The polyclinic row - who's right?

Polyclinics provide a range of services

The debate about polyclinics continues to rage.

To some, they are the answer to the challenges facing the NHS in the 21st century, providing a range of services under one roof.

The idea is that GPs will work alongside a variety of health professionals, including nurses, dentists, social workers and hospital doctors, offering patients a level of integrated care unheard of in the current system.

But others see them as a destructive force, threatening the GP system and depriving hospitals of resources. Who is right?

THE CASE FOR

Polyclinics, or GP-led health centres have become synonymous with one man - Lord Darzi.

The health minister, who is a practising surgeon, had already demonstrated his commitment to them by the time he was recruited into the government by Gordon Brown last summer.

In a review of health services in London, he said he wanted to see a network of polyclinics to replace ageing GP services.

Now in charge of a national NHS review, all the indications are that he is following a similar philosophy.

His interim report in the autumn called for 150 GP-led clinics to be set up across England.

The government says these clinics will be open 8am to 8pm seven days a week, and can be used by anyone - whether or not they are registered there.

Opponents say these are essentially polyclinics although ministers deny they are the same thing.

Hospitals have been getting clogged up especially in the cities, so it makes sense to try to relieve some of that pressure Professor Chris Ham, Birmingham University health policy expert

Lord Darzi believes they hold the key to creating an integrated and personalised NHS.

He wants to see a range of services traditionally carried out in hospitals, such as minor surgery, dermatology, diabetes care and diagnostic scans, done in these community centres.

Many agree such a move is long overdue.

Medical advancements mean that the NHS can do more and more specialised care but if that is to be achieved, hospitals need to be freed from the daily grind of dealing with minor ailments.

What is more, patients can often find themselves bounced between GPs and hospitals because of a lack of diagnostic testing facilities in the community.

The equipping of polyclinics with MRI scanners, blood testing facilities and x-rays should solve this.

Professor Chris Ham, a health policy expert at Birmingham University and former government adviser, says: "Hospitals have been getting clogged up especially in the cities, so it makes sense to try to relieve some of that pressure.

"I don't see a situation where we will have lots of polyclinics across the country. I see it as more of an issue in cities as is happening in London.

"I also believe they will help stimulate existing practices into improving access - and that is not bad thing."

THE CASE AGAINST

Criticism of the policy has come from all sides. The Tories say they will lead to the closure of GP practices, claiming one in five are under threat, and patients, as a result, will have to travel further for care.

Shadow health secretary Andrew Lansley says polyclinics will "undermine local GPs" and were "misguided and irresponsible".

The British Medical Association has also come out fighting. A campaign, 'Support your surgery', was launched last month with posters put up in GP practices across the country.

Much of the anger centres on what is perceived to be the government dictating from the centre.

Local health chiefs working for primary care trusts have been told to set the wheels in motion this summer - despite the fact that they are still carrying out their consultations about how services should look.

They talk about new ways of working, but that does not need new buildings Professor Martin Roland, of the National Primary Care Research and Development Centre

The BMA has also taken umbrage with the form of contract that is being used to set up the centres.

Health Secretary Alan Johnson has sought to quash the attacks, saying they were a "ludicrous misrepresentation of policy".

He has promised no GP practices will close - although the government is less forthcoming when asked if they can assure patients their local family doctors will not be relocated into these so-called super-surgeries.

Even the most independent bodies have concerns.

Professor Martin Roland, director of Manchester University's National Primary Care Research and Development Centre, says: "There is a lack of clarity about what the government is trying to do.

"They talk about new ways of working, but that does not need new buildings.

"Obviously, where the estate is old then polyclinics will be welcome, but I am not sure that is the case everywhere.

"The problem is that while the government says it is not dictating from the centre in PCT land it feels differently."

Professor Roland also said the centres have the potential to "disrupt" hospitals.

Under the current system, hospitals are paid per patient treated, but if polyclinics take the simple cases that may deprive trusts of valuable income, he said.