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Proposals by the health minister Ara Darzi to set up polyclinics in London to bring health services closer to patients threaten to fragment existing community services, which have a track record of delivering high quality care, says the BMA.
In a response to Lord Darzi's recent review of health care in London the BMA warns that the proposed plans may not produce the predicted savings or improvements in the care of patients that the government envisages (BMJ 2007;335:61 doi: 10.1136/bmj.39273.467697.DB).
“We concede that health care in London is not perfect, but we have several problems with Ara Darzi's proposals,” said Hamish Meldrum, chairman of the BMA Council.
Establishing polyclinics, a key component of Lord Darzi's plans for London, would require considerable “up front” investment in new buildings, equipment, and staff, and it is difficult to see how they would be cost effective, the BMA's response says.
Community hospitals already provide intermediate care services; GPs with special interests are already able to treat more patients in their surgeries; and many consultant led community health services are already based in premises outside of hospital.
“Despite the government wishing to provide more care closer to home, it is likely that for most people in London, the polyclinic would actually be further away than their existing, local GP surgery. It would be much better to invest in existing GP services, and where necessary district general hospitals, rather than imposing costly, unproven polyclinics,” said Dr Meldrum.
“The suggestion that private companies could run polyclinics would, in reality, destroy the UK model of general practice and threaten many district general hospitals. Both are respected throughout the world and are highly valued and trusted by patients.”
The BMA's response recognises that patient care can be improved by moving some services away from hospital into the community and by centralising some aspects that need more complex care. However, Dr Meldrum pointed out that although some evidence shows that centralising some services, such as trauma care, would benefit patients with considerable injuries, for some conditions, such as anaphylactic shock or asthma, having to travel further for care may be detrimental.
He expressed disappointment that the government had again failed to consult doctors or the public before announcing plans for health services, and that it continued to do so while claiming a new agenda of engagement.
“I am pleased to hear the words [engagement of the profession] but I am still not convinced that these latest consultations are different to those held by Patricia Hewitt in the past. They are somewhat stage managed. You can't just have a big event—you have to have an ongoing process with physicians and with the public,” said Dr Meldrum.
“There is cynicism among the medical profession that they [the government] have already much decided what they want to do. At the same time as undertaking the consultation they are making big policy announcements, such as extending GP hours.”
The full response is at www.bma.org.uk.