The issue has been brought into focus by the review of healthcare in England by health minister Lord Darzi.
While the proposals are wide-reaching, one of the higher profile areas is the creation of GP-led health centres, or ‘polyclinics’. Lord Darzi, a surgeon, initially proposed these under a review of London’s healthcare, but now wants a separate network of 150 GP-led health centres across England.
Polyclinics (common in Central and Eastern Europe), or ‘super-surgeries’, provide a wide range of medical services and are staffed by teams of GPs, dentists, nurses, midwives, therapists and hospital doctors offering X-rays, blood tests and diagnostic tests.
Ministers claim polyclinics will improve patient care by offering a wider range of treatments and staying open from 8am to 8pm daily. They say the clinics will be able to offer quick appointments and reduce waiting times for diagnostic tests that are currently only provided in hospital.
Doctors’ leaders and patient groups fear polyclinics will end the personal relationship between a patient and their general practitioner (GP). Additionally, the British Medical Association, which represents doctors, claims some existing GPs will be forced out of business.
However, a Department of Health spokeswoman said: ‘We are not imposing super-surgeries or polyclinics, or replacing existing services. The 150 health centres will complement existing GP practices and serve as an extra way to see a doctor.’
The King’s Fund, the healthcare think tank organisation, warns that the proposal could backfire if GPs and other healthcare staff end up being concentrated in a single building and make it more difficult for patients to visit their GP, especially those living in rural areas.
Similarly, NHS consultants have raised doubts about the merits of polyclinics. In a BMA poll, which received 1,587 responses, 60% either disagreed or strongly disagreed that polyclinics would improve patient care, and 42% were not convinced they would improve access to treatment. More than 70% said they would destabilise hospitals and GP practices.
Under England’s current system, hospitals are paid per patient treated and there is a growing concern that, if polyclinics take the simple cases, they may deprive hospital trust of income.
Dr Chaand Nagpaul, a London GP and a negotiator with the BMA’s GP committee, said the problem with the plans for polyclinics and GP-led health centres is that they are something of an unknown quantity and the details of how they would operate are not clear. ‘It is also unclear how GPs and hospital doctors will work together through the polyclinic proposals and what the financial transactions of the partnership will be,’ he added. ‘We need more details from the government on this before we really know.’
The matter is the latest in a series of issues that has brought UK GPs into conflict with the government. Recently, the BMA led opposition to plans to extend the opening hours of surgeries into evenings and weekends.
Other proposals in Lord Darzi’s report include hospitals publishing death rates for various conditions; the old and terminally ill to have the right to choose to die at home instead of in hospital; greater scope for private health care firms to supply primary care services, and a new NHS constitution that will enshrine rights to confidentiality, control of patient records and a second opinion.
Report: Mark Nicholls