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Polyclinics Q and A

August 2008

Further detailed information on polyclinics can be found on our web pages.

What is a polyclinic?
There is no clear definition of a polyclinic. Polyclinics are a term that the government has used in relation to ‘super-surgeries’ that are being set up in London. However, the term polyclinic may also be used more generally to refer to a new large surgery or GP-led health centre (eg accommodating up to 25 GPs) serving a particular area. In addition to GP consultations, these clinics would also provide some additional services (eg x-rays, blood tests, social care, etc). Polyclinics would open from 8 am to 8 pm, seven days a week. Primary Care Trusts (PCTs), the administrative body responsible for managing GP services, will establish a GP-led health centre (commonly termed polyclinic) in their area.

Is the BMA against polyclinics?
The BMA is not opposed to polyclinics in areas where local people want those facilities, and they would benefit patient care. However, we have concerns that a ‘one size fits all’ approach will lead to polyclinics being opened in areas where there is no need, or where they may undermine existing patient services.

What are the BMA’s main concerns about the government’s policy on polyclinics?
The BMA is concerned that many polyclinics are being imposed across the country, regardless of local need. This could lead to some local GP surgeries having to reduce the services they offer, or being closed if funding is diverted towards new polyclinics. Patients are also likely to have to travel further in order to see their GP.

We are also worried that if the local surgery were to close or reduce its services, then patient care could suffer. Patients, particularly those who have serious long term health problems, may be unable to see a GP they know and develop a shared understanding of their illnesses. Patients could find, in a polyclinic, that it is difficult to see the same GP, and that they will feel like a small cog in a large impersonal organisation. We believe that is important for patients, particularly those who are older and more vulnerable, to be seen by a GP who knows them, and can provide a holistic approach and continuity of care.

What is the private sector’s role in polyclinics? Are GP surgeries being ’commercialised’?
Contracts for polyclinics will be available, through a bidding process, to a number of health providers. Private commercial companies, who will be accountable to their shareholders, may bid to run polyclinics. These contracts would be offered on a short term basis and would likely employ doctors on short-term contracts. This would make it more difficult for patients to receive continuity of care (ie seeing a doctor over a period of time for a specific health condition), from their own family doctor.

Is there evidence that smaller surgeries provide good quality care?
There is strong research evidence that small GP practices provide patients with good quality care. Independent research bodies like the King’s Fund have questioned whether polyclinics would deliver higher quality care than smaller practices, even if they offered a wider range of services

What is the BMA doing to stop the rush towards polyclinics?
The BMA has run an active campaign to publicise our concerns about the government’s approach to changes in GP services. Our campaign website can be accessed on the following link: http://www.supportyoursurgery.org.uk/

The BMA presented a petition to Downing Street on Thursday 12 June, containing 1.2 million signatures of patients (collected in just under 3 weeks) who support the current system of general practice. The petition can still be signed here:

http://www.politicalwizard.co.uk/administration/campaign_layout/index.php?category=petitions&uid=3396&campid=2488&detail=y&c=s

Members of the public can also write to their MP or local PCT to register their opposition to polyclinics.

Is the BMA just opposing these changes to protect its members?
Although the BMA is a trade union for doctors, and as such, we respond to our members concerns, it has a much wider role in safeguarding high quality care for patients. We support the principles of the NHS and wish to see it expand and provide patients with the best possible health services. The BMA’s concerns are centred on protecting patients from a centralised, impersonal and bureaucratic approach to health care. The BMA, and the public, have a shared interest to protect the NHS and its values, and make it responsive to genuine local need. Doctors and patients all care about the future of the NHS and the quality of individual patient care.

What does the BMA’s Patient Liaison Group think of polyclinics?
The BMA’s Patient Liaison Group is very concerned that patients will lose the close relationship with their GPs that is the hallmark of good primary care. They have asked the government to seek evidence of clinical need and patient demand for polyclinics before committing large amounts of public money to them. The Patient Liaison Group’s letter to the BMA chairman Dr Hamish Meldrum, outlining all of their concerns, can be accessed here: http://www.bma.org.uk/ap.nsf/Content/privatgprac

What do other healthcare and policy organisations think of polyclinics?
The respected independent ‘think tank’ the King’s Fund shares many or our concerns and concludes that the government’s plans could pose a serious risk to patient care.

The Patients Association is also concerned that polyclinics could jeopardise patient care.

The Royal College of General Practitioners also argues against the use of polyclinics in a recent briefing paper.

How much will polyclinics cost?
The setting up of polyclinics would require considerable investment in buildings, equipment and staff. It would be a better use of public money to continue investing in existing local services (GP practices and district general hospitals). There is currently little evidence that suggests that polyclinics will be the best use of limited NHS resources.

How will polyclinics effect hospital services?
Polyclinics could have a long term ‘knock-on’ effect on hospital services – potentially leading to mergers and closure of services, and could divert resources away from existing local community hospitals.

How can I find out if there will be a polyclinic in my area?
To find out what changes are currently planned in your area, you can contact your local Primary Care Trust (PCT). You can find your local PCT contact details on the NHS choices website, or by calling NHS Direct on 0845 4647

How will the public be consulted on any proposed changes to GP services?
Local Primary Care Trusts will be in charge of any local consultations. The BMA Patient Liaison Group has some concerns that the public will not be actively consulted on the changes, and that the groups who are most likely to be affected by the changes (eg older people, people with learning disabilities, and people with long term health problems) may be less likely to take part in the consultation process.

Every local authority area in England should have a newly formed Local Involvement Network (LINk) taking over the public involvement role from the previous Patient and Public Involvement Forums. To find out more about whether you local area LINk is up and running, have a look at your local city or county council website.

How can I find out more about these issues?
Further in-depth briefings and information on the BMA’s position on polyclinics can be accessed here:

The impact of polyclinics on family health services
BMA activity in response to Lord Darzi's review of the NHS in England
Press and Media Work on Lord Darzi Review
Access to GP services in England