Polyclinics
About polyclinics
Technically, the term ‘polyclinics’ refers only to London, as the Department of Health uses the term ‘GP-led health centres’ to describe the new services/facilities for the rest of England.
What is a polyclinic?
There is no clear definition of a polyclinic. Polyclinics are a term that the government has used in relation to ’super-surgeries’ that are being set up in London. However, the term ‘polyclinic’ may also be used more generally to refer to a new large surgery or GP-led health centre (e.g. accommodating up to 25 GPs) serving a particular area.
In addition to GP consultations, these clinics would also provide some additional services (eg x-rays, blood tests, social care, etc). Polyclinics would open from 8 am to 8 pm, seven days a week. Primary Care Trusts (PCTs), the administrative body responsible for managing GP services, will establish a GP-led health centre (commonly termed polyclinic) in their area.
Is there evidence that smaller surgeries provide good quality care?
There is strong research evidence that small GP practices provide patients with good quality care. Independent research bodies like the King’s Fund have questioned whether polyclinics would deliver higher quality care than smaller practices, even if they offered a wider range of services
How will they be funded?
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.
How will this affect 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.
What is the private sector’s role in polyclinics? Are GP surgeries being ‘commercialised’?
Contracts for polyclinics will be available, through a bidding process, to a number of health providers. Private commercial companies, who will be accountable to their shareholders, may bid to run polyclinics. These contracts would be offered on a short-term basis and would likely employ doctors on short-term contracts. This would make it more difficult for patients to receive continuity of care (i.e. seeing a doctor over a period of time for a specific health condition), from their own family doctor.
Why is the BMA concerned?
Contracts for polyclinics/health centres come under APMS contracts (Alternative Providers of Medical Services) which is the route through 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.
We acknowledge 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.
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.
We are also worried that if the local surgery were to close or reduce its services, then patient care could suffer. Patients, particularly those who have serious long term health problems, may be unable to see a GP they know and develop a shared understanding of their illnesses. Patients could find, in a polyclinic, that it is difficult to see the same GP, and that they will feel like a small cog in a large impersonal organisation. We believe that is important for patients, particularly those who are older and more vulnerable, to be seen by a GP who knows them, and can provide a holistic approach and continuity of care.
In 2008 the BMA organised a petition under the ‘Support your Surgery’ campaign which was signed by 1.2 million patients.
