Polyclinics - supermarket medicine for the poor.

It is not easy at the moment to say anything positive about family doctors. Any suggestion that they may be providing a valuable service is nowadays met with a tirade of jealousy from nurses (see the comments here), particularly the oxymoronic “consultant nurses”, who cannot get through the day without asserting that they can do any job a doctor can do, and do it better. Then the right-wing Taxpayers’ Alliance wades in with one of their tabloid headline grabbing ad hominen attacks on public sector salaries.

This is a perfect starting point for the government to introduce the polyclinics.

They sound wonderful, don’t they? Open twelve hours a day, seven days a week, providing one stop, multi-disciplinary medical assessment, diagnosis and treatment.

Unlike many of my colleagues I feel neither worried nor threatened by these clinics. They will provide a service that is currently not well catered for in traditional general practice. Take a couple of young professionals living in their executive town house in Kenilworth and working in the centre of Coventry. Sebastian wants to “pop in” to the doctor during his lunch hour, on the way back from his exclusive gym, to get something for his hayfever. Samantha wants a similar lunchtime spot to get something for her yeast infection, and also to discuss whether she is lactose intolerant. Sebastian and Samantha are the fit worried well who hold dinner parties and contribute to the comments columns on internet sites such as this. They are the ones driving the focus group dominated perceived need for instant supermarket medicine.

And think a little more carefully about the concept of “one stop medicine”. A blood test? An X-Ray? A scan? A consultation with the onsite consultant surgeon? How is this going to work? The capital investment in medical kit, in machines that go “beep”, will be huge but will itself be dwarfed by the cost of staffing all the kit. The main problem with delay in getting MRI and CT scans in hospitals is not the cost of the machinery, it is the lack of trained staff to run the machines. There is a desperate shortage of radiographers and laboratory staff already. There is a shortage of consultant surgeons. If a consultant surgeon is going to be in the polyclinic 24/7 to support the GPs, he will not be in the hospital. Who will do his clinic and operating list whilst he is away? Where will the GPs come from? No experienced family doctor will give up his practice to work in a polyclinic. So the polyclinics will be staffed by less experienced salaried GPs working shifts constructed around child-care commitments.

There are not enough doctors to staff polyclinics. The government knows that. They intend to staff these clinics with the increasingly ubiquitous, and cheap, Health Care Professionals. Fradd the Destroyer, the GP poacher turned gamekeeper, has calculated that one doctor could be used to oversee half a dozen HCPs. Polyclinics are another step towards two-tier medicine. Do you think the air hostesses can fly the plane? Do you really think that the well heeled middle class are going to let their illnesses be treated by people with no formal medical training? Do you really thing that the well heeld middle class are going to let their children be taught by teaching “assistants” in sink comprehensives?

Meanwhile, GPs will soldier on with the patients who do not want to go to polyclinics. The seriously ill, the chronically ill, the mentally ill, the old, the very old, and the very young. This is a different group of people altogether. You will not find these patients in polyclinics.

The government has pledged that polyclinics are to be funded with “new” money. Money in addition to the current health care budget. If that is true, then I welcome them, for they will remove a small, but disproportionately irritating part of my workload. I suspect, however, it is not true. I suspect that as HCP run polyclinics are established, funding of traditional general practice will gradually be reduced. If that is what the people of this country want, then so be it. As long as you know what you are going to lose.

Comments

[Dr Fiona Kemp]

Well said Crippen!! Spot on.

When will politcians stop shuffling
deckchairs on the NHS Titanic and get real!

I only hope DC is genuine about a campaign to save family medicine and thereby save a cornerstone of the NHS; if he isn't and the party shafts us after the next election then God help us all.

[Michelle Tempest]

I'm not against competition, but I am against the dumbing down of the medical profession and subsequent patient service.

I am not against modernisation, but I am against taking money away from patients towards quangocrats and pen pushers.

