Independent sector treatment centres

Posted on October 9, 2009. Filed under: ISTC, Reports/papers | Tags: |

The King’s Fund | Author: Chris Naylor, Sarah Gregory | Published 1 October 2009 | accessed 9 October 2009

Independent sector treatment centres (ISTCs) provide services to NHS patients but are owned and run by organisations outside the NHS. This briefing paper explains why ISTCs were introduced, and how they are funded, staffed and regulated. It assesses their impact so far, including the quality of their services and whether they provide good value for money. Finally, it examines what their future may be now that the contracts ISTC providers hold with the Department of Health are beginning to expire.

2441_ISTC_Briefing-1 Independent Sector Treatment Centre (pdf)

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Andy Burnham’s preferred bidder pledge questioned

Posted on September 24, 2009. Filed under: Journals, Providers | Tags: , , |

Health Service Journal | BY REBECCA EVANS | 24 September 2009

Questions have been raised over the implications for competition and world class commissioning of health secretary Andy Burnham’s statement that the NHS is the “preferred provider” of services.

Previous Department of Health policy had been that “any willing provider” should be considered when commissioningservices.

But in a speech last week at the King’s Fund, in whichMr Burnham stressed the importance of raising quality, he said: “The NHS is our preferred provider. But it is the important job of the commissioner to test whether these services provide best value and real quality.

“Where a provider is not delivering quality – and the new accountability information will more readily demonstrate that – we will set out a clearer process that will provide an opportunity for existing providers to improve before opening up to new potential providers.”

Answering questions after his speech, he said NHS providers should be given at least one opportunity to improve before commissioners went out to tender for an alternative provider.

Unison senior national officer for health Mike Jackson told HSJ the speech was significant: “I think now there’s clarity that the NHS is the preferred provider and there ought to be co-operation before competition.”

But Primary Care Trust Network director David Stout said the speech “would potentially cross over quite a number of the co-operation and competition panel principles”.

DH spokeswoman said: “The health secretary signalled the need to clarify policy and guidance to ensure that whilst putting quality of the heart of everything we do in the NHS, staff were treated fairly by being given an opportunity to improve performance and services before commissioners considered engaging with alternative providers.”

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The provider-commissioner split: Getting it right

Posted on April 24, 2009. Filed under: News stories, Reports/papers | Tags: , |

Health Services Journal | BY INGRID TORJESEN | 23 April 2009

A new King’s Fund report warns the chance to improve services could be missed if PCTs do not prepare for shedding their provider role. Ingrid Torjesen explains

Primary care trusts have until the start of November to hive off their provider functions. This will enable them to focus on commissioning by removing the conflict of being both a provider and commissioner, and thereby encouraging competition and improving community services. Or so the rationale goes.

However, history has taught us that new organisational structures alone do not deliver benefits and may cause new problems if cultural and workforce issues are not addressed

Lessons from mental health

In 1990, the care Programme approach introduced a framework for caring for people with mental health needs in the community. It consisted of a systematic assessment of health and social care needs, the drafting of a care plan and the appointment of a care co-ordinator to monitor and review that care.

Experience tells us that a team needs an elevating goal and a set of core values. These fundamental ingredients were frequently overlooked in community mental health teams, resulting in staff burn-out and low morale. Failure to identify what type of patient should be the focus of attention frequently left teams struggling to cope as they tried to encompass everyone referred to specialist mental health services. They now focus on those who have a wide range of needs from a number of services, and/or are most at risk.

A King’s Fund report, Shaping PCT Provider Services,outlines how PCTs should grab this opportunity to take a comprehensive strategic overview of community services required.

Candace Imison, deputy director of policy at the King’s Fund and author of the report, says it is essential PCTs clearly define the role they envision for community services, their priority areas for expansion and any important partnerships they want, such as joint health and social care teams for older people.

There is also a consensus that greater links with GPs would improve services and the appropriateness of GP referrals to them. Although this has been difficult to achieve in the past, practice based commissioning consortiums now provide a structure to which community services could link. “PCTs need to be signalling quite strongly that they would encourage that,” Ms Imison says.

Service demand

While overall demand for community services is growing, the pattern of demand varies between PCTs. Ms Imison says: “It is a real opportunity to be clear about the rate at which those demands are likely to increase and where they will be most focused – the very elderly, or particular pockets of chronic disease, such as renal disease.”

