Despite the “great success” of the 20,000 capacity Loxford Polyclinic in Ilford Lane, Ilford – which nearly 17,000 people have registered to use in just over two years – plans for more polyclinics have been put on hold.

The brakes have been put on the plans while health minister Andrew Lansley decides on the future of the Health for North East London programme of changes, which include the proposed closure of the borough’s only A&E department.

In 2008, health bosses declared plans for a polyclinic on the site of King George Hospital, Barley Lane, Goodmayes, that would ease pressure on its A&E.

But the future of any GP and urgent care at the Goodmayes site hangs in the balance as part of the wider review to be considered by Mr Lansley from tomorrow (Friday).

A spokesman for Outer North East London NHS (ONEL) said: “Under the current NHS reforms it is now GPs, not politicians, who must take the lead in deciding which services are provided locally, taking on board the views of their patients and other stakeholders.”

Opened by Lord Darzi in April 2009, Loxford’s clinic was the first purpose-built polyclinic in London and a recent patient survey revealed 90 per cent of patients rated the service as good, very good or excellent.

Polyclinics include GP and outpatient services, minor operation and urgent care clinics.

The ONEL spokesman said: “This doesn’t mean that no new health centres or other facilities will be built going forward – just that we await the decision on the Health for North East London plans before GP consortia can reassess the picture locally.”

A decision on the future of King George Hospital’s A&E and labour ward is expected from Mr Lansley later this year.

Walk-in health centres are closing or having their opening hours reduced because they have proved so popular they are becoming unaffordable.

Most of the centres opened less than three years ago under a flagship Labour scheme aimed at improving access to primary care and reducing demand on A&E services.

But instead of being used by people not registered with a doctor, the walk-in centres have also proved extremely attractive to patients unable to get timely or convenient appointments with their own GPs.

This has meant demand for the services has often been far higher than anticipated and now primary care trusts (PCTs), many of which are struggling to balance their books, are being forced to cut opening hours, or even close the centres.

Flawed thinking over policy 
Research by the Bureau has identified 18 centres across the country that have been closed, are under threat of closure or have substantially reduced their opening hours.

Instead of unregistered patients, most of those seen at walk-in centres are people that have been unable to get a convenient appointment at their GP surgery.

In Yorkshire Bradford’s Hillside Bridge centre, which was opened in 2008 by then health secretary Alan Johnson, was expected to provide care for 540 walk-in patients by 2013. By December last year it was already seeing 1,530 patients, with no corresponding fall in A&E admissions registered in local hospitals. The centre’s opening hours are  currently under review.

This April a centre in Bedford had its opening hours cut by an hour and a half a day because excess demand meant it was running £100,000 over budget.

A walk-in service in Barnsley closed last October after being overwhelmed by four times theexpected number of patients. And in Calderdale, West Yorkshire health bosses are reviewing the future of two walk-in centres where demand has put huge pressure on the facilities. Their hours have already been cut.

Health chiefs in many areas incorrectly predicted the centres would mainly attract patients not already registered with family doctors, and they expected A&E attendances to plummet as a result. However there is little evidence that this has been the case. Instead many of the patients seen at walk-in centres are people that have been unable to get a convenient appointment at their GP surgery.

NHS Calderdale medical director Matt Walsh told the Yorkshire Post the centres were unaffordable: “The level of demand is much higher than we commissioned. The majority of patients using the walk-in are doing so with non-urgent conditions in core hours when they could be seen by their own GP practice,” he said. “There has been no reduction in A&E attendances and patients have not chosen to register with the practice.”

Closures across the country
Other areas where centres have closed or are closing despite their popularity include Salford andNottingham which have each closed two walk-in centres, Manchester, which is closing three, andStockport, whose centre is closing during GP opening hours. NHS chiefs are considering closing a further centre in Peterborough.

In Trafford a centre has been closed since December 2010, “until further notice”.

