The impact of polyclinics on family doctor services
April 2008
BMA view of polyclinics
The BMA acknowledges that there may be a case for establishing a polyclinic in some very specific circumstances, such as where local patients and clinicians agree on a proven need in their area. However, the BMA is opposed to the headlong rush into polyclinics or health centres that is a current feature of primary care trust [PCT] activity all over the country. The Government has not provided any clear evidence to support the rollout of polyclinics on a national scale and we have questioned whether it is appropriate to use significant sums of taxpayers’ money on a policy which is untried, untested and potentially harmful for existing primary care providers.
The BMA believes that PCTs should be encouraged to invest in local GP practices and support joint working between practices. This would deliver the goals of the Darzi review without the risk of unnecessarily duplicating or destabilising existing services, and would undoubtedly be better value for money for the taxpayer.
Lord Darzi’s Next Stage Review of the NHS- the introduction of polyclinics
In July 2007, the Secretary of State for Health, Alan Johnson, asked Lord Darzi to carry out a review of the NHS, with the ambition of setting new priorities for the health service in England. The review, ‘'Our NHS, Our Future' is due to report in July 2008 to coincide with the 60th anniversary of the NHS.
In October 2007, Lord Darzi published an interim report, which largely focused on improving patient and public access to GP services. Specifically, the interim report called for:
- The creation of 152 GP-led health centres (one for each PCT in England), which will provide a range of primary care services, seven days a week.
- The creation of 100 new GP practices in deprived and under-doctored areas
Polyclinics- opening hours and facilities
Polyclinics and health centres will be required to open from 8am to 8pm, seven days a week. The Department of Health’s GP Patient Survey (2007) showed that 84 in every 100 patients were satisfied with the current opening hours of their practice. Only four out of every hundred patients wanted practices to open on a weekday evening and seven out of every hundred on weekends. Given that only a relatively small minority of patients actually want to see an extension of ‘routine’ GP care, the BMA believes that investment in polyclinics presents neither good value for money or a good use of scarce NHS resources.
Polyclinics will be expected to provide a range of primary care services such as antenatal and postnatal care, community care, social care and specialist advice. The polyclinics are part of the Government’s wider strategy to shift services out of hospital settings and to provide integrated, one-stop-shop care in community settings.
Funding of health centres & polyclinics
The Department of Health has stated that funding for health centres will be included in PCTs’ overall budget allocations. However, information from the DH suggests that the extra money available to PCTs in these allocations will be far from adequate to properly fund the services that it is expected each health centre will provide, and may only amount to £300,000 per health centre. Clearly, if polyclinics and health centres are to offer quality services, they will need to be appropriately funded.
Potential impact on patients
While some patients may welcome the services provided by polyclinics, such as extended opening hours, other patients may find that polyclinics are located further away than their existing local GP surgery. These large impersonal polyclinics may also mean that patients rarely see the same GP twice, which could jeopardise the continuity of care that many patients, particularly those patients with long-term conditions, currently receive from their traditional GP.
Patients should also be made aware that in the longer term, the over-capacity created by the procurement of polyclinics could potentially destabilise and fragment existing hospital and GP services as resources are transferred from existing NHS structures to polyclinics. At present, there is no option for patients or clinicians to argue that a health centre is not necessary in their area – all PCTs will be required to procure a health centre regardless of the local need for one.
The provision of primary care by private, commercial companies
Communications from central government to Strategic Health Authorities make it clear that the contracts for these polyclinics/health centres are likely to be APMS contracts (Alternative Providers of Medical Services) which is the route under which private commercial companies would provide general practice care. This commercialisation of patient care in the community is the very opposite of the personalised care which the government espouses and which family doctors already provide.
The BMA is concerned that the Government is proposing to transfer public resources from GP practices to commercial companies, who are primarily accountable to shareholders rather than patients. Moreover, APMS contracts are by their nature very short-term, potentially resulting in a short-term approach to care by providers. This contrasts with the long-lasting commitment to serving patients and the community that patients experience from independent contractor GPs.
For further information, please contact the Parliamentary Unit:
Email: parliamentaryunit@bma.org.uk