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Are Darzi centres the future of general practice?

GP-led health centres offer the resources and opportunity to improve access to services locally, argues Dr Phil Yates. But Dr Andy Black counters that they will be staffed by salaried GPs, nurses and locums who will have none of the long-term commitment of a GP partner

GP-led health centres offer the resources and opportunity to improve access to services locally, argues Dr Phil Yates. But Dr Andy Black counters that they will be staffed by salaried GPs, nurses and locums who will have none of the long-term commitment of a GP partner



Satan's spawn? McMedicine at its worst, delivered by big companies and pandering to political whim? You would think so, from the vitriolic responses to Lord Darzi's planned network of GP-led health centres. But as a GP who is running one of these centres it seems to me far from inevitable that they will turn out badly.

Practices have always been adept at changing with the times and now must be no exception. Healthcare is inherently politicised and GPs must ride the waves just as with GP fundholding, PMS or the QOF. Practice-based commissioning has failed but GP-led health centres bring real resources. They bring risks too, but also opportunities. If we don't rise to the challenge, someone else will fill the void. We must mould our own futures.

What are the political drivers here? Longer and easier access, increased choice of location for the treatment and surveillance of conditions and broader availability of community-based care.

Who can argue with that? Patients won't. Of course, the Government also wants increased value for money through competition. But if GPs run these contracts we can create an environment that supports a federated model, in accordance with the RCGP vision. What better lever to integrate care locally?

Even banks are open on Saturdays now. How frustrating for our customers (patients, PCTs, the Government) that GPs have anachronistically withdrawn into a weekday 8am-6.30pm contract. This could never last. There may be considerable downsides to society in our 24/7 culture - but it's to be like King Canute to oppose it.

And patients are confused about when to attend GPs, walk-in-centres, A&E and out-of-hours facilities. No wonder the costs of expensive non-elective hospital care and emergency admissions have risen, in the absence of the sensitive filter of general practice. But GP-led health centres can reunify care for patients under the general practice banner. Patients will know we'll be there for them. And it doesn't harm GPs as providers either - it broadens our niche and strengthens all our futures.

Think of yourself as a fit person with diabetes. Do you really want to take time off work for your routine check-ups? It would probably be far more convenient to see a skilled professional, be it a doctor or a nurse, at the weekend. And let's be clear - this is GP-led. Not like walk-in centres, which were an expensive mistake that should now be reabsorbed into GP-led centres. At mine, we are negotiating twice-daily pathology collections, so all investigations can be done at patients' - not the health service's - convenience. The centre gets paid for the work and, with good communication, the practice gets all the information it needs for meeting its QOF requirements. A win for everyone.

What about quality of care? We have 100% QOF scores in an area of significantly higher than average disease prevalence. So quality does not have to be compromised. It's not hamburger medicine, just hard work and good organisation. And it's now available to patients when they want it.

Imagine you're a 16-year-old girl, stuck because the local family planning centre is only open on a Monday evening. Our GP-led health centre will offer all emergency and reversible contraception throughout our opening hours and a full sexual health service supported by the local specialist.

If we want to reduce teenage pregnancy and STIs, we need to put services where users can access them. It's a no-brainer.

We will make access to a whole raft of treatments easier, from minor injury, psychological therapies and support for behavioural changes to links with council services. We intend to use this contract to create a step change in health provision for our local population.

Dr Phil Yates is a senior partner at the Orchard Medical Centre in Bristol, which recently won a contract to run the local GP-led health centre



There can be no doubt that GP-led health centres, as Alan Johnson says, are a vision of the future. The question is, what sort of vision is it?

When I cast my mind forward, I don't see Mr Johnson's rose-tinted utopia of quality care for all at all times. I see an Orwellian nightmare of politically controlled oppression of professional independence.

GP-led health centres come at a time when our hospital colleagues are becoming more and more knowledgeable about more and more specialist fields, so that GPs are left as the last true generalists. We are also in a period of increased financial pressure on the NHS, resulting in a drive to move care into the community and redefine the gatekeeper role of GPs through use of practice-based commissioning to impose budgetary controls.

The Government's answer to these pressures is to dumb down general practice so that, like bargain supermarkets, it is piled high and sold cheap. We've seen in recent weeks plans by some PCTs to accelerate this dumbing down within their GP-led centres by removing paediatrics work from GPs.

In fact, the very name of these centres is a huge smokescreen. The early evidence suggests these centres will be profit-driven commercial centres staffed by hordes of nurses and newly qualified GPs or locums. These doctors will become a new underclass within the profession, working antisocial shift patterns on short, fixed-term contracts, outside the remit of the GPC and in some cases without the protection of the NHS.

In some centres we run the risk of recreating the inverse square law of patient care, in that patients in the most deprived areas with the greatest needs will be cared for by those with the least skills. In other centres, such as the one proposed in Hereford, where there are no local GP shortages, doctors will spend their time giving second opinions to patients and seeing those who want to delegate all responsibility for their own health, no matter how trivial the illness.

Thus vast sums of public money will be wasted at a time of stretched public finances. In my PCT, where a needs analysis showed no need for a centre, the PCT now finds itself with a £4m potential shortfall next year. Instead of cancelling this project, they propose capping prescribing budgets.

There has been nothing in what I've seen or read that would make any budding GP aspire to work in one of these centres through choice. What they will not be are beacons of excellence or one-stop shops, as initially envisaged. They will become expensive white elephants that act like financial millstones around the neck of PCTs for years to come.

These centres have also been divisive in the way they have been imposed, affecting the relationships between PCTs and GPs. This has resulted in clinicians feeling undervalued, isolated and ignored.

Patients, after their initial enthusiasm for being able to get a pill until 8pm on a Sunday, will begin to miss an alternative model of general practice. It is the model

I believe in, of smaller groups of motivated GPs who nurture and support each other, who feel a tie to their communities through financial commitment and long contracts. It's a model in which patients and doctors have time to get to know each other's hopes, fears and expectations, where doctors know patients as more than a number in a queue and can act as their advocates without fear of political or commercial intervention.

This is a vision of primary healthcare that is recognised as highly cost-effective and the envy of most of the developed world. Let's call this vision GP partnership.

Dr Andy Black is a GP in Leominster, Herefordshire, who resigned from his PEC over the decision to develop a GP-led health centre

Yes, Darzi centres are the future of general practice No, Darzi centres are not the future of general practice Are Darzi centres the future of general practice?

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