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Mrs. Maria Miller (Basingstoke) (Con): We are two hours into the debate and we have yet to hear anyone speak in support of the Governments policies on polyclinics. I am sure that the Whips are going around trying to find someone who will speak up in favour of what the Government are talking about.
It is a particular pleasure to follow the hon. Member for Birmingham, Selly Oak (Lynne Jones). I could not agree more that all the change in health care should be locally led. I am sure that the Minister will have paid close attention to the right hon. Member for Holborn and St. Pancras (Frank Dobson) who, after all, was the Governments first Health Secretary and talks a great deal of common sense on these matters.
There is nothing more important than primary health care because it is the primary interface that patients have with the health care service. That is particularly so for older residents and the very young in our communities. GP surgeries are often the last community-based service that is available not just in villages but in the suburbs. It is a service that gives people access to the NHS at the heart of their communities, close to their homes, and its future should be driven and shaped by those communities to ensure that it meets their needs. Lord Darzi made
great play of that recently when he visited the constituency next to mine, just outside Basingstoke, to talk about the future of polyclinics or GP-led health centres.
The problem we face in my constituency is that the Government have great house building targets for Basingstokewith which many local people, including me, do not agreethat are not matched by a similar expansion of local surgeries, including GPs surgeries. About 1,000 houses a year are being built, there has been a 13 per cent. increase in the number of babies born in our local hospital, and the fastest-growing group of people in my constituency are those aged 65 and over: the pensioners of north Hampshire. However, we are seeing a real lack of support for the development of those important primary health care services in my community.
Let me give three examples. Merton Rise is a family development north of Basingstoke. The plan was to have a GPs surgery at the heart of it, but that has been axed. Rooksdown, in the neighbouring constituency of North-East Hampshire, is also a family-based community. For four years, a portakabin has delivered important GP services to families who have produced not just one or two but as many as three babies while they have been living in that community. In the ward of South Ham, 25 per cent. of residents are over 65, and the largest number of 70-year-olds in the borough live there; however, its 1960s GPs surgery is bursting at the seams and long overdue for replacement.
Although it is clear that Basingstoke greatly needs investment in primary care, no money has been forthcoming. However, the town has been identified as the favoured location in Hampshire for a town-centre polyclinic. Our PCT has told us that we must have onewe know that it has little choice in the matterand it will be a significant distance from the communities that I have described. Moreover, the main rationale for the polyclinic is that Basingstoke is a commuter town. Polyclinics may have a role to play in urban and metropolitan areas, but they do not meet the urgent and pressing needs of families and elderly people in the outlying suburbs of Basingstoke. There is a need for basic GP provision, not a centrally dictated solution to a problem that is not the first priority for local residents. It seems perverse to spend money on increased access for commuters rather than mothers with young babies and the over-70s.
Basingstokes town centre already has plenty of GP provision, for historical reasons. We have a newly located GPs surgery, offering an extended range of services, right next door to our station. However, I understand that the present rules will not allow it to bid for a polyclinic, so there is a possibility of duplication where we really do not need it.
The Government have put great emphasis on new funding, but it is not altogether clear that the message has reached the PCT in Hampshire. The matter was discussed in some detail at a PCT board meeting in March. According to the board papers, the chairman of the PCT patient and public involvement forum asked whether any services would have to be cut
to enable this requirement to progress
that is, the requirement for a GP-led health centre. The PCT responded that the priorities would need to be reassessed, which does not sound to me like a guarantee
against cuts in health care services in the Hampshire area. Perhaps the Minister will clarify that when he winds up the debate.
Mr. Graham Stuart: If patients can register with an expensively laid-out new centre, they will take their money away from the GPs surgeryperhaps in the countryside, in an area such as the East Riding of Yorkshirewith which they are currently registered. That would undermine the funding of the surgery, and lead to the closure of GP services in areas such as Leven and Beeford in my constituency.
Mrs. Miller: That is an excellent point. My constituency also contains rural areas. I have already received letters from areas north of Basingstoke such as Bramley, where it is feared that the viability of providing GP services will be undermined. It is not, however, just a question of money. My main worry is that Hampshire PCTs attention will be diverted from resolving Basingstokes genuine primary care needs. The PCT has just undergone an enormous reorganisation, and is now the largest in the country. It is clear that it has been struggling to deal with specific local problems, including the delivery of primary care in Basingstoke.
During Health questions earlier today, the Secretary of State said that the Government had no intention of removing existing services, but by definition money will be divertedwhether it comes from the Secretary of State or the PCTfrom solving the problems in existing services and ensuring that they can meet the needs of local residents. We must look after the elderly and families, those who need support the most, before turning our attention to other priorities that the Government may havepriorities that may be absolutely right for metropolitan and urban areas such as London, but do not hit the mark when it comes to our problems in Basingstoke.
Dr. Howard Stoate (Dartford) (Lab): There is something funny about this debate. I am the only practising GP left in the House of Commons, and apparently I am the only one with a good word to say about polyclinics. I honestly believe that they will give patients access to services that currently require some to travel many miles, and to which many others simply do not have adequate access.
In my view, Ministers have given sufficient reassurance that most of the new services will be in addition to the existing ones. GPs will be able to work on a hub and spoke model, retaining their own practices if that is what suits the locality, or to locate their practices in polyclinics, maintaining the integrity of those practices while having access to all the extra services that are currently not so accessible.
The idea of polyclinics is not new. A recent Kings Fund paper on the subject refers to the Dawson report of 1920, which set out a vision of primary health centres that would focus on curative and preventative medicine and would provide an opportunity for GPs,
nursing professionals, visiting consultants and specialists to work alongside one another. That model is exactly the same as the polyclinic model of today.
singular lack of enthusiasm from the medical profession and in particular its BMA representatives.
The National Health Service Act 1946 allowed health centres along the lines proposed by Dawson to be set up but did not make their adoption mandatory, despite Bevan's enthusiasm for the idea, owing largely to opposition from the professionals. Their opposition stemmed from
the BMA's hostility to any proposal which appeared to turn GPs into public servants.
Vested professional interests were also partly to blame for the failure of the East German polyclinic model to survive reunification. In 2005, an article in the British Medical Journal by German academics explained:
State owned policlinics were one component of primary health care in former East Germany, housing general and specialist doctors and dentists. This integrated model was efficient and cost saving: facilities and laboratories were shared, alternative treatment and prevention strategies were coordinated, and referrals to specialists were well monitored, as well as each patients case. Policlinics did not conform to the West German concept of independently contracted doctors paid on the basis of an item of service, so they did not survive in East Germany after 1995.
increase cooperation between general doctors, specialists, and hospitals; to improve communication between institutions; and to reduce healthcare costs.
That illustrates that we need to be extremely wary about the opposition to the current polyclinics proposals expressed by professional trade unions such as the BMA. The BMA says that it is not opposed to the polyclinics model per se, but that they need to be introduced gradually over time and not be imposed centrally, and that proper regard must be paid to the specific character of each local health economy. That is a perfectly sensible position to adopt, except that the BMA has been saying exactly that from 1920 onwards.
As long as the polyclinic model remains an aspiration rather than a specific policy objective, the chances are that we will never see them in place across the country. As one speaker said last week at a meeting on polyclinics of the all-party group on pharmacy that I chaired, the irony is that the polyclinic model now being proposed has in fact existed for years in one branch of associated health care at least: veterinary care. In that field, large, one-stop, city centