Polyclinic
Encyclopedia
Polyclinics in England are intended to offer a far greater range of services than can be offered by current general practitioner
(GP) practices and local health centres. In addition to traditional GP services they would offer extended urgent care, healthy living services, community mental health services and social care, whilst being more accessible and less medicalised than hospitals. A variety of models have been proposed, ranging from networks of existing clinics to larger premises with several colocated general practitioner
(GP) practices, more extensive facilities and additional services provided by allied healthcare professionals
.
The incoming health secretary in May 2010 Andrew Lansley
has put on hold all plans to increase numbers of polyclinics and to relocate GPs to them pending a review of policy under the new coalition government, after a review by management consultants McKinsey revealed "NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care".
The government accepts that the polyclinic model may not be suitable for rural areas but may be popular in the larger conurbation
s.
(NHS). They have typically provided specialist care such as ophthalmology, podiatry, dentistry, minor injuries nursing, and therefore provided services that fell between that of the GP service and those available at the hospital.
Some primary care trusts in England have attempted to bring together even more services into such centres, most notably by co-locating GPs, health laboratories, pharmacies and other services under one roof. The Heart of Hounslow Centre for Health for example has GP services, outpatient care, physiotherapy, dentistry, podiatry, social care outreach, mental health services for children and a gym to help in rehabilitation. All these services take place in a purpose-built facility. However, the centre does not provide urgent care and only has a limited range of diagnostics.
Polyclinics were proposed only for London
by Professor the Lord Darzi of Denham in his review of healthcare in London for NHS London
: Healthcare for London: A Framework for Action. In the final report of his subsequent national review for the Department of Health
, High Quality Care for All Lord Darzi has not suggested that polyclinics would be appropriate elsewhere; instead he suggests "GP-led health centres". He explained the difference between the two models to the House of Commons Health Select Committee
on 19 July 2008.
A key principle of A Framework for Action is to "localise where possible, centralise where necessary." This would move "routine healthcare" away from acute hospitals and into community-based centres to provide a one-stop-shop for health care. "More complex care" would remain centralised. A key part of the plan is to extend the opening times of such centres, especially in the evenings, to make them more accessible to working people.
While polyclinics had not been widely implemented across England prior to 2008, they have existed in Australia, France, Germany (since 2004), Switzerland and Russia; and in many countries across Asia and Africa, although several of these countries are now seeking to remove them. In Russia, where they were introduced under communism
, attempts were made to replace them with a more western model by the new Russian government. However, the Russian polyclinic model proved robust and the authorities' prescriptive interference failed .
and the government claim that polyclinics offer:
A report by the King's Fund
has questioned many of these, observing that:
The report also observed that the proposals were likely to increase professional isolation, and threaten both professional development and motivation, and continuity of care, and that pre-existing problems in healthcare to do with the lack of an overall governance structure, and unclear lines of accountability had not been addressed.
It concluded that while polyclinics offered real opportunities for some health communities to establish more integrated, patient-focused care, these would only be realised with considerable investment of time, effort and resources into their planning and development, and that the primary focus should be on developing new pathways, technologies and ways of working rather than new buildings.
The Conservative Party
leader David Cameron
does not object in principle to the case for polyclinics but is worried that they might be imposed against the wishes of communities. He has suggested that close to 1,600 GP surgeries may have to close across the country as a whole if polyclinics are established in the way the government is suggesting. The Health Minister Ben Bradshaw
, however, denied that individual GP practices would be closed as patients would remain registered with their existing GPs. These figures have also been dismissed by Dr Laurence Buckman, chair of the British Medical Association
's General Practitioners Committee.
have drawn up plans to relocate more than 100 urban GP surgeries into polyclinics. The Conservative Party claim that unless existing surgeries close, polyclinics will leave a £1.4 billion "black hole" in public finances.
/networked
model and will involve "existing services working more closely together".
As of August 2008, more than a quarter of PCTs had plans to implement a polyclinic or GP-led health centre, including Birmingham, Cumbria, Lincolnshire, Rochdale, Cheshire, Essex and Bolton. More than 50 PCTs admitted that they would not consult local communities over plans to build polyclinics, some citing advice from the Department of Health as the reason, despite repeated government promises that they would not be introduced without consultation.
The country-wide rollout of GP-led health centres has been criticised by doctors' leaders and patient groups. Dr. Richard Vautrey, deputy chairman of the BMA, called it "a government plan that is potentially going to waste hundreds of millions of pounds of scarce NHS resources, creating very large health centres that many areas of the country simply don't need or want", while the Patients Association noted that gathering services under one roof in rural areas "may actually put patients at risk" and noted that rural patients already had to travel further and were more reliant on primary care. The other political parties have also criticised it, with the leader of the Liberal Democrats
Nick Clegg
calling it "the central imposition of a polyclinic on every primary care trust, regardless of the geography, demographics and clinical needs of the area" while acknowledging that they might be a good thing for people in some communities and Conservative leader David Cameron suggesting large-scale closures of existing GP surgeries.
The results of a freedom of information
request by Pulse on the plans for polyclinics show that nursing staff could outnumber doctors by up to three to one. The BMA said the plans would lead to "cut-price general practice". A spokesperson for the Department of Health said "where people choose to register with a GP-led health centre, they should expect the same quality and continuity of care from GPs and other primary care clinicians as they would from any other GP practice".
On 10 September 2008, an NHS London
press release and fact sheet announced details of 5 of a possible 13 polyclinics in the first wave in London. They were to be developed by the following primary care trusts:
Also anticipated in the first wave were:
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
(GP) practices and local health centres. In addition to traditional GP services they would offer extended urgent care, healthy living services, community mental health services and social care, whilst being more accessible and less medicalised than hospitals. A variety of models have been proposed, ranging from networks of existing clinics to larger premises with several colocated general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
(GP) practices, more extensive facilities and additional services provided by allied healthcare professionals
Allied health professions
Allied health professions are clinical health care professions distinct from dentistry, nursing and medicine. One estimate reported allied health professionals make up 60 percent of the total health workforce...
.
The incoming health secretary in May 2010 Andrew Lansley
Andrew Lansley
Andrew David Lansley, CBE, MP is the UK Secretary of State for Health, who has been the Conservative Member of Parliament for South Cambridgeshire since the 1997 general election, and was Shadow Secretary of State for Health from June 2004 until becoming Secretary of State for Health in May 2010...
has put on hold all plans to increase numbers of polyclinics and to relocate GPs to them pending a review of policy under the new coalition government, after a review by management consultants McKinsey revealed "NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care".
Operational polyclinics
On Wednesday April 29, 2009, the first seven polyclinics in England opened in London, marked by the opening of the Loxford Polyclininc by Lord Darzi. The seven were:- Redbridge PCT: Loxford Polyclininc (the first purpose-built polyclinic)
- Harrow PCT: Alexandra Avenue Health and Social Care Centre
- Hounslow PCT: Heart of Hounslow
- Lambeth PCT: Gracefield Gardens Health and Social Care Centre
- Waltham Forest PCT: Oliver Road Polyclinic
- Tower Hamlets PCT: The Barkantine Centre
- Hammersmith and Fulham PCT: Hammersmith Centre for Health at Hammersmith HospitalHammersmith HospitalHammersmith Hospital is a major teaching hospital in West London. It is part of Imperial College Healthcare NHS Trust in the London Borough of Hammersmith and Fulham, and is associated with the Imperial College Faculty of Medicine...
(London’s first hospital-based polyclinic)
Polyclinic services
The polyclinic model proposed in London will provide:- GP servicesGeneral practitionerA general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
– e.g. core and enhanced with extended opening hours - Other health services – including other health professionals (e.g. ophthalmologyOphthalmologyOphthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
, dentistryDentistryDentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
) - Minor procedures
- Outpatient appointments
- Urgent careUrgent careUrgent care is the delivery of ambulatory care in a facility dedicated to the delivery of medical care outside of a hospital emergency department, usually on an unscheduled, walk-in basis. Urgent care centers are primarily used to treat patients who have an injury or illness that requires immediate...
