The government in the UK is proposing to change their NHS in response to complaints about waste, delays in treatment and quality concerns.

The new idea is to create 'polyclinics' - general practitioners and specialists in one location. Will it lead to better care or just more cost? The public is against it. Recent data from 1562 patients across 24 Primary Care trusts suggests that only 1 in 10 patients favor the polyclinic model over their current practice.

Michael Dixon, Chair of the NHS Alliance and Stewart Kay, Chair of the Londonwide Local Medical Committees (LMC’s), debated the issue on today - here and here.

Dixon believes that the skepticism and negative press surrounding polyclinics is misplaced and results partly from the connotation of the term “polyclinic.” The proposed primary care polyclinics are about personal relationships, self help, personal health, and improving community health. Changing the name from polyclinic to, for example, “integrated centre” would make it clearer what the polyclinic model is actually about, he claims.

But Stewart Kay, Chair of the Londonwide LMC’s, argues that better value would be provided by investing in the current model of general practice that already provides a wide range of services to diverse communities. The polyclinic model is, he says, expensive, based on untested assumptions, and potentially harmful to existing practices.

He points out that the smaller and more local traditional general practice—which has evolved with its community—can better serve the old, young and vulnerable, as well as adapt better to meet the different cultural and language needs of a small locality. Continuity of care and personal care are more difficult to provide in large units.

Furthermore, he says, because 80–90% of medical encounters happen in general practice, it is vital that this service stays local to patients, and is not moved “to some arbitrarily situated polyclinic.” Because there are few sites of suitable size available in London to accommodate a polyclinic, it has been suggested that old hospital and community clinic sites be redeveloped — but these will rarely be well situated for patients, he claims.