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Wendy Savage |
Small is beautiful for patients, polyclinics are a big problem
Can the government afford the polyclinic palaces it has proposed? Patients fear replacing small GPs’ practices could be an expensive mistake, writes Wendy Savage
LORD Darzi’s plan for London envisages 150 polyclinics each with 25 GPs and each serving 50,000 people.
Hospital out-patient appointments will be held there, specialists will attend, there will be diagnostic facilities and there might also be dentists, pharmacies and health-enhancing leisure amenities.
This concept is not new, the Pioneer health centre in Peckham in the 1930s had a swimming pool, gym, boxing rings, a dance hall, library, a crèche, and a café serving “compost-grown” food produced at the centre’s own farm in Bromley, as well as GPs interested in holistic medicine.
Observers have three concerns about the London plan and the government announcement that every PCT in the country will have a polyclinic – another 150 in all. First, there are no details about what will be included. Second, how are these new buildings going to be paid for? Third, where will the staff come from?
In London it is proposed that these new clinics will be open from 8am to 8pm seven days a week and provide “urgent care”.
This cannot be done without additional staff, who will have to work in shifts. Clearly some of the care will not be provided by doctors. The interest shown by private companies such as Tesco, Virgin and BUPA, who lack relevant experience, show how the consumerist model of care presented by the government’s market-based reforms is seen as profitable.
The government has talked about providing £250 million over three years for the programme outside London – just over £500,000 a year for each PCT. The Tories have calculated, on the basis of a survey they did this year, that over 600 GP practices will have to close and the cost of employing extra staff will be £1.6 billion a year.
In London the rent was estimated to be £800,000 a year for each polyclinic. The government’s vagueness about cost, facilities and staffing explains why groups such as Keep Our NHS Public and the British Medical Association fear that this is another way to involve the commercial sector in healthcare.
In June 2008 the King’s Fund, an independent body, reviewed the evidence for polyclinics and concluded that, in practice, community-based services were not cheaper than hospital-based services and that “a major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas”.
The idea that patients will have access to X-rays, ultrasound scans and blood tests during one visit sounds attractive, but one does not have to build a new building to improve the availability of results of diagnostic tests.
X-rays and scans have to be reported and there is no reason why these cannot be done at the local hospital, reported on the same day and faxed or emailed to GPs. Blood tests are already done in many GP surgeries and the local hospital can have a pick-up system twice a day (as we had in Tower Hamlets over 10 years ago) with the results transmitted to GPs as soon as ready.
Rather than building shiny new palaces at enormous cost, why not use the money (if it exists) to upgrade those GP surgeries which are close to patients’ homes? We do not need any more new, expensive, PFI
(private finance initiative) or LIFT (the GP equivalent) buildings.
Small is beautiful and patients appreciate the continuity of care they receive in the best general practice.
The BMA collected 1.2 million signatures of support in just two weeks in June after a campaign labelled “mendacious” by Ben Bradshaw.
In July 2007 health minister Mr Bradshaw said in Parliament: “Whether a particular area would benefit from a polyclinic will be a decision for the health service locally, in consultation with the public and National Health Service staff.”
Now it appears that polyclinics are to be imposed on PCTs. Mr Bradshaw should be careful when accusing the BMA of mendacity.
One or two rigorously monitored pilot schemes should be set up and evaluated, but PCTs should not be forced to embrace this latest government proposal without more research.
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