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• Improve Londoners’ health in specific areas such as HIV/Aids, substance misuse, TB, mental health problems and childhood obesity.

• Tackle health inequalities – ensuring poorer communities have the resources they need to tackle health inequalities. There are far fewer GPs per head of population in some areas where there is the greatest need, e.g. in Barking & Dagenham and in Newham.
  

The proposals agreed by the JCPCT will improve the health of Londoners by:

• Specialising care for stroke, trauma and complex emergency surgery which will save hundreds, if not thousands, of lives.

• Offering a wide range of high-quality services, over longer hours, and closer to people’s homes in polyclinics.

• Tackling some of the health inequalities in London by making services available to everyone.

• Using staff and other resources to provide better value for money.

The proposals were developed by clinicians and are supported by the public and organisations. They will improve quality and access of healthcare in London.

• Develop some hospitals to provide more specialised care to treat the urgent care needs of trauma, stroke, complex emergency surgery and children.

• Extend access to GPs, especially before 9.00am, in the evenings and at weekends.

• Whether polyclinics would provide improved patient care in London.

• Provide more outpatient care, minor procedures and tests in the community, closer to people’s homes.

• More money for services for people with long-term conditions, including more GPs, specialist nurses and other health professionals.

• Polyclinics will provide better patient care, with more convenient opening hours and a wider range of services closer to people’s homes. Patients will have more choice of services while continuing to see their own GP.

• They provide better access to GP services, clinical specialists, community services, urgent care and other health professionals.

• Polyclinics come in all shapes and sizes – we need to find local solutions to local needs.

• This is about investing in and enhancing primary care in the community and building on the best of general practice.

Look at the statistics

• A national survey by the British Medical Association (BMA) found that 75% of General Practitioners feel their premises are not suitable for future needs and 37.5% of GP practices could not be adapted to meet Disability Discrimination Act access requirements.  (Framework for Action).

• Only 27% of Londoners are very satisfied or fairly satisfied with the availability of outside working hours care (Framework for Action).

• Patients in London are less satisfied with access to GP services and opening hours than nationally.

• Over half of the public and many professionals support the idea of the polyclinics. The public were consulted on the stand-alone and federated models. 

• 80% of respondents to Healthcare for London: Consulting the Capital thought it would be useful if GP surgeries were open for appointments in the evenings and at weekends.

Questions and answers

The BMA, LMC, GP Newspaper and Pulse are all actively campaigning against polyclinics.  How can you proceed with these plans in the face of such opposition?

• We have to change in order to give Londoners the healthcare they deserve – no change is not an option. I would be worried about any professional who thought his or her service is perfect. We can always do better for patients. Polyclinics are a ‘call to action’.

• The RCGP supports the ‘federated’ model of polyclinic (where it operates across a network of GP practices rather than under one roof).

• Our clinical advisory group (representing a wide range of professionals and specialisms) supports the proposal because of the benefits it will have for patients.

• A polyclinic is a new way of GPs and other health and social care professionals working together to provide care closer to people’s homes. It is a more holistic approach that aims to address all the health and social care needs of an individual.

• A polyclinic might operate as a network of individual GPs practices (each with different specialisms) and one central ‘hub’ or point of contact. This is called the networked model.

• Alternatively GPs – along with other services – might be based under one roof or at the front door of a local hospital. We believe that this is likely to happen only in a minority of cases.

• Polyclinics can be different shapes and sizes – this is about finding local solutions to local needs. This means that PCTs and the public can decide on the right set-up for their community in line with local health issues and demographics. For example, a community may have higher populations of younger or older people and will therefore want to focus on services for those people (e.g. sexual health services for younger people or hearing problems with older people). Or TB maybe a cause for concern and they will want to develop services to deal with this.

You claim that polyclinics can offer a wider range of services, give some examples

A polyclinic could offer:

• GP services - with extended opening hours
• other health services such as ophthalmology or dentistry
• procedures, such as minor surgery
• outpatient appointments
• urgent care
• diagnostic tests - e.g. blood tests
• community services such as health information, advice on managing long-term conditions, community nursing and community mental health teams
• co-located services – e.g. including local authority, social care, mental health, leisure and the London Ambulance Service.

