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Heath puts forward some solid arguments against the polyclinic concept proposed in Lord Darzi's review of health care in London,1 but she is blind to the deficiencies in our services, cited in A Framework for Action.2
In some places, access to general practitioners' services, even by telephone, is inadequate. Some practices still close for half a day each week or are not open throughout the day. The problem of poor access and availability is perceived by public and politicians as unacceptable in a service that has received so much investment in recent years and as major contributors to the rise in emergency activity and attendance at hospital accident and emergency departments. Pressure is mounting on us to increase our hours of routine availability.
Polyclinics will not solve all these problems, but they will facilitate groupings of clinicians sufficient to offer extended hours and types of care and to act as the front door to accident and emergency care in some locations. Over 50% of people attending accident and emergency departments would receive better care from primary care practitioners rather than being seen by junior doctors, over-investigated, and even admitted to hospital.
Accident and emergency care is also the preferred place of attendance of some of our most vulnerable and disadvantaged patients, including those with multiple physical, mental, and social problems, who will be much more appropriately assessed and treated in primary care. The trick, however, will be to ensure that such urgent care practitioners maintain their primary care credentials rather than defaulting to hospital accident and emergency behaviours.
I found a strong consensus among primary and secondary care clinicians about what is required to transform London's health care. This was about much more than polyclinics, laying great emphasis, for example, on the need to transform the infrastructure of local intermediate care and social services to support patients out of hospital.
Competing interests: MCW chaired the clinical working group for planned care for the report A Framework for Action.