GP-led health centres and polyclinics

Posted on August 5, 2009. Filed under: GP-led health centres, Polyclinics, Reports/papers |

The Chartered Society of Physiotherapy | accessed 5 August 2009

Published: 10 Jun 2009
Author: Gary Robjent – Head of Public Affairs and Policy Development

The terms “polyclinic” and “GP-led health centres” have been applied to a number of different models aimed at improving access to primary care services. This briefing sets out the background to these initiatives.

Definitions and development

Whilst not a specific recommendation, the White Paper Our Health, Our Care, Our Say (DH 2006) set out the principle to shift care from hospitals to more community-based settings. This approach was reaffirmed by Lord Darzi in Our NHS, Our Future (DH 2007), perhaps best summarised by the principle to ‘localise where possible, centralise where necessary’.

The term ‘polyclinic’ has been applied to a number of different models. In some, the defining feature is the co-location of a range of specialties. In others, the polyclinic is an organising principle in which services on several sites work together.

The co-located model in Healthcare for London (NHS London 2007) includes two significant proposals for the delivery of health care:

  • a major concentration of current GP practices into larger facilities, with 70 per cent of GP practices to be sited in polyclinics
  • a significant shift of some specialist services from hospital to community settings, with 40 per cent of all outpatient activity to be delivered in polyclinics.

One of the options in the original Healthcare for London report, for example, was a hub-and-spoke model in which the polyclinic was more of a referral centre for a number of practices that worked together but remained in their separate locations. In the main, though, the polyclinic is perceived as a building to co-locate GPs alongside specialists and a range of other services. NHS London has proposed the development of polyclinics serving populations of around 50,000 and housing a variety of primary, community and secondary care professionals.

The plan for the GP-led health centres was a development of the recommendation Lord Darzi made in A Framework for London (NHS London 2007) that polyclinics should be established in each PCT in NHS London – the first seven opened in April 2009. GP-led health centres were a response to two developments in primary care: changing patient expectations and the desire where possible to move services out of hospitals closer to where patients live.

The centres have several objectives:

  • to increase the capacity of primary community services and thereby improve access;
  • to provide more choice for patients;
  • to tackle some of the inequalities in healthcare; and
  • to encourage team working between a range of health care professionals located in one building.

Subsequently, the Royal College of GPs proposed a ‘federated model’ (RCGP, February 2008) and this has become an accepted alternative means of delivering the centres. In a federated model a network of GP practices remain in their existing buildings but are linked to what the Royal College of GPs called a local referral centre, which provides diagnostic tests and outpatient clinics, either housed in a separate building or in a GP practice.

The NHS Next Stage Review Interim Report (DH, October 2007) identified that more than 80% of NHS patient contact takes place in primary care. Most secondary and tertiary care is accessed through primary care, with millions of people receiving community-based care, for example for the 15 million people in England with long term conditions.

The report states,

‘We should invest new resources to enable PCTs to develop 150 GP-led health centres, situated in easily accessible locations and offering a range of services to all members of the local population (whether or not they choose to be registered with these centres), including pre-bookable appointments, walk-in services and other services. 

The guiding principle will be to ensure that any member of the public can access GP services at any time between 8am and 8pm, seven days a week. These centres will reflect local need and circumstance and maximise the scope for co-location with other community-based services such as diagnostic, therapeutic (eg physiotherapy), pharmacy and social care services. PCTs will be expected to commission these new health centres on a level playing field from existing GP groups or other providers.’

This was supported in the 2007 Pre-Budget Report and Comprehensive Spending Review which stipulated that health care should be ‘personalised – with a maximum of 18 weeks from referral to treatment by next year, new services for people with long term conditions and new measures to increase GP access, including additional resources for over 100 new GP practices in areas with low provision and 150 new health centres open 7 days a week;’

In the subsequent Statement to Parliament (Hansard, 10 Oct 2007 : Column 297. ‘Health and Social Care’) The Sec. of State for Health, Alan Johnson said,

‘Lord Darzi’s interim report drew out four overarching themes for the NHS over the next 10 years: fairness, personalisation, innovation and safety. First, an NHS which is fair: no single institution has made a greater contribution to social equity in this country than the NHS, yet 60 years on, whilst the health of all income groups has improved dramatically, stubborn health inequalities remain. We will begin to address one important element of this problem with a new £250 million access fund ….. 

