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FEATURE: Virginia Berridge Polyclinics: haven’t we been there before? BMJ 2008; 336: 1161-1162 [Full text]

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Privatised polyclinics can never be health centres

Alex Scott-Samuel   (30 May 2008)

The Pioneer Health Centre was never a Polyclinic !

Jack M Czauderna   (1 July 2008)

Privatised polyclinics can never be health centres 30 May 2008
Alex Scott-Samuel, Senior Clinical Lecturer in Public Health Division of Public Health, University of Liverpool, L69 3GB Send response to journal: Re: Privatised polyclinics can never be health centres	As a public health physician since 1973, I have worked in local government, the NHS and the academic sector. I am also a trustee of the Pioneer Health Foundation (www.thephf.org) which keeps alive the principles of the Peckham experiment, of which Professor Berridge writes. I have seen the ideal of primary health care teams, working from publicly provided health centres, flower and then wane. While I would largely echo Prof Berridge's message, I would also add a note of caution: unless the Government's destructive privatisation policies, which spell the death of British primary care as we understand it, can be entirely separated from the polyclinic strategy, it is inevitably doomed to failure. Competing interests: None declared
The Pioneer Health Centre was never a Polyclinic ! 1 July 2008
Jack M Czauderna, Salaried GP in PCTMS practice Darnall Community Health S9 5AN Send response to journal: Re: The Pioneer Health Centre was never a Polyclinic !	Virginia Berridge is right to draw attention to the long history of health centres and the ideas behind them going back well before the formation of the NHS. We have certainly been there before. I am a trustee of Pioneer Health Foundation, the organisation which keeps the Peckham ideas alive. The Peckham centre operated to study the nature of health and how it could be recognised and nurtured. It did not study disease or offer any therapeutic intervention and if there were plans to run a parallel medical institution they were never realised. The modern idea of a polyclinic is to integrate more and better therapeutic interventions in one place, combining diagnostics with specialist input in a primary care setting. This may or may not be a good idea but it is nothing to do with the Peckham principles. As a GP for nearly 30 years I have been unable to properly integrate the two approaches. Sick people need clinicians with the skills and resources to help them not be sick. Doctors are unable to make people healthy. Health can only come from people themselves. They need the right environment to find out what it means for them. Peckham provided that environment. It is not possible to bolt on health to a sickness service. However I think it might be possible to include a sickness service in a proper Peckham type health service. Unfortunately polyclinics as envisaged will not do this. Competing interests: None declared