- Diagnostics – e.g. core and enhanced testing with extended opening hours
- Community services – e.g. interactive health information, management of long term conditions, complex needs, community nursingNursing in the United KingdomNursing in the United Kingdom has a long history, but in its current form probably dates back to the era of Florence Nightingale, who initiated schools of nursing in the latter part of the 19th and early 20th centuries...
, community mental health teams - Co-located services – e.g. including local authority, social care, mental healthMental healthMental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
, leisureLeisureLeisure, or free time, is time spent away from business, work, and domestic chores. It is also the periods of time before or after necessary activities such as eating, sleeping and, where it is compulsory, education....
and the London Ambulance ServiceLondon Ambulance ServiceThe London Ambulance Service NHS Trust is the largest "free at the point of contact" emergency ambulance service in the world. It responds to medical emergencies in Greater London, England, with the ambulances and other response vehicles and over 5,000 staff at its disposal.It is one of 12...
The government accepts that the polyclinic model may not be suitable for rural areas but may be popular in the larger conurbation
Conurbation
A conurbation is a region comprising a number of cities, large towns, and other urban areas that, through population growth and physical expansion, have merged to form one continuous urban and industrially developed area...
s.
History
Generalised health centres and health clinics offering a mix of community based health care services have existed in England since the early years of the National Health ServiceNational Health Service (England)
The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
(NHS). They have typically provided specialist care such as ophthalmology, podiatry, dentistry, minor injuries nursing, and therefore provided services that fell between that of the GP service and those available at the hospital.
Some primary care trusts in England have attempted to bring together even more services into such centres, most notably by co-locating GPs, health laboratories, pharmacies and other services under one roof. The Heart of Hounslow Centre for Health for example has GP services, outpatient care, physiotherapy, dentistry, podiatry, social care outreach, mental health services for children and a gym to help in rehabilitation. All these services take place in a purpose-built facility. However, the centre does not provide urgent care and only has a limited range of diagnostics.
Polyclinics were proposed only for London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
by Professor the Lord Darzi of Denham in his review of healthcare in London for NHS London
NHS London
NHS London is a strategic health authority of the National Health Service in England. It operates in the London region, which is coterminous with the local government office region....
: Healthcare for London: A Framework for Action. In the final report of his subsequent national review for the Department of Health
Department of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
, High Quality Care for All Lord Darzi has not suggested that polyclinics would be appropriate elsewhere; instead he suggests "GP-led health centres". He explained the difference between the two models to the House of Commons Health Select Committee
Health Select Committee
The Health Select Committee is one of the Select Committees of the British House of Commons. It oversees the operations of the Department of Health and its associated bodies.-Membership:...
on 19 July 2008.
A key principle of A Framework for Action is to "localise where possible, centralise where necessary." This would move "routine healthcare" away from acute hospitals and into community-based centres to provide a one-stop-shop for health care. "More complex care" would remain centralised. A key part of the plan is to extend the opening times of such centres, especially in the evenings, to make them more accessible to working people.
While polyclinics had not been widely implemented across England prior to 2008, they have existed in Australia, France, Germany (since 2004), Switzerland and Russia; and in many countries across Asia and Africa, although several of these countries are now seeking to remove them. In Russia, where they were introduced under communism
Communism
Communism is a social, political and economic ideology that aims at the establishment of a classless, moneyless, revolutionary and stateless socialist society structured upon common ownership of the means of production...
, attempts were made to replace them with a more western model by the new Russian government. However, the Russian polyclinic model proved robust and the authorities' prescriptive interference failed .
Rationale
The Department of HealthDepartment of Health (United Kingdom)
The Department of Health is a department of the United Kingdom government with responsibility for government policy for health and social care matters and for the National Health Service in England along with a few elements of the same matters which are not otherwise devolved to the Scottish,...
and the government claim that polyclinics offer:
- A way of providing more services in the community closer to home and at more convenient times (including antenatal and postnatal carePostnatalPostnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...
, healthy living information, community mental health services, community care, and social care and specialist advice) - An improved structure within which GPs and other health and social care professionals can work together
- Improved care for patients with chronic or complex conditions
- A shift in the focus of urgent care out of hospitals and into polyclinics.
