the 'Troubles' when we had other things to think about and have not been an issue since.
When I took over this single-handed practice, based in run-down premises in 1980, I would have given a lot to move to a polyclinic, or health centre, because this would have provided me with decent premises, adequate parking, a good treatment room and access to colleagues, community nurses, physiotherapists and health visitors.
Alas there were no vacancies and so I had to find premises and develop them on my own, gradually acquiring the colleagues, equipment, staff and space essential for the delivery of primary care in the 21st century.
Politicians want us to open from 8 till late. As a consumer I want the same. As a GP I don't want to work 12-hour shifts, five days a week. It isn't good for doctors or safe for patients.
The threat from APMS is that providers will stock their practices with shifts of salaried staff, some of whom may not be vocationally trained. This may suit commuters who, on the whole, are pretty fit, but they will almost certainly have problems dealing with chronic disease, terminal illness and the mass of undifferentiated illness that is the daily diet of GPs.
By and large these patients want to see a doctor who is known to them. Private providers may find that it's not worth the hassle.
GPs should be pleased that money will be spent on premises for primary medical care. Good premises are good for GP morale.
Access to colleagues and facilities improves patient care and professional satisfaction. Sharing equipment makes sense and GPs working separately but together in the same building generate considerable camaraderie which can ease one through a busy working day.
It is even 'safe' to share patients from time to time as we discovered when we set up co-ops in the 90s.
Collaboratively, we can provide a service from 8 till late if required.
Become involved in the polyclinic process, and ensure that the design emphasises the character of different practices, each with its own personality. This is what happened in Northern Ireland.
Crisis = danger + opportunity; why not respond positively?
Dr Lewis Miller, Belfast.