Professor Sir Ara Darzi’s review of the capital’s National Health Service, which advocates driving care further into the community and claims to be able to save around £1.5 billion a year, has received a somewhat mixed response.
The review, commissioned by NHS London, suggests some major changes to the structure of healthcare in the capital, and some believe it may provide a blueprint for service reform across the rest of the country.
Perhaps the most radical change it endorses is the setting up of polyclinics – also commonly referred to as GP supersurgeries – which 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.
Under the plans, hospitals would be split to take on different roles, so that local hospitals would continue proving the majority of treatments, but patients needing complex surgery or specialist treatment would be taken care of at a major acute hospital where medical staff treat enough patients to keep their skills fresh. Those sites carrying out routine, planned surgery would not treat emergency patients, which would also help to cut the risk of infection, according to the review.
Advances support local care
The report points out that medical advances mean that more care than ever before can be provided locally, and says polyclinics would house GP surgeries, diagnostics such as x-ray and pathology, outpatient clinics, urgent care, minor procedures and associated services such as pharmacies.
"Londoners face a stark divide between primary care and hospital care, and we believe the polyclinic will fill that gap,” Prof Darzi explains. “Most GPs provide an excellent and well-regarded service, but they do not have the facilities to undertake even quite simple diagnostics on site, which means patients face multiple trips to hospital for quite straightforward procedures,” he added.
Millions of Londoners have non life-threatening, short-term illnesses, while a much smaller group suffer from more serious illness, such as stroke or heart attack, or a major injury. But, explaining the rationale behind its proposals, the report says the NHS is not meeting the demands of either of group as well as it could be.
One area in need of urgent improvement is the treatment of stroke. As Prof Darzi highlights, patients should ideally be given potentially life-saving blood-thinning drugs within three hours after the stroke but, currently, many do not even get a diagnostic scan in the first 24 hours.
Fragmentation of service?
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.
Commenting on the proposals, Dr Tiz North, chairman of the British Medical Association’s London Regional Council, said: “It seems odd to invent a new model for healthcare when there is already a successful and proven system of general practice which is highly-rated and trusted by patients.”
“The review points out that many GP practices do not have the facilities to take on extra work, such as diagnostics and some hospital outpatient services, so surely it would make more sense to strengthen and build on the excellent services already provided by family doctors rather than invest in new providers,” he added.
But Dr Gill Morgan, chief executive of the NHS Confederation, believes the report’s vision will “revolutionise London.” She went on to say: “The challenge now is to demonstrate to public and staff why this model of care is needed to deliver the highest standards of 21st century health services as opposed to the current shape of services which was fit for 1948 but cannot deliver the level of modern care the people of London deserve.”
Earlier this month, it was announced that Prof Darzi is undertaking an “unprecedented” review of the entire NHS which, the government says, will involve patients, doctors, nurses and other practitioners, and offers an opportunity to “ensure that the future of the NHS is clinically led.”
His findings will be presented next year before the Service celebrates its 60th birthday in July.