Polyclinics: panacea or plague?

Polyclinics are turning out to be one of those slow-burning political issues which, although getting the occasional piece of news coverage, have really been bubbling away in the public’s mind and concerns for a long time before really grabbing the forefront of political attention.

The possible introduction of polyclinics has been an issue in Haringey for some time now, and it’s a topic I’ve blogged about moderately regularly – but nearly each time I’ve been struck when going to research further information on the topic or to see what other people have been saying, how little attention overall the issue has been getting. Yes, there’s been the occasional news story and occasional reference in Parliament, but for an issue that could massively alter the way tens of millions of people get their health care via the NHS, it’s really been pretty low key.

The recent news that over 1 million people have signed a petition on the issue – along with the major Kings Fund report into the topic – may well change that now!

I certainly hope so, because the introduction of Polyclinics, or Neighbourhood Health Centres, or whatever the government has tried to re-brand them as this week is the biggest health issue facing my constituency – and many others – at the moment.

The idea behind these centres has some attractions – bring different health services together on one site so that you can move quickly and easily between those services without the usual delays (go to one place, get referred to another, wait for appointment) or the extra travel.

Haringey’s Primary Care Trust has chosen to be a trail blazer for Polyclinics and has enthusiastically adopted the idea. The current proposal is to close a number of local GP’s surgeries and consolidate them into four or five Polyclinics.

And that’s where the concerns start. Will these become large impersonal services where we are no longer able to see our own local doctor? We need guarantees that the relationship with your doctor will continue. Any severing the doctor/patient relationship would be a travesty. Hardly anyone wants to explain a deeply personal medical problem to a complete stranger.

Consolidation of GP’s will undoubtedly increase journey times for many people wishing to see their GP, and force them to take either public transport or their car. The heaviest users of primary care have low levels of car ownership (senior citizens 69% no car; lone parents 42%).

It’s easy for those of us who have no trouble getting around to under-estimate just what a burden it can be to extend someone’s 10 minute journey into a 30 minute with two bus changes journey.

The site of the old Hornsey Hospital is where one of the proposed polyclinics is to be built. This site is currently served by only one bus route and it takes Transport for London anything from two years to establish a bus route. This means that those with the most need would most likely have the least access to the service. I met with TfL and raised the issue of public transport provision to this site several years ago and recently raised it with Peter Hendy – the Transport Commissioner for London. But as yet – no firm plans.

Sorting out adequate access to the services should be central to any polyclinics plan – not an afterthought to play around with after the service is in place and people are already suffering from poor transport links.

The recent report by the Kings Fund concluded that there were “serious risks to access to care” posed by consolidation of primary health care and that “it is unlikely that the gains in access to some services currently provided in hospitals are worth the losses for primary care patients.”
Accessibility of service, both in terms of getting an appointment and getting to the appointment, is vital – especially as 90% of access to the NHS is via the primary care route.

And then there is the question of whether polyclinics will really add to our services and facilities? Or will consolidation mean – as it has in so many other areas – cuts?

That brings me to the problems over how the policy is being pushed through – without proper consultation or information. It’s a central imposition of Labour’s ideas on to local communities. Local health bodies have been instructed by central government that they must have polyclinics in every community. This is a classic top-down, Whitehall imposed centralising solution to local problems.

As with our post offices, we were promised that local opinion would be taken account of through consultation. Yet so far we have not been told precisely which services will be provided by polyclinics. This renders the consultation process pretty meaningless as we cannot make an informed choice about what we will gain. And so we are marching on blind – not knowing and having to keep our fingers crossed.