In the 1980s and 90s there was a polysystem-based service – it was the cottage hospital network (‘Polysystems go national in huge work shift to GPs').
Why did most of them close? Because it was uneconomic to support large numbers of small units. So on a purely financial basis it does not make sense to effectively reopen them.
As a specialist whose work is mainly outpatient-based, I have argued for years that large numbers of community clinics are both clinically and financially inefficient. I should know – I used to do some!
It is far more effective for patients to have a one-stop service – which includes blood and imaging – in a hospital than for them to visit a community clinic, then the X-ray somewhere else, then back to the clinic a second time for results.
We are risking a serious and dangerous dumbing-down. Furthermore, the opportunity for specialists to recruit patients into new treatment trials will be seriously threatened. There is also the danger to inpatients that a specialist opinion will not be available because the specialists are all in the community.
Dr Andrew Bamji
Consultant rheumatologist, Queen Mary's Hospital, Sidcup, Kent