PCTs should also examine services individually to identify which sit naturally together, for example, children’s services may benefit from being strongly aligned to children’s centres.

“PCTs have a historical legacy of services rather than a set of services that have a strategic coherence to them,” Ms Imison explains. “The thing is to really focus on the big building blocks going forward. Providers desperately need that strategic context before they can start planning sensibly.”

Once that context has been determined providers will be able to determine which type of structure would suit them best, such as a social enterprise, private sector partnership, or community foundation trust. However, a new structure will not bring about change without new ways of working.

“It will not just be a question of putting teams in place; if they create new teams they need to work hard with them to be clear about exactly who the services are for, what the referral criteria are and what are the referral routes,” Ms Imison says.

The care programme approach in mental health is a good example of a change that did not deliver what was hoped for, because there was such focus on the mechanism and staff did not understand what it was designed to deliver (see box).

“One of the reasons why some community services aren’t able to offer a proper alternative to hospitals is because they are not operating 24 hours a day,” Ms Imison explains.

PCTs need to do a workforce plan taking account of their strategic needs. If they plan to provide more care at home, this should cover issues such as how community services can attract people who have historically worked in hospitals and are used to a 24-hour culture. It should also prepare for retirement bulges. “It is important people understand what the workforce pressures are and for them to make training and workforce plans that fill the gaps,” she says.

Facilities management

The Department of Health believes PCTs should hold on to community services’ premises because it will give them more flexibility as commissioners, but Ms Imison questions whether this is the best approach.

She says PCTs do not have skills and capacities as estate managers and, as estate is a fundamental part of service provision, holding on to it might create more problems for PCTs than it solves. “While you will get the benefit of the strategic flexibility – if someone isn’t delivering a service you are not tied into them because you have the estate – there is also an issue around the providers; if they don’t own the estate then their capacity to develop and move on their service is handicapped.” 

She recommends PCTs that decide to hold on to their estate consider working with neighbouring PCTs to share expertise, perhaps linking to work around LIFT.

PCTs are under huge pressures, so there is a risk that they could simply tick the boxes and deliver a new organisational structure and arm’s-length governance without seizing the opportunity to think about the services it should deliver.

“A lot of PCTs inherited this portfolio of services and just let them carry on as they were rather than being strong commissioners of them. There is probably a strong imperative not to challenge the status quo because everyone wants an easier life,” Ms Imison says. “The opportunity of the separation is that it forces PCTs to commission the services rather than just hosting the services.”

Tips for success

  • Focus on process as much as on structure
  • Ensure a widely understood set of values underpin the new ways of working and enablers for effective team working are in place
  • Focus on the patient groups who use these services and get significant input from GPs
  • Clarify referral pathways
  • Provide a service that is needs led rather than demand led
  • Group together services with strategic coherence
  • Ensure the community estate supports the model of care
  • Ensure workforce plans take account of a growing and ageing population, and staff retirement
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Shaping PCT provider services: The future for community health

Posted on April 24, 2009. Filed under: Reports/papers | Tags: , |

King’s Fund | Candace Imison | Published: 23 April 09

Primary care trusts (PCTs) provide a broad and complex range of community-based services. However, the commissioning and management of these services have been a challenge for the NHS and in particular for PCTs. As PCTs provide community health services, there is a potential conflict of interest for their role as commissioners. The government is clear that PCTs need to separate their provider and commissioning functions. This report examines the issues surrounding the placement of community health services, the options proposed for their reorganisation, and the steps that must be taken to deliver the desired transformation in community health services.

For full report click here.

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Polyclinics, polycautious

Posted on April 17, 2009. Filed under: Journals, Polyclinics | Tags: |

Health Services Journal | BY CANDACE IMISON, JO MAYBIN, CHRIS NAYLOR |  23 JUNE, 2008 

The King’s Fund has scrutinised the dream of polyclinics and urges planners to be cautious. By Candace Imison and colleagues

Government policy is driving a fundamental shift of care from hospitals to more community-based settings. There is a growing expectation that this shift will be supported by the development of a network of new facilities in which primary, community and secondary care services are co-located.

A variety of names have been applied to these types of facilities. Lord Darzi’s report on London called them polyclinics, while the subsequent interim report from the NHS next-stage review referred to GP-led health centres.

