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Polysystems go national in huge work shift to GPs

By Ian Quinn

Exclusive: NHS managers across England are to dramatically accelerate the shift of work from hospitals to primary care, with plans for GPs to take on new services as part of London-style ‘polysystems', Pulse can reveal.

PCT documents setting out the ‘efficiency savings' required of them by the Department of Health reveal proposals to decommission hospital services on a massive scale, with many introducing new ways of working for GPs under tighter managerial control.

Our investigation discovered:

• trusts are planning annual cuts in hospital activity of as much as 10%, with whole departments to be closed and some to transfer millions of pounds of work to primary care

• the first trusts outside London are drawing up plans for polysystems, describing them as a ‘financial imperative', with GPs set to work in corporate structures managing complex illness over large populations

• in London, the SHA is putting PCT managers under pressure to close hospitals against their will and shift work to GPs.

Pulse approached all 152 PCTs requesting details of efficiency plans – to be submitted to SHAs next month – under the Freedom of Information Act.

Of 44 able to provide details, 38 said they planned to accelerate the shift of work from hospitals to primary care.

NHS Sefton aims to cut hospital activity by 10% in 2010/11 alone with dermatology ‘ceasing to be a hospital-based service' – yet also plans a 10% cut in primary care spending.

NHS Wolverhampton City said external consultants had earmarked £10m in services to be shifted to primary care.

NHS Suffolk has identified more than 20 specialist services to move to GPs, including cardiology and gynaecology clinics and diagnostic surgery.

Many trusts plan to review referral thresholds and stop funding hospital activities classed as ‘low clinical priorities'.

NHS Bury signalled its intention to adopt the polysystems model, with its draft minutes stating: ‘Work on modelling implementation of polyclinics and polysystems has not commenced but will be integral to our business plan.'

The trust later erased the words ‘polyclinics' and ‘polysystems', claiming they were ‘not appropriate', amid concerns managers are aiming to duck controversy by avoiding use of the terms.

NHS Derbyshire County plans to decommission millions of pounds of hospital services and for GPs to work in a consortium, paid under a single APMS contract for all additional work.

NHS Trafford and NHS Oxfordshire aim to adopt ‘integrated care' systems to transfer work to primary care.

Dr Michael Dixon, chair of the NHS Alliance and a GP in Cullompton, Devon, said he expected every large population centre to move to polysystems.

Polysystems could bring practices direct access to specialist diagnostics, but Dr Dixon warned they were being driven by cost pressures and risked dumping unresourced work on GPs: ‘I am convinced every trust will end up transferring a huge volume of work to GPs and in towns this will mean moving to a polysystem model.

‘This could be an opportunity for GPs to take more control over NHS services. My fear is it will be driven by cost-cutting and not properly resourced.'

In London, where all PCTs are introducing polysystems, a letter obtained by Pulse from NHS London to North West London PCTs demands more radical cuts. It says: ‘Your draft plan refers to three major acute hospital sites. We have a concern these are financially unsustainable.'

Dr Tom Coffey, Commissioning Support for London's clinical lead for polysystems, said he believed they would be introduced across the country, in both urban and rural areas: ‘This is not just a London thing. Our plans are based on research showing you can improve treatment for long-term conditions by doing it in primary care.

‘I think all SHAs will base their plans on this research as they realise these are not only more effective but also cheaper. It's a big chance for GPs.'

GPs across the UK are set to work in polysystems, often centring around polyclinics