King’s Fund fears over polyclinics

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, which concentrates on the “big building” model, examines the impact they would have on patient care.

The report stated that polyclinics could help to redesign services around the needs of patients and deliver integrated care, particularly for people with long-term conditions.

However, the evidence suggested that in practice these opportunities are often lost. In addition, there is no evidence that larger GP practices deliver higher quality care than smaller ones, although they may be able to offer a wider range of services.

For some patients access to diagnostic and other services would improve and the impact would vary depending on how large and centralised the polyclinic would be. However, a major centralisation of GP services into polyclinics would make it more difficult for patients to visit their GP, especially those living in rural areas. While there is a strong case for providing more support in the community to prevent hospital admission, there is substantial evidence that shifting some specialist services out of hospital can prove more expensive. In these cases services can be less efficient and often fail to reduce demand on hospitals, so that the costs of new services supplement rather than substitute for hospital costs.

Report co-author Candace Imison said: “There is a strong case for challenging the way we organise healthcare 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: “Polyclinics may be the right answer in some areas, but not 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 PCTs should consider alternative polyclinic models which do not require mass centralisation of family doctor services, such as the hub-andspoke or federated model where most GPs remain in their premises and draw on resources in a central polyclinic or resource centre.