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.
