It is time to stop and think about polyclinics

In the increasingly convoluted debate about Darzi reforms and 'polyclinics', GPs tend to be cast as the bad guys: a gang of medical Luddites determined to oppose or even destroy any vestige of progress.

What is interpreted as defiance, protectionism and an unwillingness to change is in fact more about a different approach to weighing up change, experience and a concern for patients. GPs see little or no evidence that the plans of PCTs based on the Darzi recommendations will actually deliver the desired changes.

There has been, up to now, little in-depth analysis of the effects of the polyclinic plans. For a start there is little consensus on what a polyclinic is: some think of it as a single, possibly PCT-run practice with 20 or 30 GPs, while PCTs seem to favour a large building housing several relocated practices and other services. The hub-and-spoke model with practices remaining separate but working with a single centre offering diagnostic and outpatient services (a reimagining of the community hospital) seems to be ignored by many despite fitting with the RCGP's federated practice model.

The result is a focus on the centralised model as a panacea for all NHS ills despite its clear unsuitability in many areas.

Beyond this issue, we come to the question of whether polyclinics could deliver the DoH's stated aims; access, quality and cost-effectiveness. These are addressed in a King's Fund report, Under One Roof: Will polyclinics deliver integrated care?

Polyclinics are touted as the answer to access but opening hours are not the only measure here. A polyclinic opening longer is no use if it is not on major transport routes, the report warns. In other words, for many a local GP surgery offers better access.

On quality the authors point out that there has been little work done on how this will be measured and assured. Furthermore, relocating staff does not mean they will change their working practices or lead to greater inter-disciplinary co-operation.

There are even questions over cost effectiveness. If polyclinic buildings are to be funded through public-private partnerships, there is evidence to show this has not created long-term saving in the past.

Plus it will be costly to move services from hospitals even if it does improve access and quality of care.

Since the interim Darzi report last year, there seems to be a headlong dash into building polyclinics or at least planning them. What this report tells us, and common sense has already suggested, is that if real value is to be found in these reforms, it is time to stop and think. Only by weighing up the evidence and addressing potential risks now can real improvements be made.

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