Polyclinics are not communities

In the UK at the moment the Government (Civil Service) is moving to roll out a plan to remove our local GP surgeries - GP stands for General practitioner

For what is described as Polyclinics. We blogged abut it previously in Who does the UK government work for? and we referenced a Guardian article A policy for junk healthcare

The topic was brought to mind by a recent report by the Kings Fund

The evidence presented in this report suggests that although there are opportunities to improve the quality of care and address some long standing problems in the English health care system, there are also risks, particularly around the transition to this new model. The report describes contextual differences that may place limits on the transferability of apparently successful polyclinic models from other countries. If polyclinics are to succeed in promoting integrated health care, policy-makers and commissioners need to recognise these differences and actively manage the associated risks.

These polyclinic have been described as community based - I am not so sure. The reason is that GP surgeries sit within specific communities, my village for example, forming part of the fabric of social life. I wonder whether the Government is designing a program which though speaks of patient care - does not embrace how communities actually function.

The report looks at...

1). Quality
2). Access
3). Cost

And key conclusions

1). For some health communities the development of polyclinic-type facilities could offer real opportunities to establish more integrated, patient-focused care, but only if considerable investment of time, effort and resources is put into their planning and development.

2). The primary focus should be on developing new pathways, technologies and ways of working rather than new buildings. Co-location alone is not sufficient to generate co-working between different teams and professionals. Investment in change management and strong clinical and managerial leadership will be required.

3). Commissioners will need to consider new waysofcommissioning primary and community services. Services will need to be contracted on the basis of clear quality standards in order to ensure that the benefits of the new models of care are realised.

4). New approaches to assure the quality of out-of-hospital care and support professional development will be needed. There needs to be a much stronger framework for inspection and accreditation.

5). Amajor centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas. A hub-and-spoke model, where the polyclinic acts as a central resource base in a co-ordinated network of practices, islikelyto be more appropriate to achieve the desired development of primarycare services.

6). To maximise accessibility, choice of location is critical– polyclinics should ideally be developed in natural transport hubs. Where this is not possible, finding ways to integrate servicesmore effectively within existing facilitiesor on existing sites would be preferable to developing a polyclinicin a lessaccessible location. Improved access by car cannotbe assumed given restrictionson car parking imposed by local authorities
on anynew developments.

7). Substantial cost savings are unlikelyto be made. Costs for some services may increase, unless hospitals can significantly reduce their unit costs and commissioners can manage demand. Scheduling of services will need to be carefully planned in order to ensure effective utilisation of building space and staff time. Developing polyclinics is likely to require transitional funding.

8). There are significant workforce implications that need to be thought through and addressed.

9). New developments should not simply be a response to a new national target, but a well thought-out element of a broader strategic plan that responds to local needs.

10). Any polyclinics developed should be subject to rigorous evaluation to help fill the current gaps in the evidence base.

the American health care system, in which the percentage of outpatient activity taking place within the
community has grown from 10per cent to 50per cent. Currently, only 10 per cent of outpatient appointments in England are delivered in a community setting.

Yet my point is, what in the above terms defines and describes community? We have lost village shops, post offices, and now GP surgeries? I am not of the blue tinted persuasion - however my research tells me that the glue that holds people together is a very precious commodity. And in a post modern world that glue becomes evermore vital.

This to my mind presents a dangerous precedent where life is no longer local but destroyed altogether.

Norman Lamb the Liberal Democrat health spokesman believes the report was a

damning critique of the Government's short-sighted obsession with polyclinics

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