Professor Lord Ara Darzi’s Next Stage Review of the National Health Service in England, which is due to be published on Monday June 30, will put primary care at the forefront of health care provision and emphasise achieving greater productivity at both the hospital and primary care level, a leading NHS spokesman has forecast.

Quality of care and outcomes will also be a focus, although this will be “affordable” quality, and the Review will include some recommendations relating to personal care, Michael Sobanja, chief executive of the NHS Alliance, told a meeting in London this week. Individuals’ ability to make certain health care decisions will be emphasised, he suggested.

The Review will talk about health inequalities, not only in terms of outcomes but also distribution of services and injecting more services into areas where the need is greatest, he told delegates at pharmaceutical industry solutions provider Cegedim Dendrite’s annual customer conference. However, the term “polyclinic” will not appear in the Review, Mr Sobanja forecast.

Nevertheless, recently-published submissions from concerned groups to Lord Darzi and his team are continuing to warn that, while polyclinics could bring benefits to patients through more integrated care, poor implementation of this model also risks creating major problems in terms of quality and accessibility of care.
Health policy think tank the King’s Fund suggested this month that bringing together multiple services does not always result in better working practices between professionals, and there is no evidence that larger general practices deliver higher-quality care than smaller ones. Shifting some specialist services out of hospital can be more expensive, there are workforce issues to be addressed and a major centralisation of GP services into polyclinics would make it more difficult for patients to visit their doctor, especially those living in rural areas, says the Fund.

The potential problems for rural communities created by a “one size fits all” approach is also emphasized in the evidence submitted to Lord Darzi by the Commission for Rural Communities (CRC) this week.
This submission emphasizes the need for flexibility in the design and provision of rural health care, and stresses that services which may work in an urban setting cannot simply be replicated in rural areas, said Dr Stuart Burgess, who chairs the CRC and is the government’s Rural Advocate. It also calls for changes in the way resources are allocated, in order to recognize the cost of delivering rural health care services and the ageing rural population.

And yesterday, the British Medical Association (BMA) continued its attack on polyclinics, claiming that in many areas there has been insufficient consultation with the public or staff on changes to local NHS services. Many clinicians also do not believe that they will be allowed to lead change locally, despite assurances from the government that change should be clinically-led, says the Association, which adds that there have been cases of doctors being blocked from feeding into the local review process.

Moreover, a new BMA-commissioned public opinion poll reveals that 72% of people are not aware of the Darzi review, the Association adds.

- Earlier this month Dr Jonathan Fielden, chairman of the BMA’s consultants committee, called on the government to “dump the polyclinic plan.”