In the South East, Haringey PCT axed a walk-in centre in March after deciding it was “not an appropriate use of resources”. And last year NHS Bromley blamed its entire primary care deficit on its walk-in centres contract, which it claimed had created “artificial” demand for services.

In some areas local pressure has forced PCTs to rethink their plans. In Southampton, a walk-in centre has been reprieved after former health secretary John Denham declared it was  “too important to close” but its opening hours are to be slashed. Two centres in Derby will also be kept open for a further two years following a local outcry over  plans to close them.

GPs have complained that the centres are paid far more per patient than their own surgeries receive.

In February 2011 the Government announced the NHS Commissioning Board would review all GP-led health centre contracts once they had expired. It said it would be up to GP consortia to decide whether they wanted to re-commission the “open access” parts of the centres.

GPs have complained that the walk-in centres are paid far more per patient than their own surgeries receive.

NHS Partners Network, which represents private providers of NHS services, said it would challenge the decision to review the contracts under competition law if it became the basis for a nationwide round of closures.

Research by the Bureau earlier this year found six privately run commuter health centres based at railways (three in London, and one each in Leeds, Manchester and Newcastle stations) were also being closed. However unlike the general walk-in GP surgeries, the commuter centreswere failing to attract enough patients.

In 2010 the flagship commuter centre in Manchester’s Piccadilly run by Atos Healthcare shut, a contract for a centre in Liverpool Street was not renewed, and Newcastle’s commuter centre (Care UK) closed in April 2011. This month the NHS confirmed that the Leeds’ centre would also close.

Peterborough Today | Published on Saturday 18 June 2011 12:00

A PATIENT liaison officer at a health centre spoke out against a panel of NHS chiefs considering its closure.

Amy Fry, who works at the Alma Road NHS Primary Care Centre, spoke passionately about its role for the Millfield community at the Central and North Neighbourhood Committee meeting on Thursday.

She spoke to the gathering at the Gladstone Park Community Centre after hearing representatives from NHS Peterborough discussing health options for the city, which include the permanent closure of the centre in Alma Road.

Ms Fry said: “The board has not done its research in this area.

“There is a high population density here – on some addresses we have up to 10 people living in a property.

“That is not taken into account and the people here need this surgery.”

NHS Peterborough was represented at the meeting by Peter Wightman, interim director for primary care, and Dr Mike Caskey, GP commissioning lead.

They discussed plans to switch to a system with fewer but larger health facilities across the city.

Dr Steve Watson, who runs a surgery in Lincoln Road, told the meeting he believes his surgery could absorb Alma Road’s 2,000 patients.

He said: “We have 11,250 patients – we could keep up with anything Alma Road does but they could not keep up with ours.

“If nothing changes we will not see the next decade in. We have problems with the building.”

Yorkshire Evening Post | By Katie Baldwin
Published on Thursday 16 June 2011 07:22

A WALK-in centre tailored to provide NHS health care to commuters in Leeds city centre is to shut – because it wasn’t used by enough of them.

The facility at The Light shopping centre on the Headrow will close later this year after the Government decided not to renew the contract of the company running it.

Six commuter walk-in centres, run by private firms providing NHS care, opened across the country between 2005 and 2007 – four are now shut.

The Leeds centre, operated by BMI Healthcare, opened in 2007. It will close when its contract runs out in November. It was open every weekday and aimed at those working in the city centre but figures showed only 22 per cent of users were actually commuters.

NHS Leeds bosses said a panel of experts, including GPs, had agreed to ensure there were enough healthcare services available elsewhere following its closure.

Philomena Corrigan, executive director of strategy and commissioning at NHS Leeds, said the contract for the centre was with the Department of Health but NHS Leeds managed it.

“The Department of Health does not intend to continue delivering services from commuter walk-in centres and this means the Leeds centre will close on November 30. The walk-in centre was commissioned to have a focus on commuters but they have not been the primary users.

“In fact, only 22 per cent of users in the year October 2009 to September 2010 were categorised as commuters with the other 78 per cent of users being from the local area.”

