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Why polyclinics work for MPs

10th March 2008

The Economist asks why polyclinics are being touted as the best way to improve services and reduce costs in the NHS, when they may not be the best option for patients.

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West London's eye-catching Heart of Hounslow Centre for Health has been open since 2007 and is heralded by Labour MPs as a way of spearheading a new way of treating patients within the health service.

GPs and hospital doctors work in two separate ways. GPs see patients first and are there to provide "primary care". Hospital doctors offer treatment within the hospital system, known as "secondary care".

The West London centre might be a way of giving patients treatment which connects the two types of care.

The centre is home to three GP surgeries, with 12 doctors who treat more than 20,000 patients. An average practice usually has four to five GPs, and some doctors choose to treat patients as sole practitioners.

The Hounslow centre also offers medical treatment which would usually require a patient to visit a hospital.

This "crossover" is still in its fledgling stages, but it is the country's closest example of the kind of care offered to patients in Germany. German polyclinics treat vast numbers of patients and provide services such as day surgery.

Health bosses will soon reach the end of a public consultation on a scheme which wants to see "as many as 150 German-style polyclinics" in London by 2018.

London's plans may soon be seen throughout the country, as the scheme comes in response to a report authored by Lord Darzi. Lord Darzi has been tasked with reviewing the NHS by the Prime Minister. He will submit his final proposals in June and has expressed his enthusiasm for polyclinics on several occasions.

There are two factors which influence Lord Darzi's approval of the polyclinic idea. One, he thinks they will offer improved care and accessibility for patients. Two, he believes they offer a more financial viable solution than hospital care.

His first idea seems "plausible but looks shaky" when examined closely. A polyclinic might be closer to a patient's home than a hospital but it will take more time to get to than a GP practice.

A patient's experience of a polyclinic will be that they are actually "less convenient" than their local GP surgery. The Royal College of GPs has said that the new clinics could destroy the "personal link" which patients have with their local GP.

Lord Darzi's second opinion also gives cause for debate. The health service will only make a financial saving if hospitals take out the "costs on activities being moved to polyclinics". This might not happen in sufficiently large numbers of hospitals to make a difference.

John Appleby, an economist at the King's Fund, has said that the transfer of care from GPs to polyclinics will be extremely costly.

The British Medical Association does not believe that polyclinics are the way forward. This might encourage MPs to believe they are a good option, since the relationship between the government and the BMA has been difficult following the negotiation of the new GP contract.

The National Audit Office said the GP contract had been £1.8 billion more expensive - from 2001-02 to 2005-06 - than MPs had envisioned. The government needs to understand that GPs can act as the "gatekeepers" to secondary care and as such ensure costs are kept low.

Germany polyclincs work in a system where hospitals do not provide out-patient treatment, However, bringing them into play in Britain is not a strong argument. Instead of a wholesale reinvention of the NHS, there are other ways of saving money and improving care.


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