What is and what is not a polyclinic

I was shocked to see the polyclinic in Hove hailed as an example of one of the only polyclinics in the country.¹ I strongly supported the principle in the early 1990s, obtaining funding from the then regional health authority to build it, but it developed as far from the polyclinic concept as you will find.

The original concept was a new large general practice in Hove incorporating additional space for such luxuries as a hydrotherapy pool, physiotherapy, and outpatient and minor surgery facilities. Local general practitioners were antagonistic because their autonomy was being removed, the concept being sold to them as, “Would you like your patients to be seen at Dr Higson’s surgery for their outpatient appointment?” Local health service managers lacked enthusiasm for a building with only one room for a manager. I therefore declined the funding and passed the monies to the local community trust.

The development that resulted was a building of useless spaces, with a whole floor devoted to management and support services and a small outpatient physiotherapy department, x ray department, and health visitor clinics. Some rooms were built for consultant outpatients but none to incorporate primary care. On subsequently applying to open a general practice in the polyclinic, I was refused access on various nebulous grounds.

The current arguments about the development of a polyclinic culture reek of a surgeon believing that general practitioners can work together and share ethic—this is rarely possible. The advantages of a polyclinic do not need all general practices to relocate to provide the same benefit. I proposed the concept of a “virtual polyclinic” to all general practitioners in Hove in the late ’80s, and it is still appropriate today.

This is the development of a central administrative centre that can provide services such as diagnostics, physiotherapy, outpatient services, and minor surgery facilities, together with responsibility for running the local computer database and centralised trend analysis to aid planning. Electronic data linkages will be made to local general practices serving a local population and need. Hence local practices can still exist but perhaps with fewer staffing overheads as appointment systems and data services are provided by the polyclinic. This maintains local provision of service while reducing the massive costs of an excessively large new-build and maintains “ownership” by the general practitioners both of their premises and of cooperative working without the need to work together. As practices evolve with time, some may elect to move to the same site as the centralised unit while others may determine their affection is elsewhere.

There is no one solution, but the enforced move of the majority of practices to polyclinic sites without the ownership and enthusiasm of those practices will be detrimental to the quality and quantity of health care provided by medical practitioners.