A report by the King's Fund
King's Fund
The King's Fund is a charitable foundation in England. Founded as the Prince of Wales Hospital Fund for London in 1897, the fund changed its name in 1902 to King Edward's Hospital Fund after the accession to the throne of King Edward VII...
has questioned many of these, observing that:
- Access to services was likely to be harder in rural areas and in urban areas where new buildings were not situated close to transport hubs
- Simply putting healthcare professionals in the same location is in practice often not sufficient to generate co-working or integration of care
- While the co-location of multiple services presents opportunities for delivering more integrated careIntegrated CareIntegrated care – also known as coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision...
, particularly for people with chronic diseases, the evidence suggests that in practice these opportunities are often lost, and accessibility of primary care is likely to be reduced for most patients if their GPs move into polyclinics, particularly in rural settings (a point emphasised in The TimesThe TimesThe Times is a British daily national newspaper, first published in London in 1785 under the title The Daily Universal Register . The Times and its sister paper The Sunday Times are published by Times Newspapers Limited, a subsidiary since 1981 of News International...
) - There is limited evidence that quality of care for services shifted out of hospitals is comparable, and there is evidence that quality may be decreased in certain cases; the limited inspection and accreditation of out-of-hospital care is also a serious deficit in quality assurance
The report also observed that the proposals were likely to increase professional isolation, and threaten both professional development and motivation, and continuity of care, and that pre-existing problems in healthcare to do with the lack of an overall governance structure, and unclear lines of accountability had not been addressed.
It concluded that while polyclinics offered real opportunities for some health communities to establish more integrated, patient-focused care, these would only be realised with considerable investment of time, effort and resources into their planning and development, and that the primary focus should be on developing new pathways, technologies and ways of working rather than new buildings.
The Conservative Party
Conservative Party (UK)
The Conservative Party, formally the Conservative and Unionist Party, is a centre-right political party in the United Kingdom that adheres to the philosophies of conservatism and British unionism. It is the largest political party in the UK, and is currently the largest single party in the House...
leader David Cameron
David Cameron
David William Donald Cameron is the current Prime Minister of the United Kingdom, First Lord of the Treasury, Minister for the Civil Service and Leader of the Conservative Party. Cameron represents Witney as its Member of Parliament ....
does not object in principle to the case for polyclinics but is worried that they might be imposed against the wishes of communities. He has suggested that close to 1,600 GP surgeries may have to close across the country as a whole if polyclinics are established in the way the government is suggesting. The Health Minister Ben Bradshaw
Ben Bradshaw
Benjamin Peter James Bradshaw is a British Labour politician who has been the Member of Parliament for Exeter since 1997, and served in the Cabinet as Secretary of State for Culture, Media and Sport....
, however, denied that individual GP practices would be closed as patients would remain registered with their existing GPs. These figures have also been dismissed by Dr Laurence Buckman, chair of the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
's General Practitioners Committee.
Funding
It is unclear whether polyclinics will be funded in addition to existing GP services or whether they will take funding away from existing practices. Although Lord Darzi has claimed that their funding would be in addition to existing funding, following the publication of his report, eight London primary care trustsNHS Primary Care Trust
An NHS primary care trust is a type of NHS trust, part of the National Health Service in England. PCTs commission primary, community and secondary care from providers. Until 31 may2011 they also provided community services directly. Collectively PCT are responsible for spending around 80% of the...
have drawn up plans to relocate more than 100 urban GP surgeries into polyclinics. The Conservative Party claim that unless existing surgeries close, polyclinics will leave a £1.4 billion "black hole" in public finances.
Implementation
Polyclinics were originally planned for and implemented in London, with every primary care trust in the country subsequently required to have at least one new "GP-led health centre". All of the first wave of polyclinics in London, which form a pilot of the model, will be of the federatedFederation
A federation , also known as a federal state, is a type of sovereign state characterized by a union of partially self-governing states or regions united by a central government...
/networked
Social network
A social network is a social structure made up of individuals called "nodes", which are tied by one or more specific types of interdependency, such as friendship, kinship, common interest, financial exchange, dislike, sexual relationships, or relationships of beliefs, knowledge or prestige.Social...
model and will involve "existing services working more closely together".
