This whole question of polyclinics and what the Darzi report may or may not have meant by them has vexed this campaign from the beginning. Finsbury Health Centre was called a ‘polyclinic’ when it was built in 1938, and by all accounts it makes sense for some primary care services to be grouped together with GP practices outside large hospitals. This model has certainly been popular in the case of Finsbury Health Centre, but it was never meant to replace the concentration of services and specialities provided by hospitals.
The ‘vision’ of polyclinics in Darzi’s report, however, sounds more like the dreaded Health Management Organisations in the US, which exist to ration people’s access to healthcare and increase profits for insurance companies. It gives private companies neat packages of profitable long-term care services outside hospitals, twinned with industrial-scale concentrations of GPs. In the US experience, these huge concentrations of GPs (20-30 on one site) in practice make continuity of care difficult, since patients often have little or no choice about who they see.
Added to the way hospitals in the UK are financed these days under the ‘internal market’, this has set up Darzi’s idea of polyclinics in direct competition with hospitals, which will suffer huge cuts in needed beds for acute care if they don’t have the income from primary care services to outpatients, or close altogether. This is the problem with the current proposals facing Whittington Hospital and others across London. In North London, the mostly unbuilt polyclinics are somehow to absorb 50,000 current A&E patients within the next three to five years, as well as providing services for long-term primary care. This circle-squaring has been strongly criticised in both the BMA’s report London on the Brink and the Primary Care Foundation‘s report ‘Primary Care and Emergency Departments’.
Rational discussion of all this, however, is severely restricted by the unaccountable Primary Care and Hospital Trusts, and their secretive nature. NHS London has yet to release either their so-called ‘clinical model’ or the McKinsey management consultants’ report upon which these proposals are based, and is trying to circumvent even the limited powers of local scrutiny committees by reorganising the trusts into secretive ‘partnerships’. This secrecy must be challenged at every opportunity.
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