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Last Updated: Thursday, 4 October 2007, 12:50 GMT 13:50 UK
Polyclinics - the next big thing?
By Nick Triggle
Health reporter, BBC News

Polyclinics are being touted as the future of the NHS with ministers wanting to see 150 built across England.

But how do these multi-purpose clinics, often dubbed super GP surgeries, work? And what are the consequences for hospitals?

Bernie Gilbertson
Mr Gilbertson has been treated for a wound that would not heal

Bernie Gilbertson is exactly the sort of patient ministers have in mind when they talk about moving care out of hospitals and into the community.

The 51-year-old granddad has diabetes and has been troubled by a wound that will not heal for the past five months.

At its worst it was the size of a 10p piece, but thanks to the treatment he has received at the Heart of Hounslow Centre for Health in west London he is now on the mend.

The 18m four-storey building is part of a new breed of super-health centres.

Commonly called polyclinics, such centres house community services such as GPs alongside care more associated with hospitals.

The care we provide helps those with chronic conditions deteriorating and being admitted to hospital
Rainer Golombek, rehab manager

Traditionally, someone like Mr Gilbertson would have ended up in hospital, but thanks to the Heart of Hounslow's specialist tissue viability service he has been kept in the community.

He said: "My care has been great. Before I came here I had been back and forth seeing doctors and it was getting worse.

"I even went to A&E at one point and was resigned to being admitted into hospital, but then I was referred here.

"Now after just three weeks the sore is getting much better."

Mr Gilbertson was given expert treatment, including the use of bacteria-fighting silver bandages, by a team of consultant nurses.

Buzz words

Julie Stevens, who has been helping treat Mr Gilbertson and divides her time between the community and hospital care, said: "Having a centre like this really benefits patients.

"It gives them fast access to an expert service as we don't have waiting lists unlike hospitals and we accept self-referrals.

"And if we can't treat the condition, we have GPs on hand to help with tests and write referrals and then once in the hospital system we can fast-track patients through. It is a much more seamless and integrated service."

HEART OF HOUNSLOW SERVICES
Heart of Hounslow Centre for Health
Outpatient care - Podiatry, tissue viability, diabetes screening and leg ulcer clinics - all traditionally the domain of hospitals
GPs - Three practices, employing 18 family doctors, housed at the centre with fourth practice due to join them
Specialist dental care - Highly-trained dentists on hand to treat people with behavioural problems, phobias and to carry out complex root canal surgery
Independent living service - Multi-disciplinary unit housing district nurses, community matrons, physios and rehab specialists
Other - Mental health and sexual health clinics on site along with a children's service offering speech therapy

And the integration does not stop there for the Hounslow Primary Care Trust centre, which houses over 400 staff.

As well as 18 GPs, there is an independent living service, which includes community matrons, district nurses, physios and neuro-rehabilitation teams.

The service, which takes referrals by the family doctors at the centre, treats a range of patients from those with diabetes and heart conditions to people recovering from strokes and elderly people who have suffered falls.

Rehab manager Rainer Golombek said: "I suppose there are a few basic strands to our work. The care we provide helps those with chronic conditions deteriorating and being admitted to hospital.

"But we also provide a valuable service in helping people once they are discharged from hospital.

"In the past, stroke patients for example would have faced long stays in hospital but with the proper support they can return to their everyday lives and evidence shows this is best for their recovery."

Hounslow PCT is so pleased with the success of the Heart of Hounslow, which opened in February and was financed in partnership with the private sector, that it is aiming to build more in the long term.

But while such centres are set to play a key role in the future of the NHS - as spelt out in Health Minister Sir Ara Darzi's review of the NHS - they do present a threat to hospitals.

Competition

Under the government's market-based reforms, hospitals are now paid per patient treated.

It means the patients seen at polyclinics are effectively the 'bread and butter' of hospitals.

Heart of Hounslow Centre for Health
The centre houses GPs and specialist services

It is, therefore, not surprising to learn that few of the consultants from the local West Middlesex Hospital have agreed to run clinics at the sites - as needs to happen if the goal of moving care into the community is to be fully realised.

The trust maintains it working with the PCT on this and described the Heart of Hounslow as a "fantastic facility".

But the question still remains - as it does for the whole polyclinic plan - are hospitals prepared to hand-over their patients?



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