Polyclinic Panic
Polyclinic Panic
By Doug Naysmith, MP for Bristol North West and member of the House of Commons Health Select Committee
Response to “Don’t lose the human face of care” by Dominique Thompson (EP 5.6.08)
I have been a member of the Labour Party for many years so I know a Trade Union’s first job is to protect its members. It should not surprise me, therefore, when the doctors’ trade union, the British Medical Association, acts in this way and puts its members’ interests ahead of those of the public. It is irritating, though, that it tries to dress up its latest scare campaign as one to protect patients against Government, bureaucrats and commercial interests.
The BMA was against the introduction of the NHS sixty years ago and held out for GPs to be private businesses (“commercial providers”?) rather than employees of the NHS. It did a good job for its members then by ensuring that GPs have life long contracts, own their practices and can sell them when they retire. Last year the BMA did all it could to stop the Government insisting that GP Practices should be open at times when many patients need them. It is now staging a concerted protest against plans to increase access to primary health care in disadvantaged areas.
Understandably, many GPs – though thankfully not all – choose not to practise in inner city neighbourhoods and this causes particular problems, especially in London. People in poorer areas have lower life expectancy and have always had the least access to primary care. For example, Cambridgeshire has more than twice as many doctors as Manchester, and men in Cambridgeshire will live six years longer. It is a sad fact that those most in need of care services are least likely to receive them. People who cannot see a GP either do without the treatment they need or go to the Accident and Emergency Departments in hospitals, taking up time that should be spent on real emergencies. To address this, the plans for London (drawn up by the NHS in London, not imposed by Government) are for centres (polyclinics) which bring together a range of primary care services, specialist services, urgent care services and social care. The first contract went to a group of local GPs, not big business, and this is expected to be the norm.
Liam Fox concedes (EP 5.6.08) that “there may be a role for polyclinics but as a supplement to not a substitute for family doctors”. He should be delighted to learn, then, that this is exactly what will happen. The money for 152 new GP-led health centres open 8am to 8pm seven days a week, one in every Primary Care Trust (PCT) is new money. The centres will be on top of existing services, not replacing them, so David Cameron’s pledge to “fight Labour’s plans to close GP surgeries…and save the family doctor service from Gordon Brown’s cuts” (speech to the King’s Fund 21.4.08) is just cynical nonsense.
The situation Dominique Thompson describes, in which a GP cares for his or her patients from the cradle to the grave, understanding their family circumstances and social problems, is far from universal but where it does exist and is wanted it is not at risk, whether the doctor works alone or in a group practice. There are dangers to the Dr Finlay model of single-doctor practices, however, and I am not just thinking of Harold Shipman. Doctors who have dealt with one of their regular patient’s stomach pains for years may well assume that the latest bout is just the same and not refer the patient for crucial tests. The Primary and Community Care Strategy will help to tackle the isolation of those who choose to work alone but personally I think it is better if doctors work together, as most do, keeping each other up-to-date and covering for their partners’ absences and time off.
Of course, the Government accepts that GPs should have time for family life and should not work excessively long hours: it also knows that patients want the opportunity to see a GP after work or at weekends. Over two million patients a year already use services like NHS walk-in centres and the new GP-led health centres, open to any member of the public, will improve services to more patients. They will provide an extra 2.6 million extra appointments a year across the country. The Government is not setting down a model to be followed everywhere but expects PCTs to consult medical practitioners and the public about where the new centres should be and what range of services they should provide. Local people know best what suits their own area.
The Conservatives have said they will stop the polyclinic and health centre programme and let doctors choose whether to open outside normal office hours. This would be caving in to self-interest and giving a slap in the face to those millions of patients who need to see a doctor in the evening or at weekends. It would do nothing to address health inequalities and would leave those living in the disadvantaged areas of our cities without the level of primary care that they need.