As of August 2008, more than a quarter of PCTs had plans to implement a polyclinic or GP-led health centre, including Birmingham, Cumbria, Lincolnshire, Rochdale, Cheshire, Essex and Bolton. More than 50 PCTs admitted that they would not consult local communities over plans to build polyclinics, some citing advice from the Department of Health as the reason, despite repeated government promises that they would not be introduced without consultation.
The country-wide rollout of GP-led health centres has been criticised by doctors' leaders and patient groups. Dr. Richard Vautrey, deputy chairman of the BMA, called it "a government plan that is potentially going to waste hundreds of millions of pounds of scarce NHS resources, creating very large health centres that many areas of the country simply don't need or want", while the Patients Association noted that gathering services under one roof in rural areas "may actually put patients at risk" and noted that rural patients already had to travel further and were more reliant on primary care. The other political parties have also criticised it, with the leader of the Liberal Democrats
Liberal Democrats
The Liberal Democrats are a social liberal political party in the United Kingdom which supports constitutional and electoral reform, progressive taxation, wealth taxation, human rights laws, cultural liberalism, banking reform and civil liberties .The party was formed in 1988 by a merger of the...
Nick Clegg
Nick Clegg
Nicholas William Peter "Nick" Clegg is a British Liberal Democrat politician who is currently the Deputy Prime Minister, Lord President of the Council and Minister for Constitutional and Political Reform in the coalition government of which David Cameron is the Prime Minister...
calling it "the central imposition of a polyclinic on every primary care trust, regardless of the geography, demographics and clinical needs of the area" while acknowledging that they might be a good thing for people in some communities and Conservative leader David Cameron suggesting large-scale closures of existing GP surgeries.
The results of a freedom of information
Freedom of Information Act 2000
The Freedom of Information Act 2000 is an Act of Parliament of the Parliament of the United Kingdom that creates a public "right of access" to information held by public authorities. It is the implementation of freedom of information legislation in the United Kingdom on a national level...
request by Pulse on the plans for polyclinics show that nursing staff could outnumber doctors by up to three to one. The BMA said the plans would lead to "cut-price general practice". A spokesperson for the Department of Health said "where people choose to register with a GP-led health centre, they should expect the same quality and continuity of care from GPs and other primary care clinicians as they would from any other GP practice".
On 10 September 2008, an NHS London
NHS London
NHS London is a strategic health authority of the National Health Service in England. It operates in the London region, which is coterminous with the local government office region....
press release and fact sheet announced details of 5 of a possible 13 polyclinics in the first wave in London. They were to be developed by the following primary care trusts:
- Harrow PCT: Alexandra Avenue
- Hounslow PCT: Heart of Hounslow
- Lambeth PCT: Gracefield Gardens
- Redbridge PCT: Loxford Centre
- Waltham Forest PCT
Also anticipated in the first wave were:
- Camden PCT: Four federated polyclinics
- Haringey PCT: Currently rethinking plans to close 37 surgeries
- Kensington and Chelsea PCT: Five surgeries to be relocated to polyclinic hub at St Charles Community Hospital
Opinion
Opinion on the plans for polyclinics is polarised.- Nigel Edwards, Policy Director NHS ConfederationNHS ConfederationThe NHS Confederation is an independent membership organisation in the United Kingdom that represents all types of providers and commissioners of National Health Service services in England. It is the only body to speak for the whole of the NHS on the issues that matter to all those involved in...
Polyclinics are based on long term trends of what works best in healthcare, and in fact there are many practices successfully operating under a similar model already. As such we have been genuinely surprised to see the level of concern surrounding these proposals among the health community and patient groups. What we need now is a calm and balanced debate about how to bring out the best in our primary care services. The name may pose a problem. Polyclinics may be associated with the previous soviet system of healthcare, however what is proposed here has no real connection to this at all. While it may sound like the polyclinic system will not resemble the service currently provided by family doctors, in reality it should build on what is best in general practice. Of course this is not something that will work in every circumstance, but delivering better organised care focused on the patient is surely a good thing. This is why it is crucial that politicians and health professionals fully engage with the benefits that polyclinics can bring. Knee jerk reactions focussing on possible problems based on pre-existing agendas rather than potential solutions could seriously jeopardise progress for patients.