Why are you introducing polyclinics?

• They will offer a broader range of services. For example, it would be much better for all patients to be able to have blood test close to home.
• They will offer more convenient appointment times.
• They will help reduce health inequalities.
• We believe that they will expand the range of quality services to patients to offer more. We will be evaluating their success as they are implemented.

There is no single solution. The polyclinic model is flexible so that it can be developed with local GPs, other primary care professionals and local communities to create health and wellbeing services that meet their needs and reduce health inequalities. 

No. Current planning is for polyclinics to serve populations of around 50,000 and to support a core range of services.  However, PCTs can work with local clinicians and the local community to develop polyclinics to the size and shape they need to offer the services that local people need.

Our ideas of what a polyclinic looks like will continue to change and grow as they are implemented.

No. The relationship between the patients and his or her GP is extremely important. Patients will see their own GP as they do now for routine appointments. However, if your GP then identified that you needed a blood test, for example, that he or she could not provide, then you could go to another GP or clinic nearby for this, rather than having to go to hospital.

No. There is no intention to ‘impose’ Polyclinics on London’s communities. Patients can choose their GP.

NHS London does believe that there is a need for change and our expectation is that PCTs will look at the polyclinic model. However, it is up to PCTs and the public to decide the exact detail.

This is about offering people a wider range of services.

How do you think GPs will feel about being told how to run their primary care practice by a surgeon?

The proposals in Healthcare for London were developed by clinicians including GPs. There were six clinical working groups which helped shape A Framework for Action as well as a multitude of meetings and events. Additionally, more than 5,000 individuals and groups responded to Healthcare for London: Consulting the Capital.

They are being protective – and that is understandable as they care about their patients and want to ensure that we move forward carefully to build on the good things that many GPs have achieved.

Will GPs be ‘herded’ or forced against their will?

No.  GPs will not be forced into polyclinics against their will.  This would not be possible under existing GP contracts. 

GPs would be free to choose whether they joined a polyclinic or not. Their practice list would remain theirs wherever they chose to work from.

80% of Londoners said they wanted GP surgeries to be open for appointments in the evenings and at weekends. 

This may be one of the reasons why so many people attend A & E at these times when GP care might be more appropriate.

We don’t believe there has to be extra burden on GPs.  For instance, in the networked model GPs could work together to offer an extended hours service with each GP working perhaps one evening a month, instead of a day.

Will this mean less independence for GPs? Will they lose their premises, for example?

This is a big worry for many GPs but we believe that there are opportunities here for GPs to shape the way this develops. GPs may want to form consortia to bid for services, for example.

The polyclinic model does not mean GPs lose their independence and become salaried doctors. The model allows for partnerships buying or leasing premises for a same-site model or using their own premises in a network of practices.

Won’t polyclinics increase travel times?

• The networked (federated) model would have very little, if any, impact on travel time. This model could be more suitable in parts of London where the population is more spread out.

• Given the concentration of the population in London it is unlikely that anyone will be too far from a polyclinic even if journeys vary.

• We would need to look closely at any impact on travel of the single-site model; however patients would be able to access a much broader range of services in one place. If correctly sited on public transport routes travel times could stay the same or improve.

We will continue working with Transport for London to ensure that we understand the implications on travel times of any decisions. Work will also be done locally between PCTs and local authorities when local services are being planned.

The polyclinic model means that patients will spend less time travelling to hospitals.  Ensuring access and minimising travel times will be important when planning polyclinics.

• The RCGP (Royal College of GPs - largest membership organisation in the UK solely for GPs) supports the federated model.

• The RCGP believes that the status quo can’t deliver the healthcare services that patients need in the 21st century. They say what’s needed is a new model of health and social care that builds on the needs of patients and the best general practice has to offer.

• The best clinical evidence we have tells us that health problems, including mental health, can be dealt with by extending/enhancing existing primary care in the community.

• It doesn’t have to. GPs will continue to own their practice list no matter where they choose to work from.

• If GPs want to be proactive they can set up partnerships or not for profit organisations to tender for services.

