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What is and what is not a polyclinic
- Nigel Higson (25 April 2008)
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Polyclinics - a learning network?
- Prasanna de Silva (28 April 2008)
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When is a polyclinic not a polyclinic? - When it is a Community Hospital
- Kit Stone (29 April 2008)
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The purpose of a polyclinic is clear(ish)
- John Bache, Crewe, Cheshire, CW1 4QJ (29 April 2008)
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Should ‘policlinics’ replace ‘polyclinics’?
- Michel R ODENT (1 May 2008)
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The Policlinic: What's in a name?
- Markus Schneemann (1 May 2008)
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Communities need local hospitals.
- Jim Sikorski, B Jacobs,L Irvine,A Platman,A Clarke,D Sharpe,W Lettington,E Ryan,J Groves,D Thompson,A Thompson,K Ismail,A Febles, M Sarder,G Deane, (1 May 2008)
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Nigel Higson, General Practitioner Goodwood Court Medical Centre, 52 Cromwell Road, Hove BN3 3ER
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I was shocked to see the Polyclinic in Hove hailed as an example of one of the only polyclinics in the country – having been a major force behind the principal in the early 90’s and having obtained funding to build the polyclinic from the then Regional Health Authority. Regrettably Hove Polyclinic developed as far from a “polyclinic” concept that you can find. The original concept was for the development of a new large General Practice in Hove which would incorporate additional space for such luxuries as a hydrotherapy pool, physiotherapy, out patient facilities and minor-surgery. While funding was obtained to build such a development there was such antagonism from local GPs who felt that their autonomy was being removed – the concept was sold to local GPs by the then FHSA as “would you like your patients to be seen at Dr Higson’s surgery for their outpatient appointment?"! Needless to say, the back fighting and lack of enthusiasm by the local health service managers for a building which only contained a single room for a manager (!) resulted in my declining the funding and passing the monies to the local community trust.. The development that resulted was a building of useless spaces with a whole floor devoted to management and support services, a small outpatient physiotherapy department, x ray department and health visitor clinics. Some rooms were built for Consultant outpatients but none to incorporate primary care. On subsequently applying to open a GP practice in the polyclinic I was refused access on various nebulous grounds. Hove Polyclinic IS NOT a primary care polyclinic in the way that Darzi and others consider it and should not be used as an example of such. The current arguments about the development of a polyclinic culture reeks of a surgeon believing that GPs can work together and share ethic – this is rarely possible. The advantages of a polyclinic do not need all gp practices to relocate in order to provide the same benefit. The concept of a “virtual polyclinic” is one which was proposed by myself to all GPs in Hove in the late 80s and which is still appropriate today. This is the development of a central administrative centre which can provide services such a diagnostics, physiotherapy, outpatient services,minor surgery facilities together with responsibility for running the local computer database and centralised trend analysis to aid planning. Electronic data linkages will be made to General practices in the locality which serve a very local population and need. Hence such local practices can still remain in existence but perhaps with fewer staffing overheads as appointment systems and data services are provided by the polyclinic. This serves the duplicate function of maintaining local provision of service while at the same time reducing the massive costs of an excessively large new-build. Such a system of virtual polyclinic also maintains “ownership” by the general practitioners of both their premises and of the concept of cooperative working without the need to work together. As practices evolve with time, some may elect to move to the same site as the centralised unit, other may determine their affection is elsewhere. There is no one solution and I can state quite categorically that the enforced move of the majority of practices to polyclinic sites without the ownership and enthusiasm of those practices will be detrimental to both quality and quantity of health care provided per medical practitioner. Dr Nigel Higson
Competing interests: None declared |
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Prasanna de Silva, Consultant Psychiatrist The Anchorage, 11 Byland Road, Whitby YO21 1JH
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My understanding of the original polyclinic concept was a learning network involving a hybrid medical firm consisting of a visiting consultant and a number of local GPs interested in that speciality. In addition, the clinic would include a specialist nurse (or equivalent) to signpost and advise on non drug treatments. Administration, secretarial services, benefit advice and carer support would provide the stable infrastructure for various clinics on different days of the week, staffed by different sets of GPs. A learning network type clinic provides the local population access to specialist advice via local practitioners who are more skilled in concordance and more aware of local resources. Furthermore, GPs are perhaps more capable of avoiding unnecessary outpatient follow up, promptly returning patients back to their own GP with a robust treatment plan. The attitude of all the practitioners would be one of collaboration and learning from one another. The Consultants main role would be to improve the knowledge base in the firm (including teaching medical students) rather than maximum direct patient contact. Brief, joint consultations in selected cases with the clinic GP would be more consistent with this educational role. This form of activity has taken place in a number of cottage hospitals (including Whitby) over the last 15 years and has been widely appreciated by the local population as a high quality, easily accessible and personal service. Perhaps we need to focus less on new buildings and think about better ways of working together across the Primary Secondary divide. Competing interests: None declared |
