Darzi seeks to build on best of NHS

Health minister Lord Ara Darzi spoke exclusively to Tom Ireland about his plans for health reform.

Lord Darzi
Lord Darzi

Lord Ara Darzi is enjoying his role as health minister, despite an anxious start and a difficult first few months.

'As a surgeon, a physician, or a GP you are constantly making interventions to make people better. To do that from a policy perspective, and have a bigger impact, is very gratifying to me,' he said.

Speaking before the extended hours row caused contract negotiations to break down, he said: 'No one is going to go round and make sure GPs' doors are always open, but there are those who wish to have appointments out of hours.

'We need to find a way in which a group of practices come together and provide continuity of care.'

Lord Darzi said there was confusion over the 'polyclinics' and 'super-surgeries' proposed in his interim report and the London review.

The arrival of a polyclinic does not signal the closure of surrounding practices, he said.

He believed the introduction of 150 large, GP-led super-surgeries would be an 'evolutionary process' rather than the 'revolution' that some consider a threat to the traditional model of general practice.

'We feel that the first and preferred model, in London, will be the federated model - as supported by the RCGP. This supports five or six practices and their lists, with a hub, providing diagnostics, like blood analysis.

'It is not possible to have cost-effective diagnostics in a small practice. It is for the local community to decide what is best for its needs.'

BMA response
The BMA has expressed concern about the £250 million access fund for the 100 new surgeries in under-doctored areas and the 150 polyclinics proposed in Darzi's interim report.

It believes the fund is not enough to cover the buildings' running costs, and that eventually money would come out of PCTs' annual budgets, leaving less funding for practices.

Lord Darzi said he did not understand this: 'This is new money to create health centres. It is not being placed there for Peter to rob Paul. It is something we should all be proud of, a massive injection of funds into primary and community care.'

Lord Darzi said he was baffled by the concerns of London mayor Ken Livingstone and his rival, Conservative MP Boris Johnson, that hospitals might suffer or close as a result of merging services into polyclinics.

'You give me one piece of evidence that enhancing the provision of community and primary services is going to lead to the closure of hospitals. There is no evidence of that at all.'

Resistance to plans
He thought that any resistance to his plans was because they were plans for the next decade.

'It is based on the problems we will face in 10 years. London's population will increase by 700,000. The impact of scientific advance means more people are living longer. The use of emergency services has risen by 6 per cent in the past five years.

'The conclusion is that in 10 years' time the hospitals will not be able to cope. The answer is to enhance primary and community services, based on the principles of integrated care.

'The polyclinic model is not a new concept,' said Lord Darzi, nor is it one he invented.

'If you leave London, there are about 100 of these across the country. I have already seen some fantastic centres, built before I started my review.'

The aspect Lord Darzi is most enthusiastic about is shifting the innovation and scientific advances from secondary care into primary care.

'What we have in the UK is something we should all be proud of. It is something we will build on, not something we want to erode,' he added.


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