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GPs to be herded into polyclinics

By Steve Nowottny

GPs face one of the biggest upheavals in their history after the surgeon heading Gordon Brown's review of the NHS unveiled plans for a radical new primary care model.

The Healthcare for London report, written by Professor Sir Ara Darzi, the newly appointed health minister, proposes merging hundreds of GP practices in the capital into a network of so-called 'polyclinics'.

Pulse has learned that SHAs elsewhere in the country are now closely studying the controversial new model, which could lead to the relocation of thousands more GPs. The proposals have caused a storm of controversy, not least because Sir Ara is now heading up what health secretary Alan Johnson has called a 'once in a generation' review of the NHS in England.

The new sites would offer extended opening hours and provide up to 50% of outpatient treatment currently carried out in hospitals. Sir Ara's report envisages the first five to 10 polyclinics being up and running in the capital as early as April 2009, with most practices in London being based in polyclinics within 10 years. Each clinic will house about 25 GPs from up to 10 practices, alongside diagnostics, consultant specialists, outpatient clinics, community services, urgent care and other healthcare professionals such as dentists and pharmacists.

The report predicts that 'over time' the separate practices at each clinic may choose to merge into one large practice. The BMA warned that polyclinics would 'destabilise and fragment' existing GP and hospital services, and GPC acting chair Dr Laurence Buckman said they were reminiscent of something from communist Soviet Union. 'The only place they have happened is in Soviet Russia, which was not especially successful,' he said. 'This review does not bode well.'

Dr Tony Stanton, joint chief executive of Londonwide LMCs, said it would 'destroy the very bedrock of British general practice' if most surgeries were relocated to polyclinics.

Dr Michael Dixon, chair of the NHS Alliance, also attacked the proposals, adding: 'I don't think it's what patients or GPs want. We need an increased focus on continuity and personal care.'

A spokesperson for NHS East Midlands said it was 'open' to the polyclinic concept. 'We are really interested in the results of the Ara Darzi review and will be looking at it closely to see if there are any models that might work well in the East Midlands,' he said.

NHS South East Coast is planning a series of polyclinics. NHS East of England said it would also consider the polyclinic model and NHS North West and NHS West Midlands both said they would not rule it out.

Primary care centres offering a range of services under one roof are already dotted across some parts of the country, including Tyneside, Yorkshire and the south coast, although PCT-led plans for 'supersurgeries' in Warrington hit the rocks after meeting fierce patient opposition.

Dr Eric Rose, a GP in Milton Keynes and candidate for GPC chair, said: 'When Warrington PCT decided it was going to herd all its GPs into polyclinics and operate on a taxi-rank system, people realised what was happening and got very angry about it.'

A spokesperson for the Department of Health said it would be 'premature' to discuss the wider deployment of polyclinics, ahead of consultation on the plans for London. However, Sir Ara said in his report he did not want to see the report 'just sitting on a bookshelf gathering dust'.

Key proposals

• Most GP practices to be relocated in polyclinics, each with up to 25 GPs, servinga population of about 50,000

• Up to 50% of outpatient treatment to be moved into polyclinics, also housing consultant specialists, diagnostics, community services, dentists and pharmacists

• Polyclinics to offer urgent care 18 to 24 hours a day, and routine GP appointments in evenings and on Saturdays

• Polyclinics could be ownedand run by the NHS, large GP practices, private companiesor foundation trusts

• Existing GP practices will be encouraged to relocate

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