The terminology may have changed but the policy of developing facilities on this model continues to have considerable momentum, with primary care trusts being asked to begin planning 150 new health centres this financial year.

The King’s Fund has conducted extensive research to identify the implications of the polyclinic model. In particular, we have looked at the experience of developing facilities similar to the polyclinics using the NHS local improvement finance trust. This highlighted some of the opportunities and pitfalls for PCTs if they seek to develop polyclinics locally.

The conclusion from our report, Under One Roof: will polyclinics deliver integrated care? is that while there are real opportunities to improve the quality of care and address some longstanding problems in the English healthcare system, there is a substantial risk of failing to realise this promise if the transition to this new model is not managed well. There are also particular risks to do with cost.

Here we look at some of the lessons from the research and the action we believe PCTs need to take to ensure any facilities developed on the polyclinic model deliver their potential benefits for patients and the broader health economy.

Delivering integrated care

The experience of the local improvement finance trust initiative suggests locating services together in one building will not be sufficient to overcome traditional barriers between staff groups. The schemes have generally been managed as facilities rather than as an integrated healthcare service. Once in the new buildings, GPs remain as independent contractors, community staff accountable to distant managers, specialists firmly rooted in their host hospitals. There is no clear managerial or strategic leadership. Little formal investment seems to have been made in supporting joint working.

To ensure polyclinics deliver more integrated care, considerable amounts of time, effort and resources need to be invested in their planning and development. Co-location alone will not be sufficient to generate co-working between different teams and professionals. There will need to be a strong focus on developing new patient pathways and ways of working, and exploiting the opportunities for joint working presented by new technologies. Investment in change management will be required, and responsibility for ongoing clinical and managerial leadership will need to be clearly identified.

Service profile

It would be inappropriate to suggest a blueprint for services that should be provided in a polyclinic. Much of the merit of schemes of this scale is their capacity to adapt and respond to local circumstances. Commiss- -ioners should build the case for a facility based on the local need.

In our research, we found some common patterns in the types of services that had flourished in local improvement finance trust schemes. For example, providing direct access diagnostic services can hugely enhance the capacity of primary and community care staff to assess and treat a range of problems. Polyclinics also offer opportunities to foster multidisciplinary team working in the community, especially for those patient groups which need to access services most frequently. Good examples are the polyclinic acting as a “community service hub” and base for teams supporting:

  • integrated chronic disease management;
  • integrated older people’s services;
  • integrated children’s services;
  • integrated out-of-hours services.

In terms of general practice, commissioners could encounter difficulties in attracting practices to new facilities. A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas; hub-and-spoke or more federated models may be a better approach to pursue. Under this model the polyclinic would act as a central resource base for a co-ordinated network of practices.

Facilities development

The key for building is to design flexibility from the start. Many recognise services will need to change significantly over the life of their building. New building techniques enable flexibility to be built in. Walls, for example can be movable.

For best access, location is critical and polyclinics should ideally be developed in transport hubs. Local improvement schemes developed in sites with poor transport links have found this can offset the access gains hoped for by shifting services out of hospital.

Finding ways to integrate services more effectively within existing facilities or on existing sites would be preferable to developing a polyclinic in a less accessible location. Improved access by car cannot be assumed given local authority car parking restrictions on any new developments.

Polyclinics do offer opportunities to innovate and develop capacity in out-of-hospital care, but will require strong clinical and strategic leadership.

Our recommendations will help ensure success. You can download Under One Roof: will polyclinics deliver integrated care? free from http://www.kingsfund.org.uk

Recommendations

  • When planning, put services before buildings.
  • Build only where there is a demonstrable need.
  • Secure strong strategic and clinical leadership.
  • Invest in change and process management – to drive the more integrated care model.
  • Underpin developments with a full benefits realisation programme.

Service profile

  • Conceptualise as a community service hub of GPs and others.
  • Provide direct access diagnostics.
  • Focus on chronic diseases, high-volume activities and specialties

Facilities development

  • Design in flexibility.
  • Plan for transport accessibility.
  • Consider alternatives to a buildings-based solution, eg through exploiting IT and new technologies.
  • Ensure a strong clinical and managerial governance framework.
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King’s Fund bursts the polyclinic plan bubble

Posted on April 17, 2009. Filed under: Journals, Polyclinics | Tags: |

Health Services Journal | BY HELEN CRUMP | 5 June 2009

Lord Darzi’s proposals for a shake-up of primary care polarised opinion. This week the King’s Fund attempts to clarify the terms of debate and set out what will work – and what won’t, writes Helen Crump

Newspapers have described polyclinics as controversial “super-surgeries” that will put GP practices and hospitals at risk, poach patients and lay the ground for the privatisation of healthcare.

