Polyclinics ‘cost far more than they saved’

By Ian Quinn

As coalition halts rollout, NHS London report reveals a legacy of multimillion-pound white elephants

The rollout of polyclinics and polysystems, until last week touted as the future of primary care, has been exposed by newly released documents as leaving a legacy of multimillion-pound white elephants costing the NHS far more than they saved.

Health secretary Andrew Lansley used the launch of the Government's coalition agreement last week to pull the plug on all top-down reconfigurations of GP services, including plans for 100 polyclinics in London and reorganisation of GPs across the capital.

But a report released by NHS London the day after Mr Lansley's intervention reveals managers have admitted Lord Darzi's plans had forced up costs and hugely exaggerated how much care could be moved out of hospital.

Mr Lansley's pledge to halt reorganisations, first made exclusively to Pulse for our 50th anniversary issue in March, was followed by the release of a series of documents from NHS London and its US consultancy firm McKinsey.

They reveal changes introduced under the Healthcare for London plans, designed to drive huge cash savings and including the opening of seven polyclinics since April 2009, had the opposite effect to that intended.

An NHS London report based on an assessment by McKinsey concludes: ‘Current projects (for example on stroke and trauma) have not yet been cash-releasing and instead appear to be leading to additive costs.'

It adds: ‘While some polyclinics have opened, the current moderate shifts of care have not yet transformed out-of-hospital care. Similarly, although hospital admissions have started to stabilise, they have not dropped to the extent expected.'

NHS London had pinned its hopes on more than 100 polyclinics and the resultant GP polysystems coping with a massive 55% of outpatient and 60% of A&E care.

But the report says: ‘There is some mismatch in ambitions. The capabilities to support large-scale change are not in place. The core principles (and expected savings) of polysystems have proven difficult to achieve with more focus on buildings than changes to behaviours.'

While announcing his plans to end top-down reconfigurations, Mr Lansley said: ‘We are committed to devolving power to the people, patients, GPs and councils who are best placed to determine the nature of their local health services.'

Future plans, he said, must have support from GP commissioners, be evidence-based and focus on improving outcomes.

But Ruth Carnall, NHS London chief executive, said the collapse of the polysystem plans left London facing a £5bn black hole: ‘We must find a new way of meeting these challenges.'

Dr Michelle Drage, joint chief executive of Londonwide LMCs, said: ‘If this means an end to the huge waste of money and the turmoil faced by GPs then I'm very relieved. But what's important is what the Government does next.'

She said there was ‘a real risk' that the coalition could yet introduce its own strategy to transfer services from hospital, which could plunge GPs into yet another reconfiguration.

It was billed as the future of general practice in an age of economic downturn. The now notorious McKinsey report for NHS London on shifting hospital care to GPs has been the subject of many thwarted Freedom of Information requests and attempts by MPs to see it published.

Now it has been released after it became clear the proposals would never come to fruition.

McKinsey proposed a brutal crackdown on costs including:

• cutting appointment times by 20%, allowing GPs to ‘spend more time where it is needed'

• nurse practitioners to handle up to 50% of consultations

• cutting primary care spend by up to £1bn by 2016/17

• decommissioning up to 30% of outpatient services.

Leaks of the proposals generated huge hostility from GPs against the London plans and similar ones further afield.

Dr Michelle Drage, joint chief executive of Londonwide LMCs, claimed the NHS had become ‘the McKinsey health service'.

New Liberal Democrat health minister Paul Burstow was among MPs who called for the report to be published while in opposition.
And NHS London claimed it wanted to ‘draw a line in the sand' – leaving it with little choice but to publish the report.