- Paul Ward, Deputy Chief Executive of the Terrence Higgins TrustTerrence Higgins TrustTerrence Higgins Trust is a British charity that campaigns on various issues related to AIDS and HIV. In particular, the charity aims to reduce the spread of HIV and promote good sexual health ; to provide services on a national and local level to people with, affected by, or at risk of...
, has commented:With HIV now a long-term condition, polyclinics have a very important role in the delivery of HIV care. Many routine services, such as regular blood tests and check ups shouldn't require a trip to a hospital based clinic. Integrating services can only make life easier for people living with HIV so it’s definitely a welcome move.
- Samantha Mauger, Chief Executive of Age ConcernAge ConcernAge Concern was the banner title used by a number of charitable organisations specifically concerned with the needs and interests of all older people based chiefly in the four countries of the United Kingdom....
London, has said:We welcome the intention of providing an integrated local health centre delivering a wide range of services in a joined-up approach. If this is done with care it could benefit many older people. While older people may be worried about possible changes to the services they currently use, many suffer at present from lack of coordination between different health and social care services. The NHS needs to work with and listen to local people's views about the services to be provided. We need improved, responsive services and easy access for Londoners of all ages from all communities.
- Although government-backed, one study by Professor Martin Roland, of the University of ManchesterUniversity of ManchesterThe University of Manchester is a public research university located in Manchester, United Kingdom. It is a "red brick" university and a member of the Russell Group of research-intensive British universities and the N8 Group...
concluded that such clinics are likely to offer poorer choice and worse access than traditional GP surgeries; and they have faced opposition from doctors, health experts, and patients. - The British Medical JournalBritish Medical JournalBMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
has claimed that the government has been bringing pressure to bear on Primary Care Trusts to implement them despite this opposition. Despite this they are a mainstay of the report by British peer Professor Lord Darzi into the modernisation of the NHSNational Health Service (England)The National Health Service or NHS is the publicly funded healthcare system in England. It is both the largest and oldest single-payer healthcare system in the world. It is able to function in the way that it does because it is primarily funded through the general taxation system, similar to how...
. - The British Medical AssociationBritish Medical AssociationThe British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
have been opposed to polyclinics from the start, observing that larger clinics were already emerging where needed, that forcing their introduction was wasteful and costly, and that they would undermine the value of a relationship existing between GP and patient. They have further commented that the design of the proposals appears deliberately to disadvantage existing GPs from applying to run the clinics, leaving the way open for privatisation of GP services. - A significant proportion of the general public are opposed to polyclinics, with more than a million signing the British Medical Association's petition against them. Press reports suggested that they were unpopular with patients, particularly the elderly, who feared polyclinics would ruin their relationship with their doctor and were finding they had to travel further to see a doctor. However, of the 4,372 individual responses and 359 organisational responses to NHS LondonNHS LondonNHS London is a strategic health authority of the National Health Service in England. It operates in the London region, which is coterminous with the local government office region....
's official consultation, 51% supported the proposal that "almost all GP practices in London should be part of a polyclinic, either networked or same-site". The consultation noted that some respondents were concerned about the effect of polyclinics on the GP-patient relationship, worse continuity of care, possible extra travel time, cost, governance, and whether the money would be better spent on improving existing services. - The Patients AssociationPatients AssociationThe Patients Association is a lobby group operating in the UK that aims to improve patients' experience of health care. It became a registered charity in 1991...
are concerned that polyclinics could jeopardise the patient-doctor relationship which they regard as a central plank of effective and personalised care and as "central to every patient's experience of healthcare", particularly in those with long-term or complex conditions. They also observed that polyclinics are not necessary to providing one-stop care, something already delivered in the NHS at one stop shops, and that they are likely to lead to the loss of other health services in rural areas. - The Liberal DemocratsLiberal DemocratsThe Liberal Democrats are a social liberal political party in the United Kingdom which supports constitutional and electoral reform, progressive taxation, wealth taxation, human rights laws, cultural liberalism, banking reform and civil liberties .The party was formed in 1988 by a merger of the...