‘The new access fund will also establish at least 150 new GP-run health centres in easily accessible locations, open seven days a week from 8 am to 8 pm. These will offer bookable appointments, walk-in services and, in some cases, access to physiotherapy, diagnostics and social care services. There will be at least one in each PCT area.

In response to the Statement the CSP issued a comment. Sarah Bazin, CSP Chair of Council, said:

“The CSP welcomes the recognition by the Secretary of State of the value of ready access to physiotherapy services. The provision of physiotherapy in the proposed GP-run health centres is good news for patients, especially for those with musculoskeletal and long-term conditions, seeking greater control of their condition. Prompt intervention by physiotherapists can achieve savings for the public purse, for example with the 500,000 plus people with musculoskeletal disorders claiming incapacity benefit.

“With up to 2,000 unemployed graduate physiotherapists waiting to treat and care for patients, there should be no delay by PCTs in taking advantage of this resource.”

The NHS Operating Framework for 2008-09 (DH 2008) made it a key priority for PCTs to complete their procurements for these new services by 31 March 2009, reflected in Annex C the ‘Vital Signs’ for inclusion in the local operational plans. It was expected that around 21 centres would be open to the public by then, with the great majority of the remaining centres opening during the rest of 2009.

The DH has avoided a prescriptive national approach; it is for SHAs and PCTs to design the service on the basis of local health needs assessments. Keeping requirements to a minimum is designed to allow PCTs to develop services which best meet locally identified need and to encourage innovation. However, the Department has set a small number of core requirements that PCTs should include in their specifications to ensure consistency across the country.

The centres should be:

  • in an easily accessible location
  • open 8am-8pm, seven days a week
  • offer bookable GP appointments and walk-in services
  • provide services for both registered and non-registered patients; and
  • maximising opportunities to integrate and co-locate with other community based services.

The only requirement on staffing is that health centres must have at their core the provision of GP services and staffing to enable patients to see a GP from 8am to 8pm, seven days a week.

The DH stipulated that the centres would be provided under the Alternative Provider of Medical Services (APMS) contract so that healthcare professionals other than GPs or commercial providers of healthcare could bid to run the centres.

The Health Committee inquiry into the Next Stage Review concluded that, ‘while polyclinics and GP-led health centres can bring benefits, we are disappointed that the Department is introducing them without prior pilots and evaluation.’ It also noted that, ‘GP-led health centres offer the potential for closer collaborative working between GPs, pharmacists and other clinicians. This should benefit patients by providing them with more integrated care. However, simply bringing health professionals under the same roof does not necessarily mean that they will work better or that they will start working together.’ (HC 53-I, 2008-2009).

Consultation

As part of the Next Stage Review, the DH published Leading Local Change (DH, May 2008). This provides the context for the publication of the 9 SHA strategic ‘visions’ which provide the framework for service development locally over the following ten years. It makes five pledges that PCTs should have regard to, to ensure that ‘the right changes happen for the right reasons, based on what is clinically best for patients.’

  1. Change will always be to the benefit of patients. This means that they will improve the quality of care that patients receive – whether in terms of clinical outcomes, experience, or safety.
  2. Change will be clinically driven. We will ensure that change is to the benefit of patients by making sure that it is always led by clinicians and based on the best available clinical evidence
  3. All change will be locally-led. Meeting the challenge of being a universal service means the NHS must meet the different needs of everyone. Universal is not the same as uniform. Different places have different and changing needs – and local needs are best met by local solutions.
  4. You will be involved. The local NHS will involve patients, carers, the public and other key partners. Those affected by proposed changes will have the chance to have their say and offer their contribution. NHS organisations will work openly and collaboratively.
  5. You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.

The SHA ‘vision’ statements whilst all adopting an approach around the same 8 or 9 clinical pathways, do reflect the varying needs and aspirations within their region. These aspirations are ‘localised’ within the planning and commissioning process by each PCT.

Furthermore, the NHS Constitution (DH 2009) – currently subject to legislation – does also include the right to staff consultation. Section 3a states, ‘The NHS commits to engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements.

All staff will be empowered to put forward ways to deliver better and safer services for patients and their families.’ It also advises that in the same way that the national Social Partnership Forum offers an opportunity to discuss, debate and involve partners in the development and implementation of the workforce implications of policy similar arrangements are being developed at SHA level and other employers’

This briefing has been prepared in response to ARC motion 36 (2009) on Polyclinics.

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