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Gold, incentives and meh

Darzi polyclinic plan has £1.5 billion hole

By Steve Nowottny

Plans to restructure general practice around a network of polyclinics lack any evidence of benefit and ‘seriously threaten' patient care, concludes an independent evaluation commissioned by LMCs.

The report, exclusively obtained by Pulse, warns the costings for Lord Darzi's polyclinic plans are ‘unsafe', with a £1.5bn black hole in the funding required to implement the plans across London alone.

The evaluation, by a leading primary care academic, forms part of the official response by Londonwide LMCs to Lord Darzi's Healthcare for London consultation, which closes this week.

It comes as documents obtained by Pulse reveal that University College Hospital and Camden PCT have already presented a joint plan to NHS bosses for the first of the new wave of polyclinics – which the Government has now said will be rolled out across the UK.

Professor Roger Jones, lead author of the report and professor of general practice at King's College London, warned: ‘There is very little published evaluation of polyclinics. We don't really know how well they work.'

He said limited evidence from Germany had raised concerns over continuity of care, while polyclinics in other countries such as Malaysia operated in very different healthcare settings from the UK.

His report concluded there were major concerns over the future of the doctor-patient relationship under the polyclinic model, warning: ‘A large organisation with many doctors is unlikely to provide an environment in which relationships between patients and doctors will be sustained.'

Concerns were raised over the greater distances patients would need to travel to see a GP, and the potential for disputes between partners. Greater access to diagnostics, though in principle welcome, could lead to overuse of investigations and unnecessary referrals.

The report claims there is no evidence that economies of scale will outweigh capital investment and meet forecasts for £1.5bn of savings under the plans.

Dr Stewart Drage, joint chief executive of Londonwide LMCs, said: ‘Our report has been drafted in a way that, if it wishes, NHS London could engage very closely with GPs and make something work. But if it blindly goes down this bean-counting route, it's going to alienate GPs.'

Dr Anouska Hari, vice-chair of Westminster LMC, said: ‘What concerns me is you're going to close down smaller general practices in order to be able to accommodate this.'

A survey of London LMCs also included with the response reveals grassroots opposition. All but two LMCs opposed inclusion of most practices in polyclinics – even under the so-called ‘networked' or ‘federated' model, which has been backed by GP bodies such as the RCGP.

What concerns me is you're going to close down smaller general practices in order to be able to accommodate this Dr Anouska Hari Darzi

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