Lord Darzi’s white elephant legacy

Posted on November 4, 2009. Filed under: GP-led health centres, News stories | Tags: |

Pulse | Editorial Comment | 4 November 2009

With GP-led health centres failing to hit their patient sign-up targets, is Lord Darzi’s dream of easy-access healthcare hubs turning into a highly expensive nightmare?

Dr Kailash Chand, GPC member and now a PCT chair, put it neatly. He said of Lord Darzi’s national network of GP-led health centres earlier this year: ‘They will poach patients from neighbouring practices or else they’ll become white elephants. Either way the taxpayer will be short-changed.’

Well, as it turns out, Darzi centres look destined to become more elephant than poacher. Pulse’s investigation this week reveals two-thirds of centres are on course to miss their PCT targets for numbers of registered patients. In some cases, they are registering patients at only a third of the rate they need. One has only 100 registered patients after six months of operation.

There is early evidence, too, that the chances of a GP-led health centre being a success are particularly poor in areas that already had an ample supply of doctors. Two of the four centres in underdoctored areas that provided figures were on course to meet registration targets, but just three of 11 in areas that were not underdoctored.

It may be a tentative trend, but it’s exactly what you would expect – the result of a simple mismatch between demand and supply. It’s that mismatch that goes to the core of the polyclinic controversy. Nobody – not Pulse, not the BMA – objected to introducing Darzi centres where there was local appetite for them. It was their blanket imposition, even in the face of active opposition from local GPs and patients, that was so destructive. It is partly vindicating, partly dispiriting, to have the futility of that policy so starkly exposed.

So the blanket rollout of Darzi centres was a mistake. But don’t just take that from Pulse – take it from the Department of Health.

It admitted at a recent NHS ‘lessons learned’ event that undertaking a mammoth 264 APMS procurements all at once had run the risk of ‘saturating the market’. And the DH conceded, in a rare mea culpa it had presumably hoped to keep private, that forcing through plans for Darzi centres without proper consultation had also been an error. ‘We should have built in more time at the first and final stages of procurements, particularly for engagement with the public,’ a presentation made at the meeting said.

It will be fascinating to see how those observations will feed into the Government’s promised review of the cost-effectiveness of Darzi centres, if that ever sees the light of day. A previous Pulse investigation found some centres were due to cost as much as £560 per registered patient, even by the projected figures for enrolment. If actual enrolment is only at a fraction of what had been expected, the cost per patient will be even higher – in the short term at least.

In the longer term, though, those running Darzi centres know a lack of patients is a threat to their existence. They are now urging PCTs to renegotiate contracts to focus more heavily on walk-in consultations – an area where demand has been much healthier.

The Government has spent two years and £250m rolling out its network of Darzi centres and practices. It will be hard to see that money as well spent if the Government ends up with a network of walk-in centres – exactly what it had when it started.

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