Thursday, 22 May 2008

Polyclinics: Poll Tax on Steroids

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.



Old BE said...

Polyclinics fill me with horror. As you say, "frontline" services should be as local as possible. GP services should look like country solicitors or one-man-band accountants not like Microsoft.

The idea that centralisation+uniformity=efficiency is nonsense, but a lot of it is driven by "the postcode lottery". In fact localism is the solution because then people have a way to indicate how they want their services configured rather than them being dictated to from on high. The Tories should push strongly on this because I think it is right and also could be very popular.

roym said...

the white well? what is this tosh?

i was beginning to like this blog, but this particular post reads like hysteria from the daily wail.

are you seriously trying to suggest that white middle-class types are incapable of wasting GPs time? or they wouldnt go to a polyclinic if they really were feeling unwell?

getting more on track is the fact that the corporates are hovering over this as a new growth market. sad days

James Higham said...

No surprises that NuLab’s Stalinist tendency has come up with Polyclinics as the latest in its plans for mass centralisation.

Makes me feel right at home - we have heaps of them round here.

Raedwald said...

If you hold onto the idea of GPs having prime purchasing power for specialist services, and therefore delegating most of the necessary rationing decisions to them, surely the invisible hand will determine the rest.

Independent Cottage Hospitals could offer cost effective obstetric, gynae and minor surgical procedures as well as stuff such as phlebotomy and bog standard radiology

County, teaching, specialist and Borough hospitals could provide A&E (paid for by central tax subventions rather than GP fundholders), major surgery, CAT scans and other specialist treatments.

The trick would be to make easily available the health 'performance indicators' at GP partnership level; poor budgeting and purchasing decisions as well as poor diagnosis and prescribing by sub-standard GP practices would show up fairly quickly and as their patient rolls fell so would their delegated budget.

GPs surgeries would have complete freedom to determine their own opening hours and days, and appointment conditions, and citizens complete freedom to choose which GP they register with.

Yes, local determination and not the dead Stalinist hand of the Central State.

Socialists will argue that GPs in 'White well' areas with excellent performances will enjoy an inefficient surplus on a basis of a standard per-capita budget on the basis of their rolls. Not so. It hasn't been the case with schools, has it? Good schools are over subscribed. Good GPs will be oversubscribed.

I want to be able to talk to the doctors who have the rationing power. Only they can assess 'quality of life' factors. The health care rationing decisions they make are why we train them for so long and so thoroughly. Let's give our professionals back their proper role and rid ourselves of amorphous grey bureaucrats, political interference and the horrid hand of the Central State.

Anonymous said...

So what's the difference between the local district hospital which has just been closed and the new polyclinic which is just about to be opened? I am confused.

Nick Drew said...

thanks for coming by, Raedwald. This, surely, is an area in which localism can be promoted without hesitation. I worry about some Tories' equivocation - their instincts for decentralisation are sometimes as suspect as their noses for a votewinner !

GG - the answer is, the local GPs will be herded into the Polyclinic.

And they will be Big: in London the aim is for one clinic per 50,000 people - equating to around 5 wards, in polling terms - within which area there would then be no freestanding NHS GP practices.

Old BE said...

Which also means not within walking distance for many people, which means ambulances or driving for relatively minor stuff. Gah.

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