GP alarm as NHS managers push for paediatric centres in polyclinics
08 Mar 10
NHS managers are to establish a series of primary care ‘children’s centres’, based in polyclinics, to spearhead the transfer of paediatric care from hospitals.
The move looks to put into practice hugely controversial commissioning guidelines laid out by Healthcare for London last year, which many fear would strip GPs of their lead role in paediatric care.
NHS East of England, NHS South East Coast and NHS Yorkshire and the Humber have also developed plans to create community paediatric practitioners and move child outpatient work out of hospitals.
But Pulse has learned GP experts in child health are furious the latest plans have been developed without consulting local practices.
NHS North Central London Strategic Health Authority aims to co-locate children’s centres in polyclinics as part of plans to move a huge volume of workload out of hospitals.
The authority, including Barnet, Enfield, Haringey, Camden and Islington, has set out plans to ‘shift of up to 40% of outpatient work to the community settings’ and for ‘consolidation and co-location’ of child services into polyclinic hubs, serving local polysystems, led by ‘specialist paediatric staff’.
But GPs on the ground, even those who practices have been earmarked as possible polyclinic hubs, told Pulse they had been left completely in the dark.
Dr Stephen Amiel, a GP in Camden who with his partner, RCGP president Dr Iona Health, published the book Family Violence in Primary Care, said: ‘As someone with a long track record in child healthcare I ought to know more about these plans than most and I know nothing.
‘Camden GPs have only just been called for a meeting with the PCT. I’m speaking as a potential hub practice yet I could write down what I know about polysystems on the back of an envelope.’
The Healthcare for London report claimed services needed to be revamped partly because of the poor training of GPs, claiming 40% had no training in paediatric medicine.
But Dr Amiel, who has served on Camden’s child protection committee, said he was strongly opposed to the plans, claiming they could damage the generalist role: ‘I have long argued in favour of a multi-agency approach, but my worry is it’s being done to cut costs.’
Dr Paddy Glackin, secretary of Camden and Islington LMC, said: ‘One of the great strengths of general practice is the holistic care we provide. I don’t believe there is any evidence we aren’t doing a good job.’
Children's GP plans
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• Shift of up to 40% of out patient departments to the community settings
• Urgent care services for children to be integrated with primary care
• Consolidation and co-location of services from a community hub (polysystem or children’s centre)
• Community based multi-disciplinary teams to provide care for children led by specialist paediatric staff
• Increased coordination and knowledge sharing between secondary and community based paediatric services
• Paediatric assessment units (PAU) at every A&E dept staffed by specialist paediatric staff
Source: NHS North Central London Strategic Health Authority strategy plan
Readers' comments
The proposals to shift 40% of outpatient work out of hospitals is probably the most dangerous visited on the NHS in the last 20 years. By focussing on the tariff cost saving it fails to notice that if you withdraw profitable services from a service, the remaining loss-making parts are unsustainable. Many outpatient departments prop up the 'loss-leaders' in acute trusts (which sadly include general and elderly inpatient services).
Furthermore the destruction of hospital-based services will do immeasurable damage to team working, inter-specialty communication, specialty management of acutely ill inpatients, training and research. Specialist working in dispersed and potentially isolated surroundings is inefficient and expensive (not least if costly infrastructure requires unnecessary duplication and worse if it is done under PFI).
The NHS is bust and likely to become more so. It is madness to throw away existing facilities and replace them with lots of smaller new ones. Tesco managers will laugh; it's not how they run an efficient retail system.
Of course there is a way to achieve the stated aim at no cost at all. Simply put doors into hospitals to separate off the outpatient areas and legislate that these are now managed by the PCT. It has been done.
Campaigners against the introduction of Polyclinics in the Camden and Islington area will be surprised to read that Stephen Amiel, as one of those very publicly involved, claims to know so little about them.Iona Heath by the way has retired from their practice but lthe book they edited jointly was published many years ago. Theory and practice change over time. The public is also better informed these days about the failings of the way Child Protection Committees and childrens' services have been set up and run. Experience gained over many years (obviously this leaves a galring hole of inexperience in between) or well intentioned people with an interest ,whatever their links or networks with other professionals, is no substitute for properly trained professionals who have been through appropriate rigorous training, have recognised specialist qualifications, have been through an interview proces before sitting on Childrens' Protection Committes and whose members will be monitored and inspected regularly. It is a highly complex area which requires full time attention yet one of the constant criticisms of the present system is that part time work by professionals engaged in other work does not afford proper protection Children and society as a whole need better protection than that which has historically been afforded by non specialists involved in childrens' services.
i agree with susanne stevens. therefore to provide high quality services should really be paid for in extra money rather then shifting money from one resource to another, and therefore politicizng the whole process. its a bit like the whole out of hours deal, it was not great before and its certainly not great now even with so much money been invested, the same will be of polyclinic and children centres, if is not great now and i expect loads of money poored in to it the service will not be good afterwards. and hospitals cant really cope with the current workload esp with opa waiting times etc as it is i wonder how successful these clinic will be run. As clinicians we should always want the best care for our patients and demand much extra resources get used to finance these clinics.