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At the heart of general practice since 1960

Polyclinic pioneers make the case

The Churchill Medical Centre in Kingston, south-west London, is not a typical GP practice.

By Steve Nowottny

The Churchill Medical Centre in Kingston, south-west London, is not a typical GP practice.

With 11 GPs and a patient list of just under 13,000, it is larger than many.

It also offers a number of additional services including respiratory specialists and minor surgery. Perhaps most unusually, it operates extended opening hours offering routine weekday appointments from 8am to 8pm. And it opens Saturday mornings.But it is not yet a polyclinic, according to Dr Charles Alessi, a GP at the practice and a contributor to the Healthcare for London report.

'I think it's a proto-polyclinic,' he says. Polyclinics, as envisaged in the report, will eventually offer an even wider range of services – outpatient care, consultant specialists and urgent care provided 18 or 24 hours a day. They will also be larger with up to 25 GPs serving 50,000 patients.

But the core concept of a larger practice offering a range of services and extended opening is very much seen as the Government's current direction of travel. Small wonder, then, that first Patricia Hewitt and now Gordon Brown, in his first weeks as Prime Minister, have visited the practice. 'I don't like the name polyclinic, but that's not the point,' says Dr Alessi. 'The grouping of doctors together is probably the sensible way forward.'

One obvious advantage for doctors joining larger polyclinics will be the opportunity to improve premises. A key reason Dr Alessi's practice operates extended opening at the moment, he says, is simply lack of space.

'Our premises are substandard. We can't take the number of patients we have so the obvious thing is to sweat the assets more,' he says. 'That is the reality of the cost of providing services in London.'

Dr Tom Coffey, a GP in Wandsworth, south-west London, and another contributor to the report, agrees.' The new premises would be the carrot, but there isn't going to be a stick,' he says. 'A lot of GPs may want to work from these polyclinics, but they don't have to and if they don't want to, they won't.'

He believes many practices will choose to take part in the federated polyclinic model, where a polyclinic with a single GP practice provides services to a handful of existing GP practices.

'At the moment, for patients to get ECGs, ultrasounds, X-rays and echocardiography they troop up to hospital, pay their parking and get lost in the hospital,' he says. 'Every single practice would have access locally to these services.'

Dr Coffey believes despite lower population density, polyclinics could eventually be deployed outside London.'London's special, more because of its rapid turnover, lots of different languages, ethnic minorities and lots of deprivation,' he says. 'But I imagine the economies apply nationally.' If you want to get your consultants and your diagnostics out of hospitals, they're not going to go to individual little practices.

Dr Alessi, too, believes polyclinics are the future, although he stresses they have to evolve naturally. 'I'm not saying this is the only model, or that it will be imposed on London,' he says. 'I don't think we're talking about imposition here.'

Grouping GPs together is a sensible way forward Dr Charles Alessi

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