Policlinics in England - Opinion

Opinion

Opinion on the plans for policlinics is polarised.

• Nigel Edwards, Policy Director NHS Confederation

Policlinics 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. Policlinics 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 policlinic 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 policlinics 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 Trust, 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 Concern 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 Manchester 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 Journal 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 Lord Darzi into the modernisation of the NHS. Bernd Rechel of the London School of Hygiene and Tropical Medicine and Martin McKee of the London School of Economics observed:

Polyclinics were a centrepiece of the Soviet model of healthcare delivery, but many countries of Central and Eastern Europe have abandoned them over the past two decades in favour of a system of general practice that draws extensively on the British model. Advisers from the World Bank, the EU, and many bilateral donors agreed that the polyclinic had failed to deliver modern, integrated health care and saw general practices as the future.

• The British Medical Association have been opposed to policlinics 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 policlinics, 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 policlinics 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 London'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 policlinics 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 Association are concerned that policlinics 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 policlinics 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 Democrats have criticised policlinics 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 Alliance have called policlinics "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 policlinics have been implemented in some places means they have got a point."
• The Royal College of General Practitioners, who support the notion of GPs working in federations, have nonetheless condemned the government's plans for policlinics, 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 Guardian have differed dramatically in tone. Polly Toynbee suggested that "it's hard to see a downside for patients" and GPs' protests are "all about profits, not patients", while George Monbiot 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 Independent has included a balanced article on them, explaining the possible benefits and disadvantages.