Fears are growing among doctors that many primary care trusts (PCTs) are already preparing for polyclinics—large centres with GPs and specialists under one roof—even before the government gives the final go ahead later this year.
Doctors’ leaders believe that, despite promises from the government that local areas will be able to choose how they modernise primary care, implementation of the policy of polyclinics is inevitable.
PCTs are placing a growing number of advertisements in trade publications such as the Health Service Journal and GP magazine for GPs or companies to run such clinics, says the BMA. It is worried that polyclinics are unstoppable and may undermine the basis of general practice.
The BMA expects that polyclinics will feature large in junior health minister Ara Darzi’s final proposals, which are due by June with the publication of his second stage review.
Professor Darzi first mentioned polyclinics in the report Healthcare for London: A Framework for Action, published in July last year (BMJ 2007;335:61; doi: 10.1136/bmj.39273.467697.DB). The report provided a blueprint for “cradle to grave” health care, with super-surgeries or polyclinics across London that would, by 2017, carry out up to half of outpatient treatment currently handled by hospitals.
Then last October Professor Darzi published an interim report of his review into the future of the NHS in England as a whole. This did not mention polyclinics but spoke of large health centres in a similar vein. On the back of that report, health secretary Alan Johnson said at the time that a £250m (€325m; $510m) access fund would be used to deliver at least 100 new general practices in the 25% of PCTs in England with the poorest provision. In addition, the fund would also pay for at least 150 new GP-run health centres (polyclinics), the idea being that each PCT in the country would have at least one.
Results from a public consultation on plans for polyclinics held earlier this month have not yet been published, but many trusts seem to be forging ahead anyway.
Two north London trusts have already drawn up plans for the capital’s first polyclinic. University College London Hospitals NHS Foundation Trust and Camden Primary Care Trust plan to have a polyclinic based next to the accident and emergency department at University College Hospital, with several practices under one roof.
Last week doctors in Warwickshire marched to protest against plans to replace single GP surgeries with larger polyclinics, and the London-wide consortium of local medical committees has said that the vast majority of GPs in its area do not support the idea (bmj.com, 8 Mar, doi: 10.1136/bmj.39511.557917.4E).
Richard Vautrey, deputy chairman of the BMA’s General Practitioners Committee, said that he knows through local medical committees that an unofficial timetable exists for PCTs to start the tendering process this month in anticipation of polyclinics starting to operate by December.
Iona Heath, a London GP and chairwoman of the Royal College of General Practitioners’ international committee, said, “I believe the plan is for all these polyclinics to be at the front door of hospitals and run by foundation trusts for their convenience.
“There would be a few entrepreneurial GPs involved, but it will mostly be foundation trusts and commercial organisations that will run these.
“It is obvious that PCTs have had instruction from somewhere in government that they should have a polyclinic. I have a horrible feeling that pressure is coming from the No 10 policy unit. There is pressure coming from strategic health authorities for PCTs to get on with this. There is such a gap now between Darzi’s rhetoric and what is happening on the ground.”
Trusts have little choice but to forge ahead, Dr Vautrey thinks. “Strategic health authorities are telling trusts that this is something they must do,” he said.
“On one hand you have health secretary Alan Johnson and Darzi himself saying that one size does not fit all and that local areas can determine how facilities are going to work, but on the other hand the reality is that PCTs are steaming ahead at a rapid rate of knots to get these facilities up and running in line with the desire of health authorities.”
Dr Vautrey said that the BMA supports the principle of doctors working together to provide better services, but he added: “Our concern about polyclinics is that this is a vehicle for introducing private commercial companies into an area and providing a potential duplication of services.”
David Stout, director of the PCT network of the NHS Confederation, the body that represents NHS organisations, said that he did not see a problem in trusts pushing ahead, but he cautioned against a “one size fits all” solution for the whole country.
Mr Stout believes that there is already an expectation in the Department of Health for the 150 polyclinics to be set up after Professor Darzi’s new report comes out.
Mr Stout said, “When Darzi’s final report comes out, that may throw some new policy challenges back to trusts, but it wouldn’t be right for trusts to sit around waiting for the national answer to emerge.
“I doubt there will be a single national blueprint for these services. Trusts are free and are responsible for setting their own health strategies. I don’t think they are jumping the gun, as long as they have gone through a proper process of developing a strategy and consultation.”
Nick Goodwin, senior fellow for health policy at the healthcare think tank the King’s Fund, said, “When you look internationally, there is relatively little evidence on the effectiveness of polyclinics on a number of criteria—quality, access, and cost.
“We have to be careful of thinking about polyclinics as a blanket policy across the country, because it seems to me that it won’t necessarily solve all of the access issues. If you are going to go ahead with this policy, it would be common sense for decisions to be made locally with response to local need and demand.”
The Royal College of General Practitioners believes that a better approach may be a federated model in which GPs work together as a legal entity, sharing staff and resources, but remain in separate locations.
Steve Field, the college’s chairman of council, said, “Where a larger health centre is built, we believe that it must be brought into an arrangement in a federated way with other practices around it. They should be developed in partnership locally and in consultation with GPs.
“I have been assured by Lord Darzi himself that the exact form of these centres will follow the purpose identified locally. We look eagerly at what is happening around the country to ensure this is happening.”