Polyclinics told to poach patients from all GPs
By Steve Nowottny
Lord Darzi's new polyclinics will be told to poach patients from practices across sweeping catchment areas that in some cases will stretch right across a PCT.
Official Government documents obtained by Pulse also reveal a drive to cut the number of GP contracts available in each trust. Some models of care would see a single polyclinic taking on management responsibility for multiple practices.
In its procurement guidelines, the Department of Health says APMS contracts – under which every PCT will get at least one new centre – should set their practice boundaries ‘as wide as possible' to ‘stimulate competition'. In some cases this could cover the entire PCT, with each new centre being told to ‘target potential patients' from existing practices.
The guidance makes clear the opening of GP-led health centres is only the first stage in a wider polyclinic programme.
It asks PCTs: ‘What do you want the provider network to look like after completion of the programme?' and proposes a number of models, involving merging practices into a single contract or developing more ‘manageable procurements'.
Some PCTs have already seized on the guidance and begun a wholesale shake-up of local surgeries, intensifying concerns that polyclinics may force hundreds of practices to close.
Shadow health secretary Andrew Lansley, who has analysed the documents, said it looked like the Government was planning a ‘complete restructuring of general practice'.
‘Sometimes, in an area, there will be a single provider. So we know what that means – a single provider with GPs effectively as the salaried employee.'
GPC negotiator Dr Chaand Nagpaul accused the Government of ‘herding GPs like sheep'. ‘The Government is in danger of destroying the fabric of list-based general practice,' he said. ‘Many PCTs are wanting to drive through structural change by diktat.'
Some PCT bosses have responded enthusiastically to the proposals, with a manager in health secretary Alan Johnson's Hull constituency claiming the new providers would ‘act as a catalyst for reconfiguring local GP services'.
Dr Russell Walshaw, chief executive of North Lincolnshire and East Yorkshire LMC, said plans had already begun to force 10 singlehanded practices in north Hull into five larger practices.
He said GPs in Hull faced competition from three new Darzi surgeries and a GP-led health centre, all offering appointments from 8am to 8pm, seven days a week. ‘There is quite severe pressure to provide similar facilities – or run the risk of patients moving.'
A Department of Health spokesperson insisted it had ‘no intention to close existing practices or force a model onto GPs'. She said beyond core requirements ‘local commissioners have complete flexibility to tailor new services to the needs of local communities'.
The guidance also advises PCTs they are not obliged formally to consult on polyclinic plans, and tells them to ensure incumbents, including existing GPs, are not involved in developing specifications or managing procurement.Polyclinics: set to target patient lists Commercial Strategy (Department of Health)