She added that since the centre opened, other services had expanded, including the creation of West Yorkshire Urgent Care Services, a walk-in centre and GP practice at Burmantofts Health Centre had opened and opening hours had been extended at other NHS walk-in centres at Middleton and Wharfedale Hospital in Otley as well as at some GP surgeries.

There is also a GP practice in the Light which is run separately and will be unaffected.

A patient watchdog group said it was important to ensure there were adequate health services.

Maureen Idle, of Leeds Hospital Alert, said: “Although we were opposed to private providers in the health service, if they are shutting the centre and even a small number of people have been using it, what are they putting in place for them?”

A Department of Health spokesman confirmed they were no longer contracting services from any commuter walk-in centres – based in London, Manchester and Newcastle as well as Leeds – apart from possibly one in the capital.

The spokesman said: “The Government is moving away from the type of contract that ties the NHS into spending money unnecessarily. Any decision to re-let a contract for such a centre is entirely a matter for local commissioners.”

Four of six commuter walk-in centres created in a £50m Labour government scheme to give busy workers better access to healthcare have closed, the Bureau of Investigative Journalism can reveal.

The walk-in clinics were created as a part of the Independent Sector Treatment Centre (ISTC) scheme, which outsourced procedures to private providers to reduce NHS waiting times.

The table below details how much was spent on the six centres.

Source: Department of Health

Almost two-thirds of trusts across England are writing in tough new ‘variations’ that in many cases allow them to unilaterally terminate PMS contracts if GPs don’t agree to reductions in funding or tough new requirements for payment.

The practice of writing in variations that allow unilateral termination could be declared illegal next month when a landmark case brought by GPs in London challenges attempts to force through 40% cuts in funding under the threat of closure.

The case was brought after the Department of Health inserted a new clause into PMS contract regulations last year that appeared to give the green light for terminations ‘without grounds’.

Our investigation reveals trusts across England have written variations into practice contracts or are in the process of doing so, with many specifically inserting clauses allowing unilateral termination.

PCTs are also requiring GPs to hit tough new performance targets, with one tying funding to GPs’ ‘use of resources’ by requiring them to adhere to specific care pathways.

NHS Sandwell has written in a host of new indicators to PMS contracts, including ‘adherence to local clinical pathways for diabetes and orthopaedics’ and achieving ‘a minimum number of appointments per 1,000 registered patients’.

NHS Sandwell would not comment on whether its targets amounted to payments for restrictions to referral.

A manager close to the PMS negotiations told Pulse the changes ‘were implemented in a very messy fashion’.

NHS Wolverhampton City has written in new indicators requiring PMS practices to operate Choose and Book and extended opening, carry out in-house surveys with 25 patients per GP, and develop an action plan for practice improvement.

Of 35 PCTs providing information to Pulse, 21 have written variations into PMS contracts in the past year, or are in the process of discussing variations.

At least one-third of PCTs, including three trusts in the North East, and nine across London, have written in variations allowing termination, leaving their actions open to legal challenge.

In some cases, such as NHS Sunderland and NHS North East Essex, this was the only clause inserted, although it leaves PMS practices open to the imposition of further performance management measures in future.

GPC negotiator Dr Chaand Nagpaul, a PMS GP in Stanmore, Middlesex, said: ‘What is important is to ensure reviews are being carried out for the right reason, to ensure there is a fair contract in place, that promotes quality care and allows for innovation. Lamentably, many PCTs are misusing the contract to vary terms for the purposes of cost efficiencies.’

Dr Jane Lothian, a PMS GP in Ashington and chair of Northumberland LMC, fought a battle against her PCT over the imposition of variations to PMS deals back in 2008.

She told Pulse some of the measures being pursued by trusts were ‘ludicrous’: ‘My fear is that [reviews] will be used to impose non clinically-sensible clauses. You’d be into very dangerous ground if you started restricting for referrals contractually.

‘Measuring the number of appointments is ludicrous and an extremely crude measure which shouldn’t be used.’