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Polyclinics and GP-led health centres: just what the doctor ordered?

The recent proposal to introduce GP-led health centres and polyclinics has become a hot topic. But why have they been given such a cold shoulder by some?

Marilyn Eveleigh
Consultant Editor

One of Lord Darzi's proposals for improved healthcare is not having an easy time in the media and professional press. It is the one about polyclinics - also known as "GP-led health centres" if outside London. There is a suggestion that the latter name has been introduced to soften the apparent threat to the continuity of care in our personalised general practice that is the envy of the world.

But do the public really want this or is it a romantic ideal of yesteryear? Has general practice met the real needs of patients? Are all surgeries providing an equal, accessible and high-quality service? Lord Darzi thinks not.

It is clear that the concept of putting the GP at the centre of polyclinics and GP-led health centres is designed to please both the medical profession and many patients. Opponents, mainly GPs, the BMA and some patient groups, are concerned that patients will lose continuity - they may see "a" GP, not necessarily "their" or the same GP.

Yet, the traditional expectation of GP continuity has already been eroded. When asked, my young adult offspring do not care if they see a doctor or nurse; they don't mind if it's a different one each time so long as they do not have to wait too long and they get an immediate result. As with many of their generation, they have never known a personal bank manager, do most of their purchasing, organising contracts and bookings over the internet, and receive results and reminders on their mobiles.
Their 80-year-old grandmother with two chronic diseases, however, wants continuity from a familiar doctor (especially for those "embarrassing" complaints), is grateful to be seen at any appointment, and has the time to go to the surgery in working hours.

Is my mother asking too much of an overstretched NHS? Does GP continuity really matter? Is the world dramatically worse for the existence of NHS Direct and the GP out-of-hours services that underpin primary healthcare today - where care is directed by a telephone voice and it is rare for patients to have the same GP on a home visit?

A recent published survey undertaken by the National Primary Care Research and Development Centre at Manchester University identified a reduction of GP contact with their patients, but a rise of practice nurse contact, and therefore continuity. The nurse involvement in the 2004 GMS Contract and QOF (Quality Outcomes Framework) management of chronic diseases has been the catalyst. This changed patient expectations and continues to give nursing a powerful and representative voice for patients in primary care.

At the present time, every English PCT is preparing to invite interested parties to run a GP-led health centre. Yes, it is a GP-led health centre with a registered patient list - but practice nurses will be vital to the service. Just like every GP practice in the country.

The range of services and accessibility is intended to reduce healthcare inequalities and is an addition to existing general practices, offering more patient choice and flexibility to satisfy the expectations of a 21st century health service. This means they are open between 8am and 8pm every day of the year in a location determined by the PCT. But it will be impossible to offer continuity of staff.
In addition, GP-led centres will provide a walk-in facility and are likely to provide mental health and substance abuse services, health promotion, sexual health and screening - continuity not guaranteed nor expected by the public in a walk-in centre.
The new providers are likely to be independent private companies and will be joining the world of GP and primary care as alternative providers. For continuity in practice nursing care there is a need for PCT nurse commissioners and leaders to ensure the core competencies of the general practice nurse are in place (see Resource below).
GP-led health centres or polyclinics?
Do you know what is happening in your PCT? Watch out for new companies and existing GP practices making bids to provide this service. Watch out for the adverts for nurses to staff these centres. Watch out - a new world is upon us - one with reduced GP continuity, but possibly an acceptable alternative?


Working in Partnership Programme