Polyclinics not the answer to improving care in London

Although there is a case for changing how some NHS services are provided in London, Government proposals do not build on the best aspects of the NHS, could result in damaging fragmentation and may not produce the predicted cost savings, or improvements in patient care, that the Government envisages, the BMA warns today (27/9/07) in its response to Lord Ara Darzi’s review of healthcare in London.

The setting up of polyclinics, a key component of Lord Darzi’s plans for London, would require considerable “up front” investment in new buildings, equipment and staff, and it is difficult to see how they would be cost-effective, the BMA’s response says. There are already community hospitals providing intermediate care services, GPs with special interests who are able to treat more patients in their surgeries, and many consultant-led community health services based in premises outside of hospital.

Dr Hamish Meldrum, Chairman of BMA Council says: “Despite the Government wishing to provide more care closer to home, it is likely that for most people in London, the polyclinic would actually be further away than their existing, local GP surgery. It would be much better to invest in existing GP services, and where necessary district general hospitals, rather than imposing costly, unproven polyclinics. The suggestion that private companies could run polyclinics would, in reality, destroy the UK model of general practice and threaten many district general hospitals. Both are respected throughout the world and are highly valued and trusted by patients.”

The BMA’s response does recognise that patient care can be enhanced by moving some services away from hospital into the community and by centralising some aspects requiring more complex care. However, it states that these changes must be based on good evidence and decisions made in partnership with clinicians in both primary and secondary care, and in consultation with the public, to ensure patients are seen in the appropriate locations by appropriately skilled and qualified clinicians.

Dr Meldrum adds: “There is evidence that the centralisation of some services would benefit certain patients, for example trauma patients with significant injuries. However for other critically-ill patients, such as those with a severe asthma attack, anaphylactic shock or choking, there may be a detriment in having to travel significantly further for urgent care.

“If the Government is serious about engaging with clinicians, it must start listening to the views of London doctors and patients who have expressed many fears about how Lord Darzi’s proposals would adversely affect patient care and potentially cost lives.”

Education, training and research must be protected and enhanced when considering how NHS services are provided. Proposals to establish Academic Health Science Centres are supported, the BMA’s response says.