A network of `polyclinics’ throughout London could provide up to 50 per cent of the outpatient treatment currently carried out in hospital by 2017, if proposals in a report by a top London surgeon are adopted.
And hospitals would take on different roles, from local hospitals doing the bulk of the routine work to major acute hospitals undertaking complex and specialist work, with three trauma units taking seriously injured patients.
The report, Healthcare for London, by Sir Ara Darzi, Professor of Surgery at Imperial College, was commissioned by NHS London, the Strategic Health Authority for the capital, and is published today (Wednesday, 11 July).
Professor Darzi points out that health services have improved for Londoners, in particular waiting times in A&E and for routine operations. But many aspects of NHS services are not as good as they should be for a major world city.
Millions of Londoners have non life-threatening short-term illnesses for which they need prompt and convenient treatment. A much smaller number suffer from more serious illness, such as stroke or heart attack, or have a major injury. The NHS is not serving either of these groups as well as it could.
He points out that best care for stroke patients means rapid access to a CT scan to determine the cause of the stroke and to provide clot busting drugs if the cause is a blockage in the blood vessel. These drugs should ideally be given within three hours. Yet, at present, many people are not even having the initial scan within 24 hours.
If stroke patients were seen by specialist teams many more could live and still more be saved from disability. Over 6000 Londoners suffered a stroke in 2005/06. A stroke strategy is a priority, the report says.
Twenty seven per cent of Londoners are dissatisfied with the running of the NHS, compared to 18 per cent nationally. Around 60 per cent of 7000 Londoners questioned said improvement was needed in waiting times to see consultants, cleanliness in hospitals, waiting in A&E and for routine operations. People are particularly unhappy with access to GP services outside normal working hours.
Medical advances mean that more care than ever before can be provided locally.
Day surgery can be provided in local hospitals, outpatients can be seen in the community and people with long-term conditions like diabetes can be supported to stay at home.
Services in the community need improvement, but GP practices in London are smaller than the England average – 54 per cent in London have only one or two GPs, compared to 40 per cent nationally, without the support and equipment to undertake treatments close to people’s homes.
Professor Darzi’s report recommends a network of polyclinics across the capital that would provide many of the treatments currently provided in hospital, giving patients more care closer to home. A polyclinic would include GP surgeries, diagnostics such as x-ray and pathology, outpatient clinics, urgent care, minor procedures and associated services such as pharmacies.
Professor Darzi said: “Londoners face a stark divide between primary care and hospital care, and we believe the polyclinic will fill that gap. Most GPs provide an excellent and well-regarded service, but they do not have the facilities to undertake even quite simple diagnostics on site, which means patients face multiple trips to hospital for quite straightforward procedures.”
Hospitals would not be all the same – local hospitals would continue to provide the majority of treatments, but patients needing specialist treatment, complex surgery or treatment for serious injury would be sent to a major acute hospital with medical and surgical teams seeing sufficient numbers of patients to keep their skills up to date. Elective centres for routine planned surgery would not treat emergency patients, to achieve better results for patients and lower the risk of infection.
Ruth Carnall, Chief Executive of NHS London, which commissioned the report, said: “London has been the subject of a number of major reviews in recent years, but not enough has actually changed as a result of these reports. We do not want Ara Darzi’s report to sit on the shelf, because its arguments and its proposals are both radical and persuasive. They also reflect very much what Londoners have been telling us.
“This report must not simply generate unproductive debate about which organisation is better than another, because the report is not about institutions but the needs of patients. It is clear we are not providing the quality of healthcare to Londoners that we could and should be, given the huge investment we have been making in our skills and resources. Ara Darzi’s excellent report will be a spur to action that will ensure Londoners receive the world-class healthcare that they deserve.”
EDITOR’S NOTES: Healthcare for London can be accessed via healthcareforlondon.nhs.uk or by telephoning 0207 932 3000. Further information from Jonathan Street on 020 7808 9899.