Is Cuba or Germany's way best?

By Caroline Parkinson
Health reporter, BBC News

Polyclinics provide a range of services

Cuba has them. So too does Germany, Northern Ireland and the US. They were popular in the Soviet era.

And now so-called polyclinics - which bring together a range of health services under one roof - are set to come to England.

The plan has been criticised by the Kings Fund think-tank, which warns the centres may not improve services for patients.

But the government says offering GP and specialist care, as well as access to simple tests, under the same roof will make it easier for people to get care they would normally have to go to hospital for. It wants to see 150 new polyclinics across England.

Analysts from the Kings Fund say it is important to understand why other countries have them, and how their needs differed from ours.

In addition, there are plenty of lessons about what not to do.

'A word of caution'

For example, Germany, which is often cited as a model for England to copy, set up its polyclinics because it had a tradition of isolated specialists offering outpatient care from individual offices, and so it made sense to bring them together under one roof.

The biggest, the Polikum at Freidnau in Berlin, has 50 doctors covering 19 specialties, including plastic surgery.

Primary and secondary care are working far too much in isolation and need to work in a more integrated fashion Candace Imison, Kings Fund

In contrast, specialists in the UK are grouped together in hospitals, and the Kings Fund warns forming polyclinics could mean the break-up of those networks.

Germany also has more specialist doctors than the UK, so there is less risk of other parts of the health system suffering because of the clinics.

Candace Imison, the lead author of the Kings Fund report, said it was especially important that people in local primary care trusts understood it wasn't a case of moving a model from Berlin or New York and replicating it in London or Manchester.

"The key message for us is a word of caution about taking international models and using them here.

"There are real opportunities to improve diagnostics and care for people with long-term conditions, and bringing services together to provide a one-stop-shop.

"But if you're going to do that, it does have implications for how you configure the workforce."

Opportunities

And she warned that simply putting people into the same building did not mean they communicated any better than when they were apart - as Cuba found when it introduced polyclinics back in the early 1960s.

Another concern over polyclinics - which has been raised by the British Medical Association - is that patients won't be able to see the same GP on each visit, something that was seen as a significant disadvantage of the polyclinic system used in former Soviet countries.

Finland, which also had similar concerns over its clinics, brought in a list system - like that already seen in UK GP practices, so each patient had a named doctor they could ask to see.

But Ms Imison said there were good reasons for England to develop an appropriate polyclinic model.

"Primary and secondary care are working far too much in isolation and need to work in a more integrated fashion."

She added: "There absolutely are opportunities that need to be seized, but I don't think that just by creating a building and putting people within it means those opportunities will be seized.

"That requires thought about what you want out of it, and investment."

A Department of Health spokesperson said: "International models provide interesting comparisons, but we agree that it makes no sense simply to transplant models of healthcare from Germany to England, or for that matter from London to any other part of the country.

"Services need to be tailored to the needs and circumstances of individual communities - and they need to take into account workforce developments."