Jill Palmer – Prescriptions

POLYCLINICS are being touted as the next big thing in the National Health Service. But are they just a back door route to increasing private practice into the NHS? Do privatisation and polyclinics go hand in hand? On the face of it, these super practices – which would house several GPs, practice nurses, community nurses, dentists and other specialist healthcare providers under one roof – appear an excellent development.

The days of the single-handed GP are numbered. In 2003, there were 2,609 single-handed practitioners out of a total of 28,568 GPs. By September 2005, the number of GPs had soared to 35,302 (one good thing this Government has done for the NHS) but single-handed practitioner numbers had fallen to 1,924. Even the number of two, three and four GP group practices are falling. The biggest rise is in practices where there are seven or more doctors – from 853 to 1,325 between 2003 and 2005. This is surely evidence that GPs want to practice together under a single banner. It obviously improves patient care and reduces overhead and administrative costs.

Health Minister Lord Darzi, who is carrying out a wholesale review of the health service for Gordon Brown, is expected to suggest that polyclinics are the way forward. His interim report, Our NHS Our Future, which was published last October, makes a great deal of sense.

No one can argue when he calls for “new resources to be invested to bring new GP practices to local communities where they are most needed”. No one can argue when he suggests “newly procured health centres in easily accessible locations should be offering all members of the local population a range of convenient services”. No one – except perhaps some GPs – can argue when he wants to introduce “new measures to develop great flexibility in GP opening hours”. Extending hours into the evenings or weekends”. These three “immediate steps” support his plans which would see 150 polyclinics established nationwide and nine in London by spring 2009. But what is very worrying are the words in between which are more than a hint of the continued and growing involvement of the private sector in the NHS.

New GP practices could be organised by “new private providers”, says Lord Darzi. Greater flexibility should be developed in GP opening hours “including the introduction of new providers”. This, added to the active encouragement of primary care trusts by the Government to use “alternative provider medical services”, can only mean yet more privatisation.

The provision of primary care by more private providers could radically alter the face of healthcare in Britain. It is likely to lead, in the longer term, to higher costs, reduced accountability and increased fragmentation – all things to which Lord Darzi, in his “vision” of a world-class NHS, is adamantly opposed.

Private providers are more likely to be answerable to their shareholders, work on short-term contracts and have less commitment to the long-term care of patients and the development of the practice. They are also more likely to be attracted to practices in more affluent areas where they can earn more money and see fewer disadvantaged patients with complex problems. This would be a serious risk to the ability of the NHS to reduce health inequalities, which is top of the Government’s agenda.

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs’ committee, is voicing very genuine concerns when he says: “What is actually going to happen here with these proposals is large, outside multinational private companies will be setting up in direct competition, because that is the way the Government is going about tendering for these new health centres. It is effectively going to be looking for the cheapest bidder.”

However, let us for once give the Government the benefit of the doubt on privatisation and the NHS. If the private sector were kept out of them, I believe polyclinics could revolutionise healthcare for the better. For the “healthy” patient who only uses the GP practice for a fast diagnosis of a minor condition, accessing prescriptions and getting referral to a specialist, they would be ideal.

The idea of seeing the same doctor doesn’t really matter and there would always be a GP available. I would do away with the need for separate walk-in centres (and the administrative costs to run them), as patients could walk into their polyclinic and see a specialist nurse at any time.

For patients with chronic and long-term conditions, it would still be possible to see the same doctor and ensure continuity of care and they could also see other specialists on site, such as a physiotherapist, nutritionist or diabetic nurse. It would surely be better than using supermarkets to host GP surgeries. From next month, GPs from three different practices will work from a consulting room at Sainsbury’s in Heaton Park, near Prestwich, Lancashire, in the evenings and on Saturdays.

The GPs involved will work at the store in addition to their regular hours at local surgeries in Heywood and Middleton. But do patients really want to combine their weekly shop with a doctor’s appointment? Wouldn’t it be far better if the GPs worked together in a polyclinic all the time so they could simply open their extra hours surgeries there?

Yet controversy surrounds polyclinics and it is not just because of the fears they will further encourage creeping privatisation of the NHS. According to a recent survey in The Times, four out of five GPs believe polyclinics would lead to worse healthcare – although almost half of patients disagreed.

Seventy-six per cent of the 500 GPs polled said that increasing the hours that GP surgeries are open will not improve access for patients and 64 per cent said longer opening hours would worsen the quality of healthcare. How can Lord Darzi’s vision of a patient-centred NHS ever become reality when GPs think like that?