GPs will visit Downing Street this week to deliver a petition signed by thousands of patients to Gordon Brown.
The petition condemns government plans to close down GP surgeries and health centres in favour of new polyclinics – which would bring together GPs, specialist clinics, x-ray facilities and blood tests in large centres, likely to be privately run.
The scheme fits with what is happening elsewhere in the public sector – everything is getting bigger and further away, and is increasingly under the control of private companies.
But the government faces a big problem with its polyclinic scheme – GP surgeries remain incredibly popular with the public. So it has been orchestrating a press campaign to discredit GPs.
Polly Toynbee’s recent article in the Guardian newspaper was a good example of this. In it she claims that GPs’ opposition to polyclinics stems from pure self-interest.
She tries to undermine any sympathy with GPs, talking of them having “life-long contracts that can’t be removed, with a guaranteed income, and large increments for doing things that should be part of their job”.
Toynbee argues that polyclinics will ensure a more even distribution of GPs around the country. Nothing could be further from the truth.
Polyclinics will be in Private Finance Initiative (PFI) buildings funded by Virgin, United Healthcare and other companies.
Virgin’s business model is precisely to build them in more affluent parts of the country where they can market private physiotherapy and other services alongside NHS care.
The polyclinic scheme is about to piloted in London and will then be rolled out across the country. About 50 GPs will be press-ganged into each polyclinic. The result will be two-fold.
There will be a massive increase in travelling time for patients to go and visit the doctors, and there will be a complete loss of personal care.
So why is the government pushing polyclinics? Fundamentally it is because general practice has been the biggest obstacle to the government’s plans to privatise the health service through stealth.
Plans in the hospital sector are already far advanced. New hospitals are now only built through PFI, where private firms own the buildings.
Where hospitals are not failing, they are being destabilised by the opening up of privately run “Independent Treatment Centres” next door.
But general practices have been more difficult to hand over to the multinationals because they are already run by groups of GPs in partnership with each other.
Only by herding GP practices into polyclinics can they be grouped together into packages large enough to become attractive to private firms such as Boots, United Healthcare and Virgin to buy out.
It’s not just GPs and patients who are against polyclinics. The influential health policy unit the King’s Fund has just published its independent evaluation of the polyclinic idea.
It found no evidence for the idea that bringing together multiple services in one building leads to higher quality care, and no evidence that larger GP practices provide a better service than smaller ones.
It also found that, contrary to government propaganda, polyclinics would make accessibility more difficult for most patients, and argues that successful examples of integrated care in polyclinics in other countries cannot be transferred here because the NHS has a different structure.
The evaluation points to an alternative way of organising health care. It argues for new ways of working between GP practices, networks of practices, rather than single polyclinic buildings.
This model is also supported by the Royal College of GPs and the British Medical Association (BMA).
So far there has been very little public debate over polyclinics. Seven out of ten patients surveyed by the BMA had not heard of the £4 million “Healthcare for London: Consulting the Capital” exercise and 57 percent of people still don’t know what a polyclinic is.
A staggering nine out of ten patients wanted to keep their NHS GP at their present surgery and to see any additional NHS funding spent on developing the services it already provides.
The government does not want a debate because it would lose it. It especially does not want a debate about who will own and run the polyclinics.
It confuses the public with talk of instant access to care and 12 hours a day, seven days a week opening times, without mentioning the inevitable loss of personal doctoring that goes with it.
And it conceals the fact that this is part of a long-term plan for salami-style privatisation of the NHS.
Kambiz Boomla is a GP in Tower Hamlets, east London
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