The British Medical Association has objected to Health Minister Professor Sir Ara Darzi’s suggestion of setting up polyclinics in London, on grounds that they would not be cost-effective.

The idea of polyclinics – also commonly referred to as GP supersurgeries - in London was put forward by Sir Ara in his report on the capital’s National Health Service in July, and he envisages that they would offer a much wider range of services to patients, thereby taking some of the heat off hospitals and pushing more care into the heart of the community.

According to Prof Darzi, a network of polyclinics throughout the capital could provide up to 50% outpatient treatments currently carried out in hospitals by 2017, and help towards saving £1.5 billion a year, but some critics fear that such a move will lead to more confusion and fragmentation of the service.

The BMA argues that setting up of polyclinics would need a considerable “up front” investment in new buildings, equipment and staff, and says it is difficult to see how they would be cost-effective. There are already community hospitals providing intermediate care services, GPs with special interests who are able to treat more patients in their surgeries, and many consultant-led community health services based in premises outside of hospital, the BMA explained.

“Despite the government wishing to provide more care closer to home, it is likely that for most people in London, the polyclinic would actually be further away than their existing, local GP surgery,” commented Dr Hamish Meldrum, chairman of BMA Council. “It would be much better to invest in existing GP services, and where necessary district general hospitals, rather than imposing costly, unproven polyclinics,” he argues.

Moreover, the suggested involvement of private companies in running these polyclinics “would, in reality, destroy the UK model of general practice and threaten many district general hospitals,” Meldrum claims.

Evidence-based decisions

Although the Association concedes that driving some services away from hospitals and into the community and centralising some aspects of complex care could well boost patient care, it stresses that any changes must be evidence-based and made in partnership with primary and secondary care clinicians as well as after consultation with the general public.

“There is evidence that the centralisation of some services would benefit certain patients, for example trauma patients with significant injuries,” Meldrum notes. But he warns that, for other patients who are critically ill, such as those with severe asthma attack or anaphylactic shock, “there may be a detriment in having to travel significantly further for urgent care.”

Furthermore, he called on the government to “start listening to the views of London doctors and patients who have expressed many fears about how Lord Darzi’s proposals would adversely affect patient care and potentially cost lives.”