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GP supersurgeries that stay open till 10 pm and provide facilities for radiography and trauma care have been called for by the surgeon and newly appointed health minister Sir Ara Darzi, in a report.
Healthcare for London: A Framework for Action, commissioned by NHS London, the capital's strategic health authority, calls for a radical overhaul of the capital's health services, which it says are “not meeting Londoners' expectations.”
Topping the list of proposals—and immediately prompting fears of hospital closures—is a network of supersurgeries or “polyclinics,” which would massively expand the role of primary care.
The polyclinics would include GPs' surgeries; diagnostics such as radiography and pathology; outpatient clinics; facilities for urgent care and minor procedures; and associated services, such as pharmacies.
Professor Darzi said, “Londoners face a stark divide between primary care and hospital care, and we believe the polyclinic will fill that gap.
“Most GPs provide an excellent and well regarded service, but they do not have the facilities to undertake even quite simple diagnostics on site, which means patients face multiple trips to hospital for quite straightforward procedures.”
The report envisages that the clinics will provide up to half of the outpatient treatment currently carried out in hospital by 2017.
It adds that the size and scale of the new clinics would “allow them to improve accessibility by offering extended opening hours across a range of services.” Patients requiring “urgent care” would be able to see GPs on rota at the polyclinic up to 10 pm, but could still book appointments with their own GP at other times.
A spokesman for NHS London denied that the proposals would inevitably result in hospital closures.
“Darzi's not recommending hospital closures. [Emergency departments] that are open at the moment could stay open, though they would be doing less stuff that could be done by GPs,” he said. He added the changes were needed to improve the health of London's large, transient population, which has less contact with GPs than the rest of the country.
A spokeswoman for the BMA said, “There is a case for changing how some services are provided in London, but doctors fear that some of these proposals may not be in the best interests of patients.
“The concept of polyclinics may sound appealing but it has the potential to destabilise and fragment existing hospital and GP services. Any changes to health services must be safe, based on sound clinical evidence, and be in the best interests of patients. We will need to examine the details of Ara Darzi's proposals to see whether these principles have been met.”
The report also calls for more health care to be provided at home; local hospitals to provide the bulk of inpatient care; high throughput surgery to be done in elective centres; and some hospitals to be designated “major acute hospitals” to handle the most complex cases.
For the United Kingdom to remain at the “cutting edge of medicine,” Professor Darzi calls for the establishment of “academic health science centres,” along the lines of the Massachusetts General Hospital and Harvard Medical School models in the US.
The report says that restructuring would allow patients with the 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 either of these groups as well as it could, says Professor Darzi.
He notes that many patients with stroke in the capital do not receive computed tomography within 24 hours, let alone within the three hour limit recommended for best use of anticoagulant drugs.
A spokeswoman for the Stroke Association welcomed the report's emphasis on improving treatment after stroke.
She said, “Currently about a third of people who have a stroke die within a month, a third are permanently disabled, and a third recover. However, there is nothing inevitable about these figures. The evidence clearly shows that if every stroke was treated as a medical emergency, outcomes for stroke patients would improve.”
Ruth Carnall, the chief executive of NHS London, described the report's proposals as “both radical and persuasive.” “They also reflect very much what Londoners have been telling us,” she said.
“It is clear we are not providing the quality of health care to Londoners that we could and should be, given the huge investment we have been making in our skills and resources. Ara Darzi's excellent report will be a spur to action that will ensure Londoners receive the world class health care that they deserve.”
Professor Darzi is currently beginning a year long review of the NHS throughout England.
See Personal View doi: 10.1136/bmj.39272.731470.94.