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Is there a conspiracy of silence over the polysystem programme?

By Richard Hoey

It is the latest of Lord Darzi's big ideas to be destined for national rollout, but the term itself is suspiciously scarce in official documents

The term ‘polyclinic' was quite bad enough, with its slightly sinister Iron Curtain connotations, but ‘polysystem' beats it hands down.

It's not only stupendously ugly, but appears to be have chosen solely to riff on the prefix ‘poly', rather than in any way to describe what one actually does.

But ugly name or not, polysystems look all set to become a fact of life for GPs. Dr Tom Coffey, polysystems lead for Commissioning for London, was pretty explicit about it when he spoke to Pulse earlier in the week.

‘This is not just a London thing,' he said. ‘Our plans are based on Primary Care Research and Development Council and University of Birmingham research which has shown you can improve treatment for people with long-term conditions by doing it in primary care.

‘I think all SHAs are going to be basing their plans on this research and people are also realising not only are these systems more effective but they are cheaper.'

Dr Michael Dixon, NHS Alliance chair, was of much the same mind. And Dr Michelle Drage, joint chief executive of Londonwide LMCs, went further still, warning that all GP practices are likely to end up part of polysystems.

The idea is that getting GPs to club together under a corporate structure to take on hospital work will not only be cheaper than current care, but also finally deliver care closer to home. And our investigation did indeed find evidence of polysystem models springing up across the country.

NHS Derbyshire, NHS Trafford and NHS Oxfordshire all had plans that sounded pretty indistinguishable from London polysystems, without actually using the term.

NHS Bury was quite open about its plans for ‘polyclinics/polysystems' – but only in its draft minutes. By the final document, all reference to the terms had been expunged.

Indeed, it's hard not to be suspicious at just how rarely the term ‘polysystem' crops up outside London. We've been googling furiously here, but PCTs appear to be showing an eerily uncharacteristic solidarity in just never mentioning them in official documents.

Dr Coffey said polysystems were in fact more in advanced in Birmingham – which for around two years has been pursuing a controversial ‘franchise' model of primary care – than they are in London.

But again, you wouldn't know it from the official plans.

Could it be that the term polysystem – which will forever be associated with Lord Darzi – has been marked out as predestined to become a dirty word?

Could PCTs have been briefed by the Department of Health to begin work on polysystem models, without ever owning up to it to GPs or patients?

Could we, in fact, be on route to a polysystem programme by stealth?

Pulse editor By Richard Hoey