A polyclinic by any other name

Tom Ireland looks at the latest visions and proposals for England's polyclinic roll-out.

The NHS Confederation's latest report attempts to calm the polyclinic debate - but could actually provide more reason for GPs to worry.

Although the report backs the less controversial 'federated' polyclinic model, where existing practices share services from a 'hub', it also recommends going further than the current DoH plan for one polyclinic per PCT.

The report highlights plans for Liverpool city centre and from Heart of Birmingham PCT as model examples of how polyclinics will be used in the future.

Both plans suggest the push for polyclinics will not stop when one is developed in each PCT this year.

Model examples
The proposal for Liverpool would see the city's current 40 practices networked to create 25 smaller polyclinics or 'hubs', which provide shared services. A further three larger polyclinics would provide GP services, diagnostics, more complex treatment and secondary care services.

Heart of Birmingham PCT's proposals centre on its controversial 'corporate franchise strategy' which aims to move all of the area's 76 practices into 24 standardised, franchised health centres. Even the plan's author, Sarb Basi, the PCT's director of service development, has said it was comparable to McDonald's fast-food franchise.

The definition of a polyclinic seems to have evolved since health minister Lord Ara Darzi first proposed a network of up to 150 for London, in 2006.

The RCGP's 'road map' in September 2007 outlined three models of polyclinic, including the federated model, which allowed existing practices to share services from a central hub. The merged model houses all local practices in one building. The 'co-located model' combined elements of both.

When opposition to polyclinics began in January, Lord Darzi told GP that the federated model would be the first to be rolled out in London. Then the DoH announced in January it was providing a GP-led health centre for each PCT, not a polyclinic.

The DoH definition of a GP-led health centre became more vague, and could be either a federated or merged polyclinic (see box right).

Damaging effect
NHS director general Mark Britnell told the Public Accounts Committee in March that GP-led health centres were not even buildings, but a description of services that must be provided.

So far, most PCTs that have talked about their proposals to GP are simply building new premises to house local GPs, sometimes on the doorstep of existing practices.

The NHS Confederation report says the BMA 'is almost certainly right,' about the damaging effect polyclinics might have in rural areas.

The report admits polyclinics will affect existing practices, suggesting they may duplicate existing services, creating surplus capacity. The NHS Confederation also questions the quality of large APMS providers and the fairness of the tendering process.

But this does not seem to be enough to stop them being developed across England.

Conservative shadow health secretary Andrew Lansley said the report was 'missing the point' and the way to calm the debate was 'to persuade the government to shelve its plan for imposing polyclinics'.

The RCGP said federations of GP practices are already working well in some areas of the country and group practices are providing many of the services suggested in the NHS Confederation report.

The BMA says PCTs should be encouraged to invest in their local GP practices.

GPs need to know which polyclinic model is favoured locally. Will it be the 'federated' model or will GPs be forced to move into the 'merged' model, where all local practices are housed in one building?


NHS Confederation report

What is a polyclinic?

DoH (GP-led health centres)
Integrates community services; accessible locations; 8am-8pm; seven days a week; bookable and walk-in GP appointments; registered and non-registered patients.

NHS London
Core GP services plus dentistry, minor surgery, outpatients, pharmacy, urgent care, diagnostics, social care, mental health, leisure and ambulance services.

Federated model provides common services to existing practices. Merger model combines multiple practices into one large practice.

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