Polysystems are an extension of the London polyclinics transformed into GP-led health centres. Various studies debate the differences between models consisting of single large buildings and ‘hub-and-spoke’ models. Hutt et al ask the question: ‘How is primary care best configured?’1
The King's Fund quotes international examples from countries such as Russia and Cuba, arguing that it is more important to develop new ways of working than to construct buildings, and that new configurations are unlikely to be cheaper than existing systems.2 In addition, a report from Australia concludes that in the UK, existing medical practices are responsive and are able to meet community needs.3
In Italy, the national government is in the process of attempting to convince family doctors to sign new contracts requiring many additional medical duties without increased remuneration, as well as considering the creation of new mega-aggregations of professionals within practices covering large populations. At the same time, the government is contemplating a shift of many services from secondary to primary care.
The reaction of associations of GPs is essentially negative. They predict a disruption of the existing structure into micro-groups, problems for patients having to travel considerable distances, and large institutions where there will be longer waiting times, confusion, and loss of doctor–patient continuity, possibly resulting in duplication of services.
Morgan and Beerstecker4 indicate that there is no evidence to suggest that very large practices can provide greater patient throughput or diversity of services than is available at the current average English practice. Therefore, a policy to create larger practices may not automatically lead to a transfer of work from secondary to primary care. Also, there is an upper threshold above which practice size simply creates spare capacity and untapped expertise.
It is most important to consider these data when we see, as at present, multiple national governments calling for new systems of governance for family medicine that involve top-down approaches not agreed to by primary caregivers, by secondary caregivers, or by patients themselves.5 It is dangerous for these changes to be pushed by politicians with the aim of achieving financial savings without considering what family medicine was, is, or will become. It is crucial that we remember the WONCA European Definition.6
References
- 1.Hutt P, Singh S, Modell M, et al. Polyclinics and polysystems: evolving ambiguity, evidence required. Br J Gen Pract. 2010;60(575):400–401. doi: 10.3399/bjgp10X502083. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Imison C, Naylor C, Maybin B. Under one roof: will polyclinics deliver integrated care? London: King’s Fund; 2008. http://www.kingsfund.org.uk/document.rm?id=7699. (accessed 5 Jul 2010) [Google Scholar]
- 3.Powell Davies PG, McDonald J, Jeon Y-H, et al. Integrated primary health care centres and polyclinics: a rapid review. Sydney: Centre for Primary Health Care and Equity UNSW and Australian Primary Health Care Research Institute; 2009. [Google Scholar]
- 4.Morgan CL, Beerstecker HJ. Practice size and service provision in primary care: an observational study. Br J Gen Pract. 2009;59(560):186–190. doi: 10.3399/bjgp09X419538. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Union Medici Italiani. Reaction to pre-agreement on a new contract with mega-aggregations. www.unionemedici.it/it/default.asp (accessed 5 Jul 2010)
- 6.WONCA. The European Definition of General Practice/Family Medicine — 2005. http://www.woncaeurope.org/Definition%20GP-FM.htm (accessed 7 Jul 2010)