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Kit Stone, Consultant Psychiatrist/Medical Director Blandford Hospital, Milldown Road, Dorset DT11 7DD
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There has been much debate about the new concept of polyclinics. However when reading the above article last week, I realised that our Trust, as with many other rural Trusts, has been running polyclinics for decades except we call them Community Hospitals. We run 11 of these spread across most of the small Dorset market towns. They are usually within a few hundred yards of the local GP practice and the GPs are variously involved from managing beds, doing minor op lists, gastroscopy sessions etc. Consultants from all the local hospitals run clinics in the Community Hospitals and surgeons perform a sizeable number of operations there. Several of the hospitals have small Mental Health Inpatient units and several Community Mental Health units are based there. The different hospitals provide physiotherapy, occupational therapy and a range of diagnostic services. Many elderly patients can be investigated or, if necessary, admitted which prevents admissions to acute hospitals and the small size allows innovative joint working between old age medicine and psychiatry. Perhaps the most important thing is they are hugely popular with staff and patients alike and Hospital Friends’ Groups have raised sums in excess of a million pounds to invest in a local hospital for which they feel a real sense of ownership. If polyclinics are to become a successful development, perhaps the key therefore is to only create them when there can be clear benefits for patients, primary and secondary care and for all three groups to be very much involved with the planning design etc from the outset. DR KIT STONE
Competing interests: None declared |
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John Bache, Consultant in Emergency Medicine Mid Cheshire Hospitals NHS Trust, Crewe, Cheshire, CW1 4QJ
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Anyone who watched Sir Gerry Robinson speaking to the chief executive of Rotherham Primary Care Trust on BBC2 on 12 December 2007 is quite clear (well, slightly clearish) on the function of a polyclinic. It is for people who feel "a bit iffy in their lunch hour". As a consultant in emergency medicine, however, I do have a few questions. What if you feel very iffy? Or just ever so slightly iffy, for that matter? What if the iffiness strikes outside working hours? Aren't general practitioners trained in treating iffiness? Will polyclinics stop patients with iffiness attending emergency departments? So many questions. Competing interests: None declared |
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Michel R ODENT, Director Primal Health Research Centre, London NW3 2JR
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The spell-checkers of my English and French computers accept both words. Etymology suggests that when the former spelling is chosen the focus is on the multiple competences of the heath professionals. When the latter is chosen (Greek: polis, the town) the focus is on the concept of proximity. Can the spelling influence the contents of the current discussions? Competing interests: None declared |
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Markus Schneemann, Consultant in Internal Medicine CH-8091 Zuerich, Switzerland
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Dear Editor, I saw the cover plus your articles on 'polyclinics' in the United Kingdom and spotted a common error in the spelling of the word. It is called policlinic with an 'I', and not with a 'Y'. This is, because it is derived from the Greek word 'polis', meaning 'city'. A policlinic is a clinic in a city for the people living in the city. The spelling 'poly' suggests another Greek word, 'poly' meaning many. I could, however, not find a source when this error occurred in history. See 1) The American Heritage® Dictionary of the English Language: Fourth Edition. 2000, at http://www.bartleby.com/61/19/P0411900.html 2) Merriam-Webster's Online Dictionary, at http://www.merriam-webster.com/dictionary/policlinic Competing interests: None declared |
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Jim Sikorski, General Practitioner Sydenham Green Health Centre, 26 Holmshaw Close, London SE26 4TH, B Jacobs,L Irvine,A Platman,A Clarke,D Sharpe,W Lettington,E Ryan,J Groves,D Thompson,A Thompson,K Ismail,A Febles, M Sarder,G Deane,
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While you have recently highlighted fears over the advance of polyclinics (1), we would like to draw your readers’ attention to local health professionals’ fears over the future of hospitals in south London. A recent consultation document, entitled ‘A Picture of Health’ (2) states that local doctors, nurses and midwives think that the greatest level of quality and safety would be provided by Lewisham and Queen Mary hospitals losing their A&E departments, emergency surgery, emergency medical beds, doctor-led maternity units and inpatient children’s services. We are unaware of GPs being consulted in drawing up this statement and entirely disagree with it. The proposed changes would leave Lewisham and Sidcup without effective general hospitals and would be disastrous for their local communities – locating many essential services out of the boroughs and reducing access from areas of significant deprivation. It is particularly astonishing that children’s services at Lewisham hospital, recently rated by the Health Commission as one of the very best in the country (3), should be threatened with closure. The essential reasons why these changes are being proposed are the huge financial burden of neighbouring Public-Private Partnership hospital buildings and fears over the impact of employment legislation on future staffing levels. Your News section recently highlighted the BMA’s campaign to increase consultant numbers in key areas as a means towards solving the latter problem (4). The people of Lewisham and Sidcup deserve strong and effective hospitals close to their homes. We think our NHS can and should afford this as a priority over and above untested polyclinics which carry no evidence base relating to quality, access, and cost (1). 1. BMJ 2008;336:635 (22 March), doi:10.1136/bmj.39521.479618.DB 2. www.apictureofhealth.nhs.uk 3. http://2007ratings.healthcarecommission.org.uk/healthcarepro viders/searchforhealthcareproviders.cfm/widCall1/customWidge ts.content_view_1/cit_id/11012/element/IR_CHILD 4. BMJ 2008;336:797 (12 April), doi:10.1136/bmj.39546.513345.4E Competing interests: None declared |
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