have criticised polyclinics as part of the government's "obsession with imposing models of care from the centre", noting that this flies in the face of their "rhetoric on local decision-making". - The NHS AllianceNHS AllianceThe NHS Alliance was formed to bring together Primary Care Trusts with practices, clinicians with managers. It was formed in 1999, but has its roots in the Locality Commissioning Groups that formed in the early 1990s.- Members :...
have called polyclinics "lost in translation", commenting that while they are good when implemented in the right way, this "means general practices locally deciding to integrate their services" with willingness from both doctors and local people. "The BMA and patients are afraid that they might be losing the good bits of general practice - and the way that polyclinics have been implemented in some places means they have got a point." - The Royal College of General PractitionersRoyal College of General PractitionersThe Royal College of General Practitioners is the professional body for general practitioners in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges, with...
, who support the notion of GPs working in federations, have nonetheless condemned the government's plans for polyclinics, and have set out their own proposal for "Primary Care Federations", saying "GPs and patients must be involved in the planning, and we cannot afford for existing high quality GP practices to be destabilised". - Opinion pieces for The GuardianThe GuardianThe Guardian, formerly known as The Manchester Guardian , is a British national daily newspaper in the Berliner format...
have differed dramatically in tone. Polly ToynbeePolly ToynbeePolly Toynbee is a British journalist and writer, and has been a columnist for The Guardian newspaper since 1998. She is a social democrat and broadly supports the Labour Party, while urging it in many areas to be more left-wing...
suggested that "it's hard to see a downside for patients" and GPs' protests are "all about profits, not patients", while George MonbiotGeorge MonbiotGeorge Joshua Richard Monbiot is an English writer, known for his environmental and political activism. He lives in Machynlleth, Wales, writes a weekly column for The Guardian, and is the author of a number of books, including Captive State: The Corporate Takeover of Britain and Bring on the...
called it the "outright privatisation of primary healthcare" and suggested it would make primary care "more expensive and less efficient" and see "those who can't afford to pay are either excluded or treated like battery pigs". - The IndependentThe IndependentThe Independent is a British national morning newspaper published in London by Independent Print Limited, owned by Alexander Lebedev since 2010. It is nicknamed the Indy, while the Sunday edition, The Independent on Sunday, is the Sindy. Launched in 1986, it is one of the youngest UK national daily...
has included a balanced article on them, explaining the possible benefits and disadvantages.
External references
- Polyclinics: An integrating or disintegrating force?: A Civitas debate held on 29 May 2008 at the Royal College of Surgeons of EnglandRoyal College of Surgeons of EnglandThe Royal College of Surgeons of England is an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients, regulating surgery, including dentistry, in England and Wales...
. Chaired by Professor Aidan Halligan with contributions from Professor Steve Field, Chairman, the Royal College of General PractitionersRoyal College of General PractitionersThe Royal College of General Practitioners is the professional body for general practitioners in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges, with...
; Professor Steve Smith, Principal, Faculty of Medicine, Imperial College LondonImperial College LondonImperial College London is a public research university located in London, United Kingdom, specialising in science, engineering, business and medicine...
and CEO of Imperial College Healthcare NHS TrustImperial College Healthcare NHS TrustImperial College Healthcare NHS Trust is an NHS trust based in London, United Kingdom. It is the largest NHS trust in England and together with Imperial College London forms an academic health science centre....
; Dr Oliver Bernath, CEO, Integrated Health Partners; and Professor Martin Roland, Director NPCDC, University of ManchesterUniversity of ManchesterThe University of Manchester is a public research university located in Manchester, United Kingdom. It is a "red brick" university and a member of the Russell Group of research-intensive British universities and the N8 Group...
. Commentary by Professor Sir Ian Kennedy, Chairman, Healthcare CommissionHealthcare CommissionThe Healthcare Commission was a non-departmental public body sponsored by the Department of Health of the United Kingdom. It was set up to promote and drive improvement in the quality of health care and public health in England and Wales...
. - Ideas from Darzi: Polyclinics NHS Confederation report
- Local hospitals: lessons for the NHS, Central Middlesex Hospital case study