A report into the government’s proposals for new ‘polyclinics’ in primary care has concluded that they face a range of managerial and logistical challenges to succeed. The Kings Fund think-tank’s document, Under one roof: will polyclinics deliver integrated care?, written by Candace Imison, Chris Naylor and Jo Maybin, has looked at research evidence and international examples of this kind of healthcare provision.

The report concludes that “the primary focus should be on developing new pathways, technologies and ways of working, rather than new buildings” – a sentiment echoed by all speakers at a recent event debating polyclinics by the Civitas think-tank.

‘Polyclinics’ are generally understood as new buildings which will co-locate a number of GPs, nurses and other healthcare staff in a new building which will house facilities for a range of diagnostic tests, outpatient clinics and minor operations formerly done in hospitals. Health Minister Lord Darzi used the concept in his 2007 Healthcare For London review.

Questionable assumptions
King's Fund chief executive Niall Dixon points out that much of the thinking behind polyclinics assumes that bringing staff together under one roof will automatically lead to better co-working. However, he notes in his foreword to the report that “co-location alone is often not sufficient to generate co-working or integration of care”.

The British Medical Association and the Conservative Party have opposed the imposition of polyclinics. The BMA depicts polyclinics as threats to local general practices in a recent campaign, likening them to local post offices and banks. David Cameron gave a recent speech to the King's Fund suggesting that the proposed 150 polyclinincs would threaten up to 1,700 GP practices (20% of the UK’s total) with closure. The mechanics behind this number of closures remain unclear.

There has been much concern among commentators that polyclinics will threaten practices in rural areas, where single-handed GP practices are more common and public transport less available. The King's Fund report adds that “evidence suggests that use of primary care is more sensitive to distance than use of outpatient or acute services. Hub-and-spoke models for primary care are likely to be more appropriate, and particularly so in rural areas”.

Reactions
Nigel Edwards, policy director of the NHS Confederation said: “This report provides a useful and balanced review of the risks and opportunities in the polyclinic model. While polyclinics could deliver significant benefits for patients it is crucial that a “one size fits all” model is not imposed on a national level. The NHS Confederation highlighted in a recent report Ideas from Darzi: polyclinics that it would be a mistake to assume polyclinics can always save money by moving care out of hospital; rather we should focus on how they can allow the NHS to work in a more organised and effective way. Polyclinics are not just big new buildings. Centralisation of services would not work in every area, especially rural areas. Models can be virtual, or use existing estates to bring clinicians together. It is essential that clinicians change ways of working and improve care pathways, not just move buildings."

“This is not about closing surgeries, but where appropriate, using a polyclinic approach to improve the access to and quality of care for all.”

Dr Jonathan Fielden, chairman of the BMA’s consultants committee called on the government to “dump the polyclinic plan. The centrally enforced polyclinic plan holds no water, has no benefit and no financial gain” at the UK’s annual consultants’ conference, where consultants overwhelmingly rejected an imposed model of privately-owned polyclinics across England. In a recent BMA survey, six out of ten consultants said polyclinics will not improve the quality of patient care.