No surprises that NuLab’s Stalinist tendency has come up with Polyclinics as the latest in its plans for mass centralisation. One’s hostile instincts are reinforced by reading guff like Ignore GPs: Polyclinics are the future from David ‘former communist’ Aaronovitch; and a moment’s research into the ‘consultations’ that are being conducted will reveal (a) there is strong grass-roots opposition and (b) the government intends to go ahead anyway, with PCTs under enormous pressure to get GPs in line (and PCTs have many instruments of torture with which to threaten a GP).
The Conservative Party is officially skeptical. But one sometimes finds senior Tories ambivalent, often having being approached for support by the PCTs and GPs who have been got at already. There will be a lot of money involved, and Big Business is waiting in the wings …
As ever, the centralist argument is the classic one: efficiency through uniformity and scale. You’ll rarely read the true story because there is a deal of pussy-footing around on the issue: and there’s more than money at stake. One of the thrusts for Polyclinics is to extend NHS treatment to ‘increasingly transient populations’ – code for ‘people who don’t actually have the right’. Another is to be able better to enforce politically-set healthcare goals.
And the main losers will be a group known in NHS planning circles as the “White Well”. This means middle class white folk, who keep themselves in good shape by being fairly ready to seek prompt attention from an NHS GP they know well, but who would be very much less likely to attend a vast, impersonal Polyclinic in a timely fashion for this niggling pain here or that minor ailment there.
Any ‘efficiency’ gains from putting the squeeze thus on the White Well will be more than squandered, not only by reduced amounts of preventative medicine being carried out, but by a huge upsurge in time spent on another significant category – the malingerers, hypochondriacs and general timewasters. GPs, of course, know exactly who they are, and can handle them fairly efficiently. But as it’s illegal, apparently, to mark patients’ notes ‘timewaster’, big clinics will be forced to go through the whole rigmarole every time - just as A&E departments are at present. (During public holidays and big football matches, Casualty units are populated almost entirely by these unfortunates, who enjoy the undivided attention they get.)
Opposition parties need to line up solidly with their supporters on this issue and ignore the siren voices of PCT and big-Pharma lobbyists. In frontline healthcare, small is beautiful. The Polyclinic could be the final nail in NuLab’s coffin.