Practices unite to form polyclinic

Tom Ireland looks into how the Waters Green Medical Centre polyclinic in Macclesfield operates.

The GPs of Macclesfield in Cheshire started planning their polyclinic 10 years before health minister Lord Ara Darzi began his NHS review last year.

Six GP practices, working in grand but antiquated Georgian buildings, teamed up with investment firm Assura Property which designed and built the £13 million Waters Green Medical Centre in the heart of Macclesfield, which it now leases to the GPs.

The 6,000m2, four-storey building opened in 2006. It now houses 44 GPs and serves over 60,000 patients.

The Waters Green model has many unique features that address some of the concerns GPs and patients have about polyclinics. The practices have remained independent, retaining their GMS and PMS contracts.

Its location means over half of patients are now closer to a GP. The building is split into the original six practices, so patients recognise the same staff from the old surgeries. Each GP has kept the same patient list, which Waters Green GPs see as a vital difference between it and Darzi-style polyclinics.

GP Dr Val Pickles believes the building is a great place to work.

'We can get services in here we would never have dreamed of in a small practice,' she said.

Dr Pickles said it took about a year for patients to warm to the idea. However, now practices are scoring higher in patient satisfaction surveys.

Separated by a large and airy courtyard, the reception of each practice has retained its own unique mixture of patients, staff, posters, toys and noise.

The second floor of the vast building houses the additional services the practices share. This area buzzes with a variety of patients, each attending any one of the 20 clinics held on the floor, including smoking cessation, vasectomy, chiropody and blood testing.

Seeing these patients being treated straight after a GP consultation below, the idea of a 'one-stop shop' for patients seems logical.

The polyclinic's strategic development manager Justin Johnson explains how the PCT saves money every time a patient is seen, diagnosed and treated in the building: 'It could mean three or four visits to hospital in other areas.'

Assura Property finances the building. But its sister company Assura Medical provides the in-house pharmacy and some additional services next door, like a GUM clinic and X-ray services.

The staff explain how useful these services are, but all the rooms in this section are locked, dark and quiet compared with a typical X-ray suite at a hospital.

The third and fourth floors are a maze of admin, training and IT suites, as well as a few rooms used by the PCT.

After walking round endless corridors, passing hospital-like signposts and empty rooms, it starts to feel as if there is too much space and equipment. The building is twice as large as all six of the original practices put together.

Dr Pickles concedes that some of the economies of scale have not quite worked out: 'We thought we'd save money coming together but there are costs like managing the car parks, that we weren't expecting.'

But the staff feel well placed to deal with the new demands GMS and extended hours. They plan to have one GP from each practice working for a few extra hours but share a nurse and receptionist.

Waters Green is similar to the model proposed by Virgin, where GPs remain independent, but is not recognised in the DoH plans for polyclinics, which involve all APMS contracts and 8am to 8pm opening, as well as walk-in services.

Dr Gill Plant, chairwoman of the board of GPs at Waters Green, thinks the best thing about working in the centre is having a say in which services it provides: 'We get what we want, and our ideas are clear about what's best for the patient.'

Dr Plant is not keen on providing walk-in services, because they are not evidence based.

This is possibly why another polyclinic is to open little over a mile away, in order to meet the DoH's demands for convenience over continuity of care. Perhaps there will be even more rooms lying empty when that opens.

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