Dr Michelle Tempest: Polyclinics could spell the end for health localism

Dr Michelle Tempest, a psychiatrist, blogger, and editor of the The Future of the NHS, fears Brown's Stalinist approach to the healthcare delivery.

‘The invisible hand’ metaphor was first coined by the economist Adam Smith, to demonstrate how in a free market, an individual pursuing his own self-interest, tends to also promote the good of his community, through a principle he called ‘the invisible hand’.  The clunking fist metaphor is an apt description for Gordon Brown, sapping up any individual instinct to do better, and replacing it with a state, ‘top-down’ approach.  This Labour ethos leaves a ‘tight bureaucratic straightjacket’ in its wake, and pervades everything Gordon Brown has put his hand to.  Schools and teachers lack the power to keep order, with legal bureaucracy preventing the exclusion of disruptive pupils, who consequently distract the rest of the class.  Even planning powers have succumbed to Labour micro-management.  Responsibility set to be transferred back more centrally, to unelected ‘Regional Development Agencies.’  One can almost see that clunking fist smashing down into the very heart of a local community, dispersing community spirit.   

And does the clunking fist ever learn?  Even after the unforgettable data scandal where 25 million private records went missing, following a systemic failure at HM Revenue and Customs (a body set up by Gordon Brown to ensure greater control over Britain’s tax system) the expensive ID card scheme still has the green light.  It seems to highlight a stark problem in Labour ideology, where focus is solely on data, rather than on people, or trying to solve problems.  As Nick Herbert MP summarised, “A Government which tries to control everything but cannot run anything.”

So, what’s next?  Is the clunking fist set to create a new medical condition -  ‘Bureaucratic Paralysis’?  The past ten years have overseen vast sums of money poured into the NHS, wasted on top-heavy, bureaucratic systems and squandered on NHS white elephants, such as electronic records.  Seemingly money merrily spent on numbers, targets and quotas; anywhere but much-needed patient care.   

The next Labour plan is to centralise GP services by enforcing polyclinics. In some constituencies they may be welcome, but in other areas polyclinics are neither wanted nor needed. Andrew Lansley MP has described how polyclinics “would completely destroy the relationship between local people and their family doctor.”  The one-size-fits-all mentality could prove to be the nail in the coffin for ‘health localism’, where local communities could decide how they want their health needs met.  Instead, polyclinics are to be uniformly built across the country, ignoring a recent survey, which showed that nine out of ten patients favoured current practice over the polyclinic model. Dr Steward Kay (GP) stated:

"the smaller and more local traditional general practice, which has evolved with its community, can more easily serve the needs of old, young, and vulnerable people. Continuity of care and personal care are more difficult to provide in large units.... I truly believe we need to keep GP practices local and use the bottom-up approach."

Polyclinics have so far been allocated £250 million from the Department of Health budget, although this sum is barely expected to cover the cost of the new buildings.  Government plans for new supersize polyclinics and health centres will leave a £1.4 billion black hole in public finances - unless other GP surgeries close. So, will Labour repeat its habit of throwing NHS money away from patients and into a bottomless pit?  Preferring to spend taxpayer’s money on polyclinics, proudly paraded by Labour spin-doctors, but with little evidence of patient benefit?  As Tobias Ellwood MP (who requested the petition against polyclinics) stated, “polyclinics resemble the Emperor’s new clothes; naked political ambition but lack material substance.”   

I believe we need to support areas that choose to oppose the polyclinic model, encourage local primary care initiatives, free current services from red tape, and say no to central control from a dictatorial Prime Minister.  Otherwise, polyclinics may prove to be the clunking fist knocking out the invisible hand.

Comments

[Graham Doll]

Well said, I quite agree. Another New Labour health service experiment to add to the list of failures, including NHS Direct, centralised records, ISTCs, PFI etc etc

[Simon Wentworth]

You will note that Johnson and Bradshaw are now calling polyclinics 'GP-led health centres' (one doctor for 5000 patients, the nurse will see you now) and claiming that the polyclinic model is not being imposed - this is in direct contradiction to what PCTs have been instructed to do. The lie needs to be exposed.

[Geoff]

2 fatal weaknesses with this article

(1) The health centres are additional to existing GP practices. No GP need move. In fact you can see them as well as staaying registered at your local GP down the road

(2) Andrew Lansley cant claim that they “would completely destroy the relationship between local people and their family doctor.” But then say they work in some areas, such as his constiuency - He in fact openened the largest polyclinic in the country last year!!!

