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Polysystems are too often just a fig leaf for NHS cuts

There's nothing wrong with polysystems – they just won't work if under-resourced. And with PCTs across the UK bringing them in to make efficiency savings, what are the chances of sufficient funding?

There's nothing wrong with polysystems – they just won't work if under-resourced. And with PCTs across the UK bringing them in to make efficiency savings, what are the chances of sufficient funding?



How do they come up with these names? Just as GPs were getting used to the term ‘polyclinic', up pops the ‘polysystem', under which practices are supposed to work together as a corporate entity to take on a raft of new hospital work. Until now, polysystems have been one of those slightly strange London concepts, born from Lord Darzi's review of the capital's healthcare, designed to tackle its particular health problems and acute financial difficulties. But as Pulse reports this week, the polysystem looks set to become yet another concept that is exported to the rest of the country – in spirit if not in name – as NHS managers desperately look for ways to dress up cuts as bold reorganisations of healthcare.

Creating polysystems is not inherently a bad idea. Practices should be able to retain their identities within each system, so the threat is not as acute as with the original polyclinic plans, which proposed herding GPs en masse under a single roof. Polysystems could bring all sorts of specialist diagnostics into primary care, with pilots around the UK already looking at community endoscopy and ultrasound. They might also act as host for various GPSI clinics – from heart failure to ENT to dermatology – and so finally make care closer to home a reality.

At least, that's what the brochure says. The problem, as NHS Alliance chair Dr Michael Dixon warns in this issue, is that polysystems are being developed primarily not to drive improvements in healthcare, but to find the millions of pounds of ‘efficiency savings' the Department of Health is requiring of PCTs. They are a fig leaf for severe cuts in hospital services, which are unlikely to be compensated for with equivalent funding rises in primary care. An under-resourced polysystem becomes a dumping ground for hospital work and a breeding ground for dissatisfaction among overstretched, disenfranchised GPs.

Pulse's Manifesto for General Practice demands the BMA and the DH agree a reiteration of the terms of the GP contract, to ensure no new work is transferred from hospital without the resources to do it properly. We will be taking this case, and the nine others distilled from your survey responses, to politicians and policymakers around the country in the run-up to the general election. The Government must not be allowed to spin funding cuts as a boost to services on a patient's doorstep. And GPs must not be forced to shoulder the burden of financial crisis elsewhere in the NHS.

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