Polyclinics

 

Lord Darzi is Parliamentary Under Secretary of State at the Department of Health. On 4 July 2007, the Prime Minister and Health Secretary announced that Lord Darzi would lead a review of the NHS that would advise on how to meet the challenges of delivering health care over the next decade. However Lord Darzi recently reported an interim report of his findings, the issue of polyclinics featured prominently within his recommendations.

 

Following Lord Darzi’s Report ‘A Framework for Action’ in July 2007 and the interim report ‘Our NHS, Our Future’ published in October 2007 Lord Darzi’s recommendations were that a significant stage of the NHS reconfiguration would be the proposed 150 polyclinics established nationwide.

 

The proposed polyclinics are to be served by numerous GP’s with the intention that a wider range of specialist services could be provided. Polyclinics would reorganise the GP system and take over much of the work of local existing hospitals. Hospitals would potentially lose some services such as minor procedures, matron services and diagnostics. These would be dealt with by the proposed polyclinics in addition to GP services. The Health centres would house GP’s alongside a selection of different healthcare specialists, formerly part of hospital services, which would include community matrons (who provide sick or disabled elderly people out of hospital with care in their own homes),district nurses, physios and neuro-rehabilitation teams. With specialist residents under one roof, they would be able to deal with childcare and women problems, through providing access to antenatal and postnatal care, as well as social care and mental health services, which are normally situated in hospitals.  Initially the scheme would be rolled out through urban, larger G.P surgeries.

 

Conversely, with the widening of services at GP practices, this will mean complex and specialist care will be concentrated but carried out in fewer hospitals. By bringing many specialists under one ‘super practice’, this would undoubtedly cost closures of smaller local hospitals and some A&E and Maternity departments would be siphoned off to join with other hospitals. Some local hospitals will still exist but will treat non-complex inpatient and offer care for all but the most severe emergency cases. Some GP practices will exist, although they will be in direct competition with polyclinics.

 

Although most G.P surgeries currently operate with a handful of GP’s, the envisaged establishments of large polyclinics serving 50,000 people and staffed by twenty five or more GP’s does raise some serious concerns. Historically the culture of G.P care in Britain has been built upon personal, ‘cradle to the grave’, care. The very personal G.P-patient relationship is a vital component of patient’s primary care services and this continuity could well be lost with the establishment of polyclinics. As commented by Peter Weaving GP: “It's very important that whatever developments modern medicine brings, we don't lose that underlying personal relationship.”

 

Under these plans, easy accessibility will diminish, and travel time to the hospital will clearly increase. Critical travel time will be lost in emergencies if these proposals will go ahead. This will affect all but especially noticeable to those in rural areas

 

The policy is also flawed in its ‘one size fits all’ approach. The government must recognise that the scheme would encounter considerable obstacles when attempting to implement the scheme in rural, sparsely populated areas. Additionally, the scheme would increase the potential for privatisation to take root within NHS primary care. Large polyclinics would inevitably invite competition from large multinational companies looking to run health centres.

 

The Patients Association recognises the potential benefits that could result from the roll-out of polyclinics however the potential losses that the scheme could inflict on rural areas must be mitigated by effective management and adaptability.

 

However the greatest concern that the Patient Association harbour’s in regard to polyclinics is the need for continuity in doctor-patient relations. This continuity is crucial to allow for effective treatment and allows the doctor to effectively use their understanding of different patients social and cultural backgrounds. As all diagnosis are in fact estimations: deductions given the symptoms, by zoning in on a specific part of the body one can overlook a broader diagnosis where many parts of a body can collectively contribute to a larger problem/ diagnosis. Specialists tend to just focus on one part. Here blurs the line between holistic and specific. GPs are created for the former approach and if needed will refer a specialist, whilst hospitals are intended to treat the latter. By merging the two, GP’s overall diagnosis of all factors and information into consideration will be overlooked for the faster and ‘simpler’ treatment that may be ill-informed.  

 

The Patients Association’s Chairman Anthony Halperin commented: "What I believe patients want is to see their own GP, to have a regular relationship with a GP, and when they require further or more specialist treatment to go to a hospital, what you are now doing is interposing a third layer of a polyclinic and I really don't see any advantage for it".

 

We await Lord Darzi's findings in full which are due to be published this summer.