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Some say the way we gain access to our GPs may change forever.
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Polyclinics - the way forward?
Paul Taylor17/ 6/2008
THE debate about polyclinics rages on. Over a million people signed a petition against the idea of the super-surgeries, delivered to Downing Street by the British Medical Association.
But Prime Minister Gordon Brown condemns as “ill-founded” the BMA’s claims that polyclinics would mean many smaller surgeries facing the axe and a creeping privatisation of the health service.
Even the terms of the argument are fraught with confusion. Polyclinics – which centralise a range of primary, specialist and urgent care services into one building – are specifically a London solution, say health chiefs.
What we here in the north west will get are GP-led health centres, which will be in addition to existing provision. In Greater Manchester, that will mean ten new health centres and 20 new GP practices.
Two local GPs from opposite sides of the argument put their case:
Dr Kailash Chand, GP in Ashton under Lyne and regional representative of the British Medical Association
Polyclinics, or GP-led health centres, a name for Polyclinics outside London,will mean the end of family medicine as we know it. The initiative ismore about opening up primary care to big business than it is about improving services.
Traditional general practice is dying; or rather, being killed, because of the dogmatic neo-liberal belief of Brown et al that private solutions must trump public ones.
Polyclinic plans for moving primary care towards “Martini-style” healthcare - anytime, anywhere, any doctor - is not good for patients or longer-term doctor-patient relationships. I have been in practice for nearly 25 years, and during this period I have enjoyed the richness of looking after patients from when they were babies to when they’ve grown up, and then consider my joy when they’ve brought their babies to me! It’s very important that, whatever developments modern NHS reforms bring, we don’t lose that underlying personal relationship. The doctors’ surgery is more than a local post office, but there are symbolic similarities between them. The concept of polyclinics erodes such a binding and traditional relationship.
Patients will have to explain their problems all over again to a doctor they are not familiar with. The clinical service will be less personal, case records of patients may not be shared between different clinics that the patient might choose to visit.
One undesired effect would be the closure of some of our traditional health centres. The idea is that in addition to housing up to 25 GPs these centres will provide other services such as antenatal and postnatal care, community care, social care and specialist advice. Health centres will open from 8am to 8pm, seven days a week and will be available to registered and non-registered patients.
Some patients may welcome those services , but others may find they are further away than their current GP surgery. Patients who have their own transport may not find this a problem, but those who don’t – particularly if they live in a rural area – could find it is a real issue. Older patients, or those with chronic, destabilising conditions (the patients who use their surgery the most), may feel the impact hardest.
I don’t object to polyclinics in principle. There is merit in GPs working together and sharing premises with specialists and pharmacists. What I object to is the imposition of them on local communities without any evidence of need or benefit, without public support and against the wishes of GPs themselves. New surgeries need to be planned with the public and with local GPs so that investment is targeted on actual need, not political need. I believe that financial resources currently earmarked for these new mini-hospitals would be better spent investing in existing local GP practices.
These proposals run the risk of irrevocably changing the organisation and structure of health care . It is only right that the public must be fully informed of the implications and threats of these proposals. Most recently, Lord Darzi pledged that no change should be forced through without local professional and public support. The onus is on him to honour his word on this.
Dr Andy Cole, GP in Poynton and senior clinical advisor at NHS North West
In response to Dr Chand’s comments, it needs to be made clear that there are no plans to build polyclinics in Manchester or indeed the north west. However, an additional £63 million a year has been allocated to the North West to provide new surgeries and a new range of health centres that will give access to GP and primary care services.
The GP-run health centres here in Manchester will include services that range from easily accessible GP practices to more enhanced and targeted services such as sexual health, physiotherapy or services for older people. Any member of the public (regardless of which GP practice they are registered with) will be able to book an appointment or simply walk in and see a GP or nurse, from 8am-8pm, seven days a week. This will provide additional choice for patients in accessing primary care service, whether they prefer to do so during the day, in the evening or at weekends.
Some areas of Manchester have the lowest number of GPs per thousand of population in the UK and the new practices should help with this. The new health centres will provide greater choice and flexibility for people to access appointments, whether near their home, where they work or near where they go to school, college or university. These appointments will also be available at weekends and up to 8pm in the evening.
It is important to stress that the new health centres are being created in addition to, and in support of local GP services. Some GP services are struggling to currently meet the demand placed upon them. These health centres will provide extra services and increase access to primary care.
The new services are not forcing people to change the way they have access to a GP they are simply giving them more choice.
The issue of who will staff these health centres is also currently being addressed. There has been a significant increase in GP training and this means that there have been more newly trained GPs than posts. Our analysis shows that there should be sufficient numbers of GPs for these new developments although it is recognised that involvement of senior GP’s is desirable.
The people of Manchester and the North West want healthcare that is personalised and convenient. It is appropriate that primary care should respond and invest in local health services to tackle the health inequalities that are present within the North West.
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19/06/2008 at 22:43
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