GPs in London have rejected the idea put forward by the junior health minister Ara Darzi that polyclinics will solve the capital’s health problems. The clinics could in fact throw up a number of serious problems, they warn.
A consultation with all the 24 local medical committees in London, which represent GPs in the city, found that 17 out of 19 committees either strongly disagreed or tended to disagree with the proposal that almost all general practices in London should be part of a polyclinic.
The idea of polyclinics was put forward by Professor Darzi in Healthcare for London: A Framework for Action, which wascommissioned by NHS London, the capital’s strategic health authority, and published in July last year (BMJ 2007;335:61 doi: 10.1136/bmj.39273.467697.DB). In the report Professor Darzi recommends the development of 10 pilot polyclinics and envisages that London could have 150 such clinics in 10 years’ time.
In its response to the proposal, published this week, Londonwide LMCs, the umbrella group for the city’s local medical committees, said, “The polyclinic models . . . are based on a number of untested assumptions and may have unpredictable and adverse effects on patient care and the costs of care.
“There are many parts of London in which general practice standards are high and where practices already work together as commissioning clusters, and where enforced merger and co-location would undoubtedly have disruptive and adverse effects.”
Responses to a questionnaire from Londonwide LMCs showed that only one committee thought that the proposed changes would improve access to health services and the health of people in London. People from deprived and disadvantaged groups in particular would suffer, the GPs said, because they would be forced to travel further to get those services.
Better targeting of resources to deprived communities, for example by focusing more on the healthcare of migrants and providing better interpreting services and English lessons, would better achieve one of Professor Darzi’s aims, to reduce health inequalities, says Londonwide LMCs’ report.
There was also strong opposition from the London GPs to extended opening hours. Altogether 18 out of 21 committees responding to the questionnaire (some committees submitted joint responses) considered that for GPs’ surgeries to be open in the evenings and at weekends was either “not very useful” or “not at all useful.” Their main concern was that extended hours would mean the loss of continuity of care for many patients and that there was too little demand for these extra hours.
However, strong agreement was expressed with other aspects of Professor Darzi’s plan for London. Most committees agreed that more specialist centres were needed for the treatment of patients with severe injury, stroke, and complex emergency surgery and that these would lead to better outcomes for patients. And 20 out of 21 committees supported the proposal for ambulance staff to take seriously ill patients directly to specialist centres, even if there was another hospital nearby.
Tony Stanton and Stewart Drage, joint chief executives of Londonwide LMCs, say in their introduction to the report, “London’s GPs are concerned to ensure that the correct balance is struck between continuity of care and convenience. This balance is quintessential to the provision of a comprehensive primary care service within the tight financial limits expected by the taxpayer.
“Within London, the additional pressures of high mobility and turnover, language and cultural diversity, demographic change and the nature of work and commuting—all point towards the need for ever-more locally sensitive provision.”
Responses to the government’s proposals for London from individual local medical committees and Londonwide LMCs can be seen at www.lmc.org.uk.
