Polyclinics are in the firing line

Even health ministers are avoiding the word polyclinic as opposition grows, reports Tom Ireland.

Opposition to Lord Darzi's polyclinic plans is gathering pace as GPs, patient groups and high-profile primary care organisations express their concerns. As a result health ministers are distancing themselves from the term to try to calm fears over surgery closures.

In a GP survey of 205 GPs, 62 per cent believed a polyclinic would have a negative effect on their practice because many of their patients would be lost and 94 per cent said it was a bad use of NHS resources.

Many responses said that polyclinics would undermine and destabilise general practice.

A GP in Rugby, Warwickshire, told the survey: 'It will attract young patients away from us, leaving us with patients of above average need and threatening our financial viability.'

Despite the concerns, the reforms roll on, months before the DoH consultation finishes, and PCTs are already submitting their polyclinic plans.

Mixed messages
This is despite confusion over what the DoH actually means by polyclinics.

Health minister Ben Bradshaw has appeared to separate 'GP-led health centres' from polyclinics.

Responding to a question in parliament last month on the need for polyclinics in rural areas, he said: 'The DoH wrote to SHAs in December to confirm the core criteria of new GP-led health centres. Local commissioners should determine whether or not to go beyond these criteria to achieve more integrated service models, such as polyclinics.'

NHS director general Mark Britnell faced a similar question from the Public Accounts Committee last month. He replied that reforms were about new services, and that it was 'not necessarily new bricks and mortar', suggesting polyclinics would not be needed if GPs could provide the services.

This contradicts the DoH's 2008/9 operating framework, which has demanded that each PCT has at least one polyclinic up and running by 2009.

Extended opening hours
Under the DoH operating framework, polyclinics should open seven days a week, from 8am until 8pm. But in London they will open longer, for as much as 24 hours a day. But again there are mixed message. Recent proposals suggest a split in the polyclinic model. Polyclinics must open for at least 18 hours a day, seven days a week, while GP-led health centres will be open from 8am until 8pm, says NHS London.

Continuity of care
But GP opposition is about more than destabilising local practices. More than half of GPs believed the current polyclinic roll-out would have a negative effect on patient care.

GPs' common concerns were that polyclinics could not offer the same continuity of care.

One GP in Hull wrote: 'I know my patients individually and there is much evidence confirming that patient care is improved when they have continuous care.'

Mr Bradshaw said that patients wanted convenience rather than continuity of care.

But Dr Anthony Halpin, chairman of the Patient's Association, said patients wanted to see the same GP each time.

'We are concerned the personal contact with a GP will be lost within a polyclinic because another layer of treatment is being introduced.'

Dr Tony Stanton, joint chief executive of Londonwide LMCs, expressed his concern about NHS London's latest proposals, which were published before the capital's £1 million consultation had even finished.

'What disturbs me is that this came out ahead of the results of the consultation. The argument is predicated on false assumptions about access,' he said.

A similar pattern is seen elsewhere. The majority of GP readers that have a polyclinic being developed near them, 87 per cent described the consultation as 'poor' or 'very poor'.

There was also criticism from Professor Martin Roland, director at the Primary Care Research and Development Centre, who urged Lord Darzi to rethink his plans.


Bad for practices

62% of GPs believe a polyclinic would have a negative effect on practice — Source: GP survey

Poor consultation

87% of GPs with polyclinics planned near them say consultation was poor — Source: GP survey

Polyclinics in London
Polyclinics plans are most advanced in London. GP asked the candidates for London Mayor for their views

  • Brian Paddick, Liberal Democrat — 'Polyclinics have a place in the overall healthcare system, but they should not be a replacement for local GPs. Older people, the infirm and seriously ill need to be able to access their GP within a short distance of their home. Minor procedures can be provided in such clinics rather than hospitals, but the reassurance provided by a familiar GP, close to your home should not be lost.'
  • Boris Johnson, Conservative — 'Polyclinics are untested: they would cost £3 million, threatening public health budgets, which tend to be raided when trusts need cash; they would break the valued GP-patient link; and by centralising GP services they would leave patients having to travel further to find a doctor. GPs should not be coerced into polyclinics and the proposals should be re-thought.'
  • Ken Livingstone, Labour — 'Londoners will support proposals for high-quality community-based services; but they will want guaranteed accessible local hospitals, not closures. London should have world class health services and I will fight any proposals for closures or cuts.'
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