With the barrage of negative press about GPs via the labour spin team. The understanding of their job within the NHS is getting lost in the process. As a hospital doctor I rely on good GPs daily, to know their patients and provide vital information about both long term health and subtle changes in patient presentation. Good GPs save the NHS money.

[Letters From A Tory]

The staffing problems are an entirely separate issue from the possible benefits of polyclinics.

It is utterly ridiculous that services such as x-rays and blood tests should be situated miles and miles away from the doctor who said you needed to get one. Basic tests and scans should be available in medical practices - let a nurse or other professional get the scan and let the doctor diagnose the condition. In fact, I've experienced precisely this system through private medical insurance in the UK and it's absolutely brilliant.

[Belle Elmore]

There is already a multi level structure to the services we receive from GPs throughout England. It is becoming ever more evident that if you are lucky enough to be the patient of a conscientious, dilligent, compassionate and caring Doctor in a G.P. practice of like minded partners then you really have hit the mother lode!

If however, you are one of the ever increasing number of ordinary, hard working people whose G.P.s work within the ever tightning grip of Government targets and restrictions. Doctors who are unable ( and un willing in some cases ) to extend opening hours and provide those extra services within the practice that make all the difference to patients. Then as one of these growing numbers the chances are that you will grudgingly trudge along to the Polyclincs and take what is on offer.

I have had the good fortune in my life to have been the patient of several good G.P.s, prior to the changes in 2004, but currently find myself in a "Super Surgery" which houses 5 G.P. practices. The level of service provision is quite different even between these 5 practices so goodness know what it must be like when you move from Town to Town.

I remember ( maybe it is with rose coloured spectacles ) the care and dedication with which I was "Looked After" by my G.P. and lament the passing of the service levels that, in the main, were there for all.

I don't know where the NHS G.P. service is going, but one thing is for sure, that this current generation will never know the standard of care and level of service that once made up the bulk of G.P. healthcare here in England.

[moreen]

Nice to think these are just about young executives, but the truth is they will be HUGELY popular with young working and middle class families.

If both parents work and they just want to take their son in for a fever or a rash having to take time off work is crazy and thats one of the things clogging A&Es.

These might be less good for the elderly, but lets not kid ourselves that families will love them

[Teck Khong]

What we need to do is to understand the thrust towards polyclinics, and then plot appropriate counter-measures to be at least by the helm, for by the time the General Election comes around, any damage that could be done due to inappropriate decision for their existence in any locality in the first place would be minimised.

So, is anyone willing to join me in these APMS bids? It's better to work hard for the fruits than to accept the droppings!

[Rachel Joyce]

Polyclinics are a poorly thought through confusion about "patient access" and "transferring patients to the community" - DOH buzz-words.
What we get is de-personalised services, dumbed down care, and overall the costs will be higher.
Whenever care is dumbed down, there are more costs up stream in picking up the pieces. And if you can't see a local doctor who knows you well, you may as well go to the local A&E. Unnecessary admissions, deaths and other poor clinical outcomes will result.
I don't know a doctor who is in favour - in reality. Managers are often hood-winked by the department of health, but the best ones know this is substandard care.

[Jeffrey Horner]

"Whenever care is dumbed down, there are more costs up stream in picking up the pieces."

Hear here. It's something that is common to all established systems with bits thoughtlessly tacked on to them.

And polyclinics sound most certainly thoughtless: abritrarily implemented adjuncts to the surgery system which has evolved over decades. Let's not even mention the lack of comprehensive budgeting, risk assessment or consultation (by the health professionals that are actually professionals).

[Matt Munro]

I agree with crippen, poly clinics sound like the wet dream of the worried well who self diagnose, via the internet, the media or by being told which conditons are currently trendy at dinner parties and then go to the doctor to have their self diagnosis confirmed. I do think GPS have brough this upon themselves with their ridiculous 1950s opening hours (my GP still closes for 2 hours for "lunch") and a refusal to see patients out of hours have mede them superflous in the eyes of many patients, and obviously the government. And don't start me on trying to get a "pre-bookable" (lol) appointment