Alot of foaming at the mouth - very little sense on this important health issue im afraid

[Peter]

New Labour is totally disingenuous on this issue - the plan is ultimately to divert funding to polyclinics, which will attract younger, more mobile patients, leaving traditional practices with a rump of high-demand elderly patients and reduced resources to serve them. Result - closures. One might call the real agenda an open secret. Look at this, received in my in-box yesterday:

'The Expert Patients Programme Community Interest Company (EPP CIC) welcomes the proposal made by the Department of Health to replace traditional GP surgeries with new polyclinics, which will incorporate a variety of services all under one roof.'

Note that the EPP CIC is a private company who might stand to gain from the prvatisation of general practice which is currently underway.

[Michelle Tempest]

Geoff you highlight some good points.

1) In areas that don’t need additional GP surgeries, why waste money? In one local area they may struggle to find the budget to clean hospital wards whilst money is being poured into new polyclinic buildings.

2) For further comments about polyclinics in the Cambridgeshire area see URL below. Mr Lansley has said he’s in favour of GPs working together if it’s in the best interests of patients. He said: "If the Government gets carried away with one-size-fits-all policies it will not work."

Health localism should be about what fits a local area and their health needs, not a one-size-fits all approach. GP practices have evolved with their local community and I believe this should be encouraged not stifled.

(http://www.cambridge-news.co.uk/cn_news_cambridge/displayarticle.asp?id=252620)

[Steve Bell]

I think in all this we are forgetting a strange phenomena, which is the people of the United Kingdom are looking to us the Conservatives to not only save the NHS, by the campaigns we have run up and down the Country, but to stand by our word and . provide Local medical care for local people at local level.
Who would have thought this 11 years ago, that the Nation would be looking to us!

[Anonymous GP]

Congratulations on your article Michelle. You have eloquently drawn attention to the next 'Brown' disaster on the horizon. The introduction of polyclinics is yet another example of a 'top down' health policy from this top heavy government. Not only are polyclnics not needed in the great majority of the country, they are also not what general practice is about. The close relationship between a patient population and the practice which serves it, leads to better healthcare delivery and, as a consequence, a healthier community.
In response to Geoff (1208):
1) Yes the clinics will be in addition to established practices, however, as I understand it, each time a patient attends a polyclinic the cost of the consultation will be levied upon the practice at which he/she is registered, i.e. more bureaucracy. Furthermore, why is it a good thing to 'double up' on the provision of primary care?
2)There are areas of the country, primarily urban, where new health clinics are required to replace a number of singlehanded practices, many of which are ceasing to exist with the retirement of GPs. What do you suggest as a replacement for these, bearing in mind we are now post-Shipman?
It strikes me that you should try understanding the issues before criticising what I feel was a rather good article.

[Click here]

Good letter in Telegraph last week from one of my GPs on this very issue - click on my name below.

[stephen hoffman]

there is nothing wrong with polyclinics -they provide a better service than local gps do eg out of hours , they provide more choice and reward the most efficient gps at the expense of the most inefficient . for too long gps have had no competition and have got cushy pay deals at the expense of poor service for patients - polyclinics provide better care for patients what's wrong with that. It's not like gp surgeries are providing a good service for all .

Thatcher wouldn't have supported this approach of favouring a crap service at the expense of a better service.

[stephen hoffman]

incidentally i know a way we can save the NHS - cut down to size the state monolith and favour a social insurance style system - like they have on switzerland -that would be best for the uk -provide more choice and competition -the poorest are subsidised -and you can change the healtcare package each year - and the government has to ensure the providers be they public , private or charity meet a certain requirement. at the moment and for the past 50 years - the NHS is a state monolithic stalinist run service which relies on targets - it is way to big and overstretched. conservatives should not be following the tax and spend policy on the NHS that we are doing at the moment - we need to get some balls ,and create a social insurance style system - look 19 out of 29 in europe for healthcare-doesn't that tell people system.

[stephen hoffman]

*doesn't that tell people something

[Michelle Tempest]

Thanks to all who commented on this article.
Thanks also to Stephen Hoffman. As for Margaret Thatcher, she linked her economic reform drive to Adam Smith, which I believe is under threat from Gordon Brown. This article is about driving to improve the service bottom-up, reducing red tape and encouraging innovation.

[duncan Macwhirter]

This is a clear and concise summation of the fading persona of the NHS healthcare system. I have had rather too much exposure to the NHS,through circumstance. The personnel are fabulous;their bureaucratic burden however hobbles them, and smothers all the good they do.
This government is trying the same top down control over my profession in the veterinary field. This is likewise unravelling the veterinary profession and stifling any free thinking individual.