Under One Roof
Text from the Fund press release in June 2008
The report draws on original research into facilities similar to the polyclinic models developed both in the UK and abroad. The proposals, which have been discussed as part of Lord Darzi’s NHS Next Stage Review, could bring together family doctors and specialists alongside other services, such as diagnostic testing, minor surgery, blood tests and X-rays.
The term polyclinic has been used to describe a variety of different approaches from very large super surgeries, which involve closing current GP practices and moving their services into the new unit, to the so-called hub-and-spoke model where most existing practices continue but share access to a set of new services in one facility. The King’s Fund report concentrates on the ‘big building’ model and examines the impact they would have on patient care.
It welcomes the government’s ambition to develop more patient focused and integrated models of care but warns that poor implementation of this model could create significant risks for patient care. Its key findings are:
Report co-author Candace Imison said: ‘There is a strong case for challenging the way we organise health care in England. For some health communities the development of polyclinic-type facilities could offer great opportunities to establish more integrated care that delivers real benefits to patients. But these benefits will only be realised if the focus is on changing the way we deliver care, not just changing where care is delivered.’
King’s Fund Chief Executive Niall Dickson added: ‘Our model of health care has changed little since the NHS began 60 years ago – advances in technology, changes in the composition and working hours of staff, as well as patient expectations and evidence about what is effective, all signal the need to review how and where care is delivered. The polyclinic approach could be one way to redesign services around the needs of patients but we must not underestimate the amount of time, energy, and resources that would be needed to make it work.
‘We welcome the government’s assurance that there will be no national blueprint but that needs to be spelt out in unequivocal terms. Above all we appeal to ministers to make it abundantly clear that there will be no compulsion on local NHS organisations to erect buildings or follow this or any other centrally dictated model of care. Polyclinics may be the right answer in some areas, they will not be right for others. That should be a matter to be decided locally on a case-by-case basis using the best clinical evidence available together with a full assessment of the costs and the impact on patient access.’
The report’s analysis of polyclinics suggests that local planners should be careful to assess the benefits and costs of the polyclinic approach. Its recommendations aim to provide guidance for local NHS services and commissioners on realising the opportunities and avoiding the risks of introducing these new models of care: