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Polyclinics disastrous for everyone

Dr Kailash Chand believes the threat posed by polyclinics must become a cause celebre for all doctors

Dr Kailash Chand believes the threat posed by polyclinics must become a cause celebre for all doctors

Lord Ara Darzi's proposals to herd GPs en masse into polyclinics would be the most radical reform of the health service since 1948. The idea of moving care closer to home might sound appealing, but there is a complete lack of evidence for the polyclinic concept.

One thing the NHS always does well is to find innovative new ways of spending money. Sadly, the reality does not always live up to the aspiration, and this latest money-gobbling scheme must be greeted with great caution.

The medical profession is already confused and exhausted by the Government's constant NHS reforms, and these latest proposals have the potential to fragment and dismantle the services we already have.

But although primary and secondary care may be destabilised, polyclinics appear to be of great benefit to the private sector. The proposed polyclinic appears to be a combination of a supersized health centre, a minor injuries unit, a small-scale outpatient department and a base for community health services. Polyclinics will be, by their nature, out of the financial reach of GPs, even if they form consortiums. Inevitably, their development will depend on private companies – which may or may not have any experience of providing healthcare. And the mass movement of the commercial sector into the NHS may spell the end of GPs' independent contractor status. Private companies will buy out GPs, and either put them on a salary or retire them.

Realising assets

The polyclinic reforms will spark a mad scramble to acquire lucrative practices, in which GPs will not be able to compete with the private sector. For large numbers of GPs who are approaching retirement tired and disillusioned, the question now is how much they can get by selling their share of their practice. Lord Darzi's reforms may initially be confined to London, and here they will prompt asset sales worth billions, as the capital's 93 hospitals, 1,400-plus mental health and community services and 1,600-odd GP practices potentially face the bulldozer.

But will these sweeping reforms bring any benefits for patients? The terms primary care and general practice are often used interchangeably, but they are not the same. GPs do general practice exceptionally well. Polyclinics will do primary care. They will prove the last nail in the coffin for continuity of care and will kill off the notion of the GP as the patient's advocate.

The development of polyclinics is likely to be driven less by medical or social need, and more by commercial concerns. There is a real danger that Lord Darzi's report will be used primarily as a smokescreen for local NHS managers to force through unpopular cuts in services. These cuts will reduce access to frontline care for those who need it most and who find it most difficult to travel long distances for treatment – the poor, the elderly, the infirm and those with disabilities. And will such centralisation mean the end of home visiting?

By moving most GPs into polyclinics, the Government may also be aiming to rule general practice by dividing it, as it has tried previously via fundholding and PMS. In the past, the BMA has often sidestepped these difficult issues, and not opposed them as vigorously as it should. But polyclinics are a serious threat not only to GPs, but to consultants at district general hospitals as well. The BMA must make the pitfalls of the polyclinic model a cause celebre for the whole medical profession.

Dr Kailash Chand is a GP in Ashton-under-Lyne, Greater Manchester. He is a member of the GPC and the BMA council

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