Monday, 9 June 2008

Polyclinics (2): Fisking Alan Johnson

The Poll-Tax on Steroids – aka Polyclinics – is predictably under fire as it continues its onward march. In yesterday’s Observer, Alan Johnson made a slippery and disingenuous crack at promoting it.

We dissect.

Soon we will publish our vision for the next decade, the Next Stage Review, led by the eminent surgeon Lord Darzi.

Well OK, he may not know much about GP services – but he is a respected surgeon – and believe me, this is all about the Knife ! (my little joke)

We want to create GP-run health centres that open from eight till eight, seven days a week. No current GP practices will be closed.

Just physically re-located to a different building and submerged within a vastly larger practice. Yeah, OK, fair cop, we're closing them. If you insist.

Most important, our 150 GP-run health centres will offer patients appointments and walk-in services without registration, so families can make use of them while they remain registered with their existing GP.

Or indeed not registered at all: “transitory populations”, you know …

In some major cities, such as London, clinicians and managers want to go further than GP-run health centres and develop polyclinics - centres that offer an extended range of treatments.

Yes, interesting, isn’t it - a spontaneous, grass-roots movement – probably something to do with the estuarine climate. “And who are these clinicians and managers in London ” did someone ask ? – oh, just some managers we met … American chappies, as I recall … well, who do you imagine runs something that goes further than a GP-run centre ?

That might be achieved by bringing several GPs into a single building or they may be 'virtual', with GPs in their existing practices collaborating more closely.

Several ? well actually, several dozen GPs: these shiny new communes clinics will have patient-rolls of 50,000, you know. ‘Bringing’ ? yes, you know, as in “I am bringing these turkeys to market …”

I will insist that such decisions are taken in consultation with local people and driven by clinical evidence of what works.

But mostly whatever Lord D decides (which, let’s face it, is more or less the same as clinical evidence!), since the early consultations were *ahem* disappointing.

Controversy may well be caused by some GPs, worried that they themselves will lose out. But we have made clear that they are not going to lose funding in this process.

Indeed, taking our cue from Aneurin "I-stuffed-their-mouths-with-gold" Bevan, we intend to bribe them, as usual. Or bully them. I don’t mind which.

The Tories’ plans would make it harder to see a GP.

Well, not harder than now: harder than when we force the buggers to stay open. “My own GP ?” – no no, not your own GP, a GP, there will be loads of ’em wandering around ! The idea of a GP who actually knows you is very elitist, we can’t have that.

The scaremongering and misleading claims we have seen from the Tories, and sadly from the BMA, should have no place in the crucial debate about our health service.

Indeed, Jacqui has suggested we make it illegal for Tories and the BMA to say anything at all. Just a small amendment to her Terrorism Bill, apparently …



Letters From A Tory said...

Talk about trying to dodge the issues by blaming the opposition!

Polyclinics have not been thought through properly and will therefore be yet another step sideways for the NHS.

Bill Quango MP said...

I will insist that such decisions are taken in consultation with local people....

Like we did with the Heathrow expansion, Post Office closures, and end to meals on wheels, local Primary schools and librarys. Your views will all be collated,examined, discussed and ignored.
Remember "we are appearing to be listening."

Anonymous said...

"In some major cities, such as London, clinicians and managers want to go further than GP-run health centres and develop polyclinics - centres that offer an extended range of treatments."

Any reason why they can't do that now, as they are so enthusiastic to do more work for the same money? I was under the impression that there was already some benefit in "economy of scale". However, I suspect that living in the country will have its benefits - the country practice will be overrun with GPs desparate to avoid being part of some huge anonymous polyclinic in a city centre.

Nick Drew said...

letters - or backwards. And costly, natch

Bill - already in the bag, they know they are not wanted but it just encourages them - sign of a good policy, as far as they are concerned!

Ryan - not so far as I know: a good friend of mine is a GP oop north, where a dozen or so of them banded together several years ago, entirely on their own initiative, to give better out-of-hours service: and it remains strictly GP-run

but the 50,000-patient monsters will go way beyond economies of scale, deep into diminishing returns / inefficiency territory, see the link to the earlier post

the key point, of course, is that the size of these bigger units will be more attractive to commercial takeover, hence the phrase 'go further than GP-run'

Tuscan Tony said...

Interesting. One nettle that needs to be grasped in the UK IMHO is the "free at point of delivery" canard. Some NuLab mong said a couple of years ago that "people definitely didn't abuse the NHS with timewating trivial ailments because everyone clearly understood it wasn't free and they always thought carefully before going to their GP/whatever."

Yeah. Right. I thought at the time that if that mindset was the reality, wouldn't it be easier to leave wheelbarrows of "the people's cash" at every street corner and assume said people would only take enough for their own requirements.

Err...lads isn't that AKA a form of communism, and hasn't that cult been rather on the wane recently?

Man in a Shed said...

Just heard Johnston on R4 a few minutes ago. He was asked if Poly Clinics would mean GP surgeries closing and he gave a slippery non-answer on the following lines:

No - no GP surgeries will close due to act at the centre.

So that means the PCT will be expected to do it eh ?

Its classic shameless Labour - give people an answer you expect them to misunderstand.

Anonymous said...

Is it compulsory for GPs to be part of the NHS? If not, why don't they just tell to Health Sec to bog off and mind his own business. If the docs are unhappy with what is proposed why can they not simply tear up (or threaten to) any contracts they might have with the NHS and carry on as private concerns (as happens all over the rest of the world). They would of course need to charge a small fee for their services and medicines etc but patients who did not wish to become merely a number in some soulless leviathan would surely use the local individualised practice services. I know I would.

Nick Drew said...

TT - yup, if there is currently only modest disincentive to timewasting (see our 1st piece on this), there will be even less with these anonymous monstrosities

ShedMan - the words are always chosen with weaselly care, aren't they ? and yes, it's the PCTs that will do the Dirty Deeds, they have the whip-hand (see that link again)

GG - in practical terms the PCT's have got them over a barrel (link again !). It would need much more than just charging small fees to keep most of them afloat. Sadly

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