The jaw-dropping price of Darzi centres

01 Jul 09

This week marks the anniversary of one of the most hyped documents in the history of the NHS. Lord Darzi’s NHS Next Stage Review could hardly have failed to disappoint, promising as it did to transform the health service from ageing institution into sleek, modern, patient-centred dream.

In the end, Lord Darzi pulled back from many of his more radical pronouncements, dropping plans to roll out full-scale polyclinics nationally, and focusing instead on heart-warming but arguably meaningless concepts such as quality and clinical leadership.

But the review was not all motherhood and apple pie. While the prospect of 25-doctor supersurgeries may have receded, their cousins, the GP-led health centres, were ushered into every corner of England. The policy was sold as a huge injection of cash into primary care, but over the past year has been rigorously imposed on even the most unwilling PCTs. And, as our investigation this week shows, there are questions over what all the extra money has bought.

There have been suggestions for almost a year now that the cash on offer for these centres might be rather more generous than for a typical practice. Last October, Pulse reported Derbyshire County PCT was offering twice the funding for its health centre that GMS practices get. But trusts have proved far from willing to release their figures, rebuffing previous Freedom of Information requests with complaints about commercial confidentiality and claims that the release of data would prejudice tendering. Now we know why NHS managers were so reluctant to let the numbers enter the public domain.

Some of the figures are simply astonishing. In NHS Halton and St Helens, the GP-led health centre is initially receiving £560 per registered patient, more than seven times typical GMS funding. NHS Doncaster’s health centre gets £412.50 per registered patient, plus extra cash for walk-in patients. And the resources allocated to NHS East Riding of Yorkshire’s centre are particularly likely to raise eyebrows. It gets £381.47 per patient, and is run by a group of GPs that includes BMA chair Dr Hamish Meldrum.

PCTs insist that GP-led health centres do not provide the same level of service as GMS or PMS practices. They open eight till eight, seven days a week, 365 days a year, and offer a range of extra services too, so of course they cost more – so the argument goes. Up to a point, they are right. Offering a wider range of services, for longer, will have a higher price. But rather than being an answer, that surely raises fresh questions.

If this is the true cost of opening at evenings and weekends, can the NHS possibly afford it? If running a GP-led health centre costs this much in Lancashire and Yorkshire, how can two PCTs in the south of England run their centre for just £63.21 per patient? How can the NHS justify offering some patients highly expensive services and not others? And is the ability of the BMA to scrutinise the rollout hampered by the involvement of its chair?

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