• Most GPs are independent contractors and therefore could be considered by many as being private sector. 

• Some polyclinics might be owned by GPs in a partnership. Some may be owned by a joint venture between another private sector organisation and GP partnerships. Some may be owned by a variety of different forms of private sector organisations. Some might involve an NHS Foundation Trust.

Won’t this mean that local services such as community pharmacies might have to close?

Healthcare for London is working closely with professional groups including community pharmacists.  Pharmacy would be a core service provided as part of a polyclinic model. However, most Londoners would continue to use their local pharmacy for medication and self-care including repeat prescriptions; about 80% of prescriptions are repeats.

Community pharmacists already perform a very useful service in the community and this role is expanding meaning more people will visit their pharmacist for advice and treatment in the future, such as help with managing diabetes or stopping smoking.

What is the benefit of shutting down hundreds of GP surgeries in areas where primary care is being delivered to a good standard?

We are not advocating shutting down hundreds of GP surgeries where primary care is being delivered to a good standard. GP surgeries that are providing excellent services to all members of their communities will simply continue to do so.

Polyclinics do not replace GP practices.  There are various sources of savings e.g.:

• Preventing unnecessary hospital visits, particularly for people with long-term conditions. There is strong evidence that well-planned care for long-term conditions can prevent a large amount of emergency hospitalisations through proactive treatment in the community setting.

• Preventing unnecessary visits to A & E. There is significant evidence that London has excessive A&E usage; by improving access to primary care in extended hours we expect to reduce unnecessary A&E attendances.

• Developing minor procedures in primary care. There are some procedures which are currently carried out in hospital but should take place in primary care with lower costs.

• Stopping unnecessary hospital outpatients will free up patient and consultant time.

Have you done any modelling about the scale of potential savings of moving care from hospitals into the community?

We believe a number of services can be provided to the same quality possibly more cheaply in the community. We are working on modelling tools for PCTs to look at the impact of this.

We will be evaluating polyclinics as they develop. All 31 PCTs in London are looking at the polyclinic service model through a three-month developmental programme.

There are none in London currently. However, there are examples of GP practices already offering an expanded service in London.

There are a lot of single-handed GP practices, out in the East End in particular. It is said that a polyclinic could have about 25 GPs practicing in it.  If you can hardly get enough GPs in the East End, where are you going to get them from and will they happily move in together?

One of problems is a lack of good buildings so the single site model could help attract GPs to the East End.

Remember too that the polyclinic service model is not restricted to a same-site option.  A number of GP practices linked together to provide a range of services could operate as a networked (federated) polyclinic service. So you could have a network operating (and supporting each other) over a wide area.

You seem to be saying the preferred model is the federated polyclinic. Are you now backtracking and saying that the single site model is not a good option after all?

We are listening to clinicians and the public and looking at both options. PCTs and the public will need to decide which model works best for their particular community.

The King’s Fund report says that the evidence is not there to support polyclinics; that people will have to travel further and that London does not have the workforce needed.

The King’s Fund report was produced in response to the single site model. There is no evidence that polyclinics won’t work – the truth is that they are a new idea. The report was very helpful in pointing out some of the considerations we need to take on board in developing the model further.

How many polyclinics does London need and what will be the cost of running them?

We don’t know this yet. If the JCPCT decides that the polyclinic model should be implemented in London, PCTs will need to determine what is right for their community based on local needs. We’re developing financial modelling tools which will help PCTs evaluate the likely costs.

Are PCTs planning services similar to a polyclinic model, pre-empting the outcome of consultation?

Some PCTs have been developing plans over recent years to improve health and wellbeing services in their communities.  Some may already include plans to deliver services similar to the polyclinic service model.  Healthcare for London would not want to stop this work; in fact, we will encourage PCTs to look at the lessons learnt and information gathered during Healthcare for London: Consulting the Capital, to see if it will help them develop these plans further.     

Won’t local hospitals close if you move services to polyclinics and out of local hospitals?

Healthcare for London is not proposing any closures of local hospitals. We need to look at what produces best healthcare for the community.

We are modelling the impact of polyclinics and we need to wait for the outcome of this. The important principle is better patient care.