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Do patients want polyclinics?

Not only do patients like the concept of polyclinics, they also like them in practice and are already rushing to sign up, says Dr Tom Coffey. But Dr Rohit Goel disagrees, insisting that the Government refuses to listen to the mounting opposition from patients

Not only do patients like the concept of polyclinics, they also like them in practice and are already rushing to sign up, says Dr Tom Coffey. But Dr Rohit Goel disagrees, insisting that the Government refuses to listen to the mounting opposition from patients

Yes

This debate is about what patients want and deserve and – as I practice in London with its own unique health needs – I'm going to concentrate on the situation here.

We want GP services to be accessible in the capital, whether that means an unscheduled appointment at 4pm on a Sunday with or access to diagnostics as part of a standard GP practice.

Both avoid a visit to A&E – good news for the patient.

Patient surveys show us that people in nearly every area of London are less satisfied with GP services than any other part of the country.

Being able to see a GP outside of working hours is consistently highlighted as an area where patients want to see improvement and 80% favour extended hours, according to the public consultation carried out by Healthcare for London.

The numbers speak for themselves. There's been a gentle stampede in east London where 100 patients every week are joining the Barkantine Centre, the closest current model to a polyclinic.

More than 6,500 patients have joined since opening last December, offering access to services including a birth centre, dental care and a counselling service – all close to home.

And it's not just the Barkantine patients that are benefiting. Three other GP practices serving 23,000 people are networked into the centre to bring all these services closer to local people.

So what sort of service do we want to offer patients?

According to the BMA's own survey, 75% of GPs themselves believe their facilities are out of date and 36% of practices cannot be adapted to meet disability access requirements.

Healthcare for London believes this is unacceptable and there must be action.

No single solution

There is no single solution. Polyclinics are not just one-size-fits-all big glass buildings. In London, we expect to see different models of polyclinics depending on what is right for the community.

This will be determined by each of the 31 PCTs, working with clinicians, local authorities and residents.

In many cases, existing GPs could form a networked polyclinic where GPs share services and link into a local hub for specialist services. Although many GPs have skills in minor surgery, many don't have the building or facilities, and lack access to diagnostics such as X-rays and blood tests.

This networked model is supported by the RCGP in its June report Primary Care Federations – Putting Patients First, which recommended the introduction of GP networks and shared services offering more services in the community.

There have been misleading comments in the press over claims that polyclinics will lead to the breakdown of the doctor-patient relationships and increase travelling time.

But continuity of care will remain essential. We GPs on the Healthcare for London polyclinic board recognise how vital it is for every patient to retain a relationship with a doctor, and there is no reason why this can't happen in polyclinics.

The networked model will have no impact on travel times. We recognise a single site model could affect travel times, which is why we're clear that factors such as public transport need to be closely examined when considering these models.

GPs will also not be forced into polyclinics against their will as they can continue to own their practice list wherever they choose to work from.

If GPs are joining a polyclinic model, they will not need to tender to continue to provide those services.

We need to be clear that this is not about taking away or closing down services. We know many London GP surgeries are already providing excellent services in patient-friendly and accessible environments, and will continue to do so.

Primary care services in London must adapt to 21st-century needs and put the interests of patients first. Polyclinic models will not only improve access, quality and convenience but reduce health inequalities within the capital.

Dr Tom Coffey is a GP in south London and clinical director for the Healthcare for London polyclinic project

No

I recently sent a petition to my local MP protesting against plans to force small practices such as mine into large polyclinics. I was quite amazed at the response from my patients.

Neither I nor the other GPs here could believe the strength of our patients' loyalty to us.

And when our patients spoke to the local MP about us I couldn't help but feel an incredible sense of duty of care and dedication to these people who took time out from their busy lives to speak their minds.

In just three months we got signatures from 25% of our largely educated and informed adult patients. We did not – as the Government has insinuated – force or trick them into signing.

I can remember only one person who thought polyclinics were a good idea and refused to sign it.

Then just a few weeks later, after having been in to see me repeatedly and often at short notice for abdominal pains, she realised that she was getting excellent, personalised, continuous care that she would not get at a polyclinic. She then gladly signed it.

This is really what patients want. If the Government is not going to listen to us then at least listen to the public – these are the people that matter, as nobody is spared being a patient at some point in their lives.

The main issue here is that of control and quality. As GPs, most of us are also our own managers and as such are accountable directly to the PCT and the NHS.

Ultimate responsibility

With that ultimate responsibility comes a pride and dedication to quality.

Will the clinicians at polyclinics be as engaged and dedicated? I sincerely doubt it.

There is mounting evidence of the low quality of clinical services offered by some APMS providers – in some cases bringing high numbers of complaints.

As a doctor I have been trained to practise evidence-based medicine and to listen to patients.

Surely these are the cornerstones of good medical practice that should be practised by every healthcare professional?

So why is this Government – along with Lord Darzi – doing neither? There is not yet a single working model of a polyclinic in the UK open to evaluation, let alone any measure of cost-effectiveness.

From the Government's own survey the majority of patients were happy with their doctor's opening hours – yet this is still being pushed as a main reason for building polyclinics.

We as GPs and the British public are being forced into a future that has no evidence base and that 1.2 million people have petitioned against.

It's an absolute travesty that the Government can simply ignore this and state that these people were somehow bullied into signing it and still press on with its plans. It just shows how farcical the public consultation has been and makes no sense.

But I think to understand the real rationale behind polyclinics we have to look beyond the evidence and what our patients want, to the real agenda – simply money.

The excuses being thrown back by the Government are unbelievably weak and just show how desperate it is to try and get everybody on board a ship that's sinking before it has even set sail.

If you won't listen to us, listen to our patients. They'll be the passengers on this ship and we GPs will be the crew trying to keep it all afloat.

Dr Rohit Goel is a GP in south London

Dr Tom Coffey

Continuity of care is essential and can happen in a polyclinic model

Dr Rohit Goel

Will the clinicians at polyclinics be as engaged as us? I sincerely doubt it.

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