When health minister Lord Darzi first began to float potential new models for general practice last year, it is unlikely that these headlines were what he had in mind.

But with the launch of his strategies to shake up aspects of English general practice in and outside London, he was soon embroiled in a highly polarised and politicised row.

The spectre of the polyclinic first appeared in Lord Darzi’s Framework for Action report for NHS London in July 2007, before he became a minister. The centres were to offer a “far greater range of services” than GP practices while being “more accessible and less medicalised than hospitals”. They were to be “Londoners’ main stop for health and well-being support”.

Three potential models were outlined: co-located, with multiple practices moving onto one site; federated or hub and spoke, with a central core and a series of satellite practices; and merger, where smaller practices join in one large entity, possibly with satellites.

By October 2007, Lord Darzi, by now a health minister, had drawn up proposals for service reform in the rest of England.

Our NHS, Our Future proposed “newly procured health centres in easily accessible locations”, to be used by patients whether or not they were registered there. The centres would “reflect local need and circumstance and maximise the scope for co-location with… services such as diagnostic and therapeutic”. But the P word was conspicuously absent.

The Healthcare for London proposals focused on service redesign, while the centres outlined in Our NHS, Our Futureappeared to be designed to boost access to primary care and possibly to move some services out of hospitals into the community.

Alarm bells

But the battle lines were already drawn. The subtleties of the debate were soon obscured by a long-running scrap over the future of general practice.

This week, the King’s Fund stepped into the breach with a report aiming to clarify the impact polyclinics might have.

As chief executive Niall Dickson notes in Under One Roof, the term polyclinic “covers a number of rather different approaches to service delivery and can be used by different commentators to mean different things”.

Following analysis of LIFT (local improvement finance trust) centres similar to polyclinics, the think tank has found that in some areas the initiative could offer “real opportunities” to establish more integrated, patient-focused care, but only if considerable time, effort and resources are invested in their planning and development.

But the report’s long list of recommendations begins to sound alarm bells. It says “the primary focus of the initiative should be developing new pathways, technologies and ways of working rather than new buildings”; that “co-location alone is not sufficient to generate co-working between different teams and professionals”; and that “a major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas”.

The think tank also stresses that new plans “should not simply be a response to a new national target, but a well thought-out element of a broader strategic plan that responds to local needs”.

Longer waiting lists

In the absence of clearer definitions of what Lord Darzi means, the King’s Fund analysed the “co-located” model of polyclinic, serving 50,000 or more patients and including some outpatient and community services.

Its very equivocal report conjures up a worst-case scenario where a large proportion of outpatient services are moved into polyclinics without redesign of care pathways or investment in team-based models of care.

This hits quality, as specialists are split into different buildings and less able to consult with peers, and pushes up waits in some locations as queues form at each centre for the services of the dispersed specialists. Concentrating GPs in fewer, larger facilities also risks making access more difficult and where polyclinics attempt to provide 24-hour urgent care services not integrated with other services, costs rise with no parallel reduction in accident and emergency attendance.

But in the best case scenario, polyclinics are developed only where a local case can be made and are carefully planned and well supported locally. Local access and variety in GP practice size are sustained and integrated out-of-hours urgent care services are provided.

The King’s Fund finally comes out in support of a less radical “hub and spoke model” with the polyclinic as a central resource base in a co-ordinated network of practices.

But it adds that substantial savings are unlikely to be made under the drive and “significant” workforce implications will need to be addressed.

It also criticises the lack of piloting and evaluation of the initiative, on which primary care trusts are currently consulting their communities.

Mr Dickson says: “Scaling up some aspects of general practice is not a bad idea, and we certainly need more integration of specialists and generalists and to give patients more access to diagnostics.

“What our report is saying is that imposing a single model, in particular a co-located one, will not be suitable in every area.”

He adds that there is a “genuine issue” about shutting down smaller practices and calls on strategic health authorities and primary care trusts to focus on quality of care.

“Polyclinics may be a way of redesigning services around the needs of patients, but do make sure you’re bringing people together and making integrated pathways of care rather than just putting people in the same building,” he says.

“Really assess the access issue and workforce. You’ve got to be clear that you’ve got the right specialists to be able to populate the buildings.”

Mr Dickson warns: “We’ve got to where we are because of the fact that Lord Darzi wrote a report for London making it clear that it wasn’t a blueprint, got sucked into the department, and I suppose people have assumed what he meant in London he meant in the rest of the country.”

He adds that he is “not really sure” that the Department of Health should be telling trusts to build anything.

Weight of responsibility

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, feels the BMA’s main dispute is with the way the polyclinic proposals have been introduced.

He says: “It’s primarily about the implementation – it’s about the plan that’s being imposed on every PCT whether they really need it or not, and about giving PCTs and practices the real freedom to innovate that builds on existing practice rather than being expected to go out to tender for new practices that ultimately could destabilise those practices that are existing and thriving.”

So the weight of responsibility rests on PCTs and SHAs to salvage the initiative by making sure that they are developing models relevant to their communities in the new post-Darzi localised landscape. PCT Network director David Stout says models can be virtual, or use existing estates to bring clinicians together. “Careful planning will be key to success, and we hope to see a model develop that allows the required local discretion to meet local need, and builds on existing services in consultation with local people,” he says, adding that trusts must take the PR battle to their constituencies: “It is important that the public know this is not about closing their surgeries, but where appropriate, using a polyclinic approach to improve the access to and quality of care for all.”

Redbridge PCT chief executive Heather O’Meara, who is leading on London’s polyclinic programme, is keen to stress the importance of local strategic input. She says: “This has to be an integral part of a strategy for primary care, rather than being estates led.”

And she questions whether the London models proposed by Lord Darzi are as different as has been claimed: “The models are all the same if you look more carefully at them – a model co-located at a hospital will have more urgent care. For the others, it’s a gradation of how many GPs are providing primary care from the hub. “If you want to provide a service for 50,000 people, it’s never been the intention that every element of care would be provided in one building.”

She adds that the London PCTs have still not yet identified which types of polyclinic they will build.

And responding to criticism that various polyclinic models are unsuited to non-urban areas, she stresses that the three initial models were only in the London proposals.

Meanwhile, in the rest of the country, trusts are grappling with the thorny issue of how to design a GP-led health centre, and indeed, what such a development is.

The DH is keen that the new “Darzi centres” should be viewed as measures to improve access to general practice, with add-ons such as extra diagnostics to be decided on by trusts locally.

Michael Dixon, NHS Alliance chair and an adviser to Lord Darzi’s primary and community care strategy, says: “If you’re asking is this a Trojan horse to concentrate minds in general practice locally on improving access and seeing that the writing’s on the wall as far as lack of competition goes, I think the answer is yes. It’s about saying that life’s changed.”

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Doctors welcome King’s Fund report criticising polyclinics

Posted on April 17, 2009. Filed under: News stories, Polyclinics | Tags: |

Healthcare Republic | 06-Jun-08

Doctors have welcomed a King’s Fund report which found that polyclinics would mean worse access and higher costs.

Speaking at a BMA conference this week, Dr Jonathan Fielden, chairman of the BMA’s consultants’ committee, said: ‘The centrally enforced polyclinic plan holds no water, has no benefit and no financial gain.’

He called on the government the ‘dump’ the plan and work with the profession. ‘Together we will deliver the changes across the capital and the country our patients need.’

Opposition politicians, meanwhile, said that the report showed it was time to ditch the ‘one-size-fits-all’ approach.

Shadow Conservative health secretary Andrew Lansley said the government should ‘stop pushing forward with a scheme which is likely to lead to the closures of hundreds of GP surgeries and completely destroy the relationship between local people and their family doctor’.

But Nigel Edwards, policy director at the NHS Confederation, said that the report provided a ‘balanced review of the risks and opportunities’.

He called for the government to focus less on infrastructure and more on services.

jonn.elledge@haymarket.com

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‘No evidence’ to support polyclinics

Posted on April 17, 2009. Filed under: News stories, Polyclinics | Tags: |

GP Newspaper via Healthcare Republic | 05-Jun-08

Professor Martin Roland

Researchers warn that polyclinics could worsen access, increase cost and damage care.

Moving GPs into polyclinics could worsen access, increase costs and damage care, according to an influential think tank.

The King’s Fund report, ‘Under One Roof: will polyclinics deliver integrated care?’, says that there are ‘compelling arguments’ for providing integrated health services closer to patients’ homes.

But it warns that there is no evidence that larger GP practices provide better services, and argues that ‘a major centralisation of primary care is unlikely to be beneficial to patients’.

The report calls for PCTs to abandon plans to concentrate GP services into larger sites. Instead they should pilot several models, such as hub-and-spoke and ‘virtual’ polyclinics, it says.

Dr Niall Dickson, the King’s Fund’s chief executive, called for ministers to spell out ‘in unequivocal terms’ that PCTs will not be forced to build the new centres.

The report examines polyclinics abroad, as well as health centres built under Local Improvement Finance Trusts.

It argues that the planned reforms will not improve services without clinician support.

Other experts have echoed the report’s suggestion that policy should focus on redesigning services, instead of just moving them to new buildings.

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said at an event hosted by the think tank Civitas last week that polyclinics risked becoming an ‘expensive exercise in building new buildings without clear thought about what they would do’.

GPC chairman Dr Laurence Buckman said: ‘The report provides scientific, logical and international evidence that polyclinics won’t deliver the things the government believes they will.’

But he added: ‘This government doesn’t listen to evidence.’

A DoH spokesman said it was not policy to impose polyclinics outside London.

jonn.elledge@haymarket.com

Kings Fund report

Polyclinic risks

  • Benefits of co-location not realised because of poor planning.
  • Access to GP services damaged in rural areas.
  • Potential increase in costs.
  • Co-location does not mean more co-operation.
    Source: King’s Fund.

Think tank: ‘No evidence’ to support polyclinics

Healthcare Republic | 05-Jun-08

Moving GPs into polyclinics could worsen access, increase costs and damage care, a King’s Fund report has warned.

The report, ‘Under One Roof: Will Polyclinics deliver integrated care?’, says there are ‘compelling arguments’ for providing integrated health services closer to patients’ homes. 

But it warns that there is no evidence larger GP practices provide better services, and argues that ‘a major centralisation of primary care is unlikely to be beneficial to patients’.

The report calls for PCTs to abandon plans to concentrate GP services into fewer, larger sites. Instead they should pilot several models, such as hub-and-spoke and ‘virtual’ polyclinics, it says.

Dr Niall Dickson, the King’s Fund’s chief executive, called for ministers to spell out ‘in unequivocal terms’ that PCTs will not be forced to build the new centres. 

The report examines examples of polyclinics abroad, as well as integrated health centres built under NHS Local Improvement Finance Trust (LIFT).

It argues that changes will not improve services without clinician support.

Other experts have echoed this suggestion that policy should focus on redesigning services, instead of just moving them to new buildings.

Professor Martin Roland, director of the National Primary Care Research and Development Centre, said at a Civitas event last week that polyclinics risked becoming an ‘expensive exercise in building new buildings without clear thought about what they would do’.

GPC chairman Dr Laurence Buckman welcomed the report. He said:  ‘It provides scientific, logical and international evidence that polyclinics probably won’t deliver any of the things the government believes they will.’

But he added: ‘This government doesn’t listen to evidence.’

A DoH spokesman said it was not government policy to impose polyclinics outside London. New GP-led healthcare centres are ‘about additional access and choice for everyone’, he added.

jonn.elledge@haymarket.com

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Under one roof: Will polyclinics deliver integrated care?

Posted on April 17, 2009. Filed under: Polyclinics, Reports/papers | Tags: |

King’s Fund | Authors: Candace Imison, Chris Naylor, Jo Maybin | Published 5 June 2008

Government policy is driving a fundamental shift of care from hospitals to more community-based settings. There is a growing expectation that this shift will be supported by the development of a network of new facilities in which primary, community and secondary care services are co-located, often referred to as polyclinics. Will this model improve the quality and accessibility of health care and deliver cost savings? Drawing on published information and original research into facilities similar to the polyclinic model in the United Kingdom and abroad, this report identifies and explores both opportunities and risks in relation to: quality of care, accessibility of services and cost.

For full report click here.

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