Polyclinics open till 10 pm proposed for London

doi:10.1136/bmj.39273.467697.DB

BMJ 2007;335:61 (14 July), doi:10.1136/bmj.39273.467697.DB

News

Polyclinics open till 10 pm proposed for London

Michael Day

London

GP supersurgeries that stay open till 10 pm and provide facilitiesfor radiography and trauma care have been called for by thesurgeon and newly appointed health minister Sir Ara Darzi, ina report.

Healthcare for London: A Framework for Action, commissionedby NHS London, the capital's strategic health authority, callsfor a radical overhaul of the capital's health services, whichit says are "not meeting Londoners' expectations."

Topping the list of proposals—and immediately promptingfears of hospital closures—is a network of supersurgeriesor "polyclinics," which would massively expand the role of primarycare.

The polyclinics would include GPs' surgeries; diagnostics suchas radiography and pathology; outpatient clinics; facilitiesfor urgent care and minor procedures; and associated services,such as pharmacies.

Professor Darzi said, "Londoners face a stark divide betweenprimary care and hospital care, and we believe the polyclinicwill fill that gap.

"Most GPs provide an excellent and well regarded service, butthey do not have the facilities to undertake even quite simplediagnostics on site, which means patients face multiple tripsto hospital for quite straightforward procedures."

The report envisages that the clinics will provide up to halfof the outpatient treatment currently carried out in hospitalby 2017.

It adds that the size and scale of the new clinics would "allowthem to improve accessibility by offering extended opening hoursacross a range of services." Patients requiring "urgent care"would be able to see GPs on rota at the polyclinic up to 10pm, but could still book appointments with their own GP at othertimes.

A spokesman for NHS London denied that the proposals would inevitablyresult in hospital closures.

"Darzi's not recommending hospital closures. [Emergency departments]that are open at the moment could stay open, though they wouldbe doing less stuff that could be done by GPs," he said. Headded the changes were needed to improve the health of London'slarge, transient population, which has less contact with GPsthan the rest of the country.

A spokeswoman for the BMA said, "There is a case for changinghow some services are provided in London, but doctors fear thatsome of these proposals may not be in the best interests ofpatients.

"The concept of polyclinics may sound appealing but it has thepotential to destabilise and fragment existing hospital andGP services. Any changes to health services must be safe, basedon sound clinical evidence, and be in the best interests ofpatients. We will need to examine the details of Ara Darzi'sproposals to see whether these principles have been met."

The report also calls for more health care to be provided athome; local hospitals to provide the bulk of inpatient care;high throughput surgery to be done in elective centres; andsome hospitals to be designated "major acute hospitals" to handlethe most complex cases.

For the United Kingdom to remain at the "cutting edge of medicine,"Professor Darzi calls for the establishment of "academic healthscience centres," along the lines of the Massachusetts GeneralHospital and Harvard Medical School models in the US.

The report says that restructuring would allow patients withthe most serious illnesses to be channelled to expert centres.This would boost the treatment given to victims of serious injury,heart attack, or stroke: the NHS is not currently serving eitherof these groups as well as it could, says Professor Darzi.

He notes that many patients with stroke in the capital do notreceive computed tomography within 24 hours, let alone withinthe three hour limit recommended for best use of anticoagulantdrugs.

A spokeswoman for the Stroke Association welcomed the report'semphasis on improving treatment after stroke.

She said, "Currently about a third of people who have a strokedie within a month, a third are permanently disabled, and athird recover. However, there is nothing inevitable about thesefigures. The evidence clearly shows that if every stroke wastreated as a medical emergency, outcomes for stroke patientswould improve."

Ruth Carnall, the chief executive of NHS London, described thereport's proposals as "both radical and persuasive." "They alsoreflect very much what Londoners have been telling us," shesaid.

"It is clear we are not providing the quality of health careto Londoners that we could and should be, given the huge investmentwe have been making in our skills and resources. Ara Darzi'sexcellent report will be a spur to action that will ensure Londonersreceive the world class health care that they deserve."

Professor Darzi is currently beginning a year long review ofthe NHS throughout England.

See Personal View doi: 10.1136/bmj.39272.731470.94.

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