Will walk-in centres be axed?

More than a fifth of walk-in centres in England have closed since 2010, and contracts for most of the remaining 185 expire within the next year.

Competition regulator Monitor warned in a review this month that decisions on their future 'require immediate attention'.

Monitor's Walk-in centre review: preliminary report warned that the division of duties between CCGs and NHS England was creating confusion over who should take charge of deciding the future of walk-in centres.

But 53 have closed since 2010 and many CCGs are conducting local reviews, some of which have already decided to add to the number of walk-in centres on the scrapheap. A further 23 centres have had their services reduced.

Although Monitor admits this amounts to 'a trend to close walk-in centres', it also found that in some areas, commissioners have instead chosen to expand the range of services they offer.

The regulator also believes the centres can compete with GP practices and act as a lever to force them to 'up their game'.

So what is the future for walk-in centres and how might they look?

Urgent care review

Many CCGs are in the middle of reviewing whether to keep or change their walk-in centres, some as part of a wider review of urgent care in their area.

Some have already decided not to keep their centres open and instead plan to integrate their urgent care services at fewer sites.

Monitor warns that the division of commissioning responsibilities between NHS England's area teams and CCGs is causing confusion. 'Commissioning of walk-in centres may work better for patients if one body is responsible,' it says.

The message to commissioners is to look at the urgent care system as a whole and work out how walk-in centres fit in.

A wide-ranging review of urgent care by NHS England medical director Sir Bruce Keogh, also published this month (see page 29), calls for the 'array' of similar urgent care services in some areas - including services operating as walk-in centres, minor injury units or urgent care centres - to be co-located and universally called urgent care centres.

Competition

GP practices 'raise their game' when walk-in centres can register patients, Monitor argued.

'GP practices have little incentive to improve their services so that their patients will choose to see them instead of attending the walk-in centre,' its review said.

Monitor has called for suggestions on 'how payment mechanisms should be adjusted to increase patient benefits within the limits of NHS funding', to feed into a final report on walk-in centres early next year.

GP leaders warn that the NHS cannot afford to pay general practice on activity, as walk in-centres are.

BMA council member Dr Louise Irvine says there is no evidence that competition creates improvements. 'Competition is unscientific and is a political statement. It is the flavour of the month to talk about competition. It is causing fragmentation and wasting resources.'

The way to improve general practice is to invest in it, she argues. 'Our practice is quite near a walk-in centre. We try to be a good practice. We don't feel it is because of the walk-in centre.'

Resources

GP leaders warn that the NHS simply cannot afford walk-in centres and argue that they must be axed.

Duplication of services already offered in primary care was one reason why commissioners decided to close them, Monitor's review found.

GPC deputy chairman Dr Richard Vautrey calls for all remaining walk-in centres - which cost £450,000-£1m a year to run - to be axed and the money to be diverted into primary care. England's 8,000 practices could receive about £25,000 each from the move.

Dr Vautrey believes Monitor, NHS England and the DH should launch a 'public relations exercise' to enable this to happen, because walk-in centres are 'unaffordable'.

'The most cost-effective way of delivering general practice services is to invest in GP practices and services,' GPC negotiator Dr Beth McCarron-Nash says.

Fans of walk-in centres argue that they provide a vital service to patients who are unable to register at GP practices, such as the homeless.

But walk-in centres are not the only option available to commissioners, Dr McCarron-Nash argues. There are already practices commissioned to serve specific populations such as homeless people, through enhanced services or PMS contracts, she says.

RCGP chairwoman Dr Maureen Baker says that on the whole, walk-in centres have not affected the increasing demand on GPs.

'Overwhelmingly, general practice remains the most popular choice with patients for urgent and non- urgent healthcare, with well over 300m consultations per year, considerably more than any other service providing urgent care alone.

'What we really need is much greater investment in general practice, so that we can provide holistic care with more appointments, services and continuity of care for all our patients, as well as value for money to the NHS.'

Future models

It is unlikely that funding saved by closing walk-in centres will be diverted into general practice.

But Sir Bruce's vision of a more rationalised urgent care service, linked more closely with GP out-of-hours care, is likely. In many areas, this could involve closing the existing walk-in centre.

Bexley CCG in south-east London is already planning to close its walk-in centre and consolidate its urgent care services. CCG chairman Dr Howard Stoate says that he wants to produce a 'seamless' service that is 'more easily understood'.

It plans to consolidate its urgent care service and reduce its current five access points to two.

'The whole point of GP commissioning is to review what is being done and produce a service that improves year on year,' he says.

Dr Stoate, a former Labour MP, says that not all walk-in centres will close, because they are working well in some areas.

Bleak outlook

Birmingham GP Dr Fay Wilson, chief executive at out-of-hours provider Badger, agrees that not all walk-in centres will close. But she says that they will cease to be stand-alone services. 'The NHS cannot afford them,' she argues.

'The ones that have lots of registered patients will carry on being practices but stop the walk-in element,' she says.

Of the 53 walk-in centres that closed, about half were GP-led health centres, and half of these were simply converted into GP practices. In some areas, walk-in centres are plugging a gap because general practice is overloaded, Dr Wilson says.

'If the problem is that we haven't got enough GPs, we need more GPs, we don't need someone to invent something else,' she adds.

GP commissioners who have been given the task of saving millions for the NHS may see walk-in centres as an easy service to cut. For many, they are simply considered a luxury the NHS cannot afford.