Major research into developing new 'polyclinics'
By Jayne Warren - 09/06/2008
There has been considerable confusion in recent months over the proposed 'polyclinics.' But what are they, what do we know about them - and are they really as bad as many in the medical profession would have us believe? To find out, the King's Fund has made a major analysis of the opportunities and risks of developing polyclinics, based on research models already developed both in the UK and abroad.
Starting with the basics, the term 'polyclinic' has been used to describe a variety of different approaches from very large super surgeries - which involve closing current GP practices and moving their services into the new unit - to the so-called hub-and-spoke model where most existing practices continue but share access to a set of new services in one facility. The King’s Fund research concentrates on the ‘big building’ model, which could bring together family doctors and specialists alongside other services - such as diagnostic testing, minor surgery, blood tests and X-rays - and examines the impact they would have on patient care.
The King's Fund basically It welcomes the government’s 'ambition' to develop more integrated models of care in polyclinics, but warns that if the way it is carried out is poor, polyclinics could end up creating significant risks for patient care. Its key findings are:
• Quality of care.
Polyclinics could help deliver integrated care - particularly for people with long term conditions. However, the evidence suggests that bringing together multiple services does not always result in better working practices between professionals. Also, there is no evidence that larger GP practices deliver higher quality care than smaller ones although they may be able to offer a wider range of services.
• Accessibility of services
For some patients access to diagnostic and other services would improve - depending on how large and centralised the polyclinic would be. However, a major centralisation of GP services into polyclinics would make it more difficult for patients to visit their GP, especially for those living in rural areas. This would be a major sacrifice given that primary care visits account for 90% of all patient contact with the NHS, and that patients are less prepared to travel further to see their family doctor than they are to use outpatient and hospital services.
• Costs
While there is a strong case for providing more support within the community to prevent hospital admission, there is substantial evidence that shifting some specialist services out of hospital can prove more expensive. In these cases services can be less efficient and often fail to reduce demand on hospitals, so that the costs of new services supplement rather than substitute for hospital costs.
• Workforce
Successful examples of integrated care delivered in polyclinics abroad may not transfer easily to the NHS in England - mainly due to significant differences in the medical workforce. Here, unlike Europe, most specialists are based in hospitals, and not in the community, so some of the polyclinic models of care would present significant workforce challenges.
King’s Fund Chief Executive Niall Dickson added: " The UK's model of health care has changed little since the NHS began 60 years ago. Advances in technology, changes in the composition and working hours of staff, as well as patient expectations and evidence about what is effective, all signal the need to review how and where care is delivered. The polyclinic approach could be one way to redesign services around the needs of patients, but we must not underestimate the amount of time, energy, and resources that would be needed to make it work.
"We welcome the government’s assurance that there will be no national blueprint, but that needs to be spelt out in unequivocal terms. Above all we appeal to ministers to make it abundantly clear that there will be no compulsion on local NHS organisations to erect buildings or follow this or any other centrally dictated model of care. Polyclinics may be the right answer in some areas, they will not be right for others. That should be a matter to be decided locally on a case-by-case basis using the best clinical evidence available together with a full assessment of the costs and the impact on patient access."
The report also recommended that PCTs should consider alternative polyclinic models which do not require mass centralisation of family doctor services, such as the hub-and-spoke or federated model where most GPs remain in their premises and draw on resources in a central polyclinic or resource centre.
To see the full report entitled: "Under One Roof: Will polyclinics deliver integrated care?" by Candace Imison, Chris Naylor and Jo Maybin, follow the link below.