New buildings not needed for polyclinics, says King’s Fund

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1270
  1. Zosia Kmietowicz
  1. 1London

Local NHS organisations should be given the freedom from Whitehall to implement large health centres or “polyclinics” in the way that they think will best serve their population, the head of one of the United Kingdom’s leading organisations for research into healthcare policy has said.

In particular, Niall Dickson, chief executive of the King’s Fund, said that local health bodies should not be required to erect new buildings to house polyclinics when other ways of implementing the policy will work.

Mr Dickson acknowledged that advances in technology, changes in patients’ expectations, and staff working hours signal a need to review how and where care is delivered. The polyclinic approach, which has been discussed as part of the health minister Ara Darzi’s NHS review, aims to meet the government’s plans for a more patient focused and integrated health service.

A report from the King’s Fund, published ahead of Lord Drazi’s final report on the next stage of NHS reform, which is due later this month, calls for a measured approach to rolling out polyclinics throughout the country. “We must not underestimate the amount of time, energy, and resources that would be needed to make it [the polyclinic approach] work,” said Mr Dickson.

Primary care trusts should proceed with polyclinics only if there are clear benefits to local communities in terms of improved quality and better access to services, says the report. The focus should be on developing care pathways that make use of technology and closer partnerships between professions.

Mr Dickson welcomed the government’s assurance that there would be no “national blueprint” on polyclinics, but he insisted that this needed to be spelt out in “unequivocal terms.”

“Above all we appeal to ministers to make it abundantly clear that there will be no compulsion on local NHS organisations to erect buildings or follow this or any other centrally dictated model of care,” said Mr Dickson. “Polyclinics may be the right answer in some areas, they will not be right for others. That should be a matter to be decided locally on a case by case basis using the best clinical evidence available together with a full assessment of the costs and the impact on patient access.”

The “big building” model, where GPs are relocated in a new unit, together with specialists and other services, is just one way that polyclinics could be set up, says the report.

Primary care trusts should also be able to consider alternative models that do not require uprooting established general practices, such as the hub and spoke or federal model, in which most GPs stay in their premises but share access to a set of new services in one facility.

The report, Under One Roof: Will Polyclinics Deliver Integrated Care?, can be seen at

View Abstract

Log in

Log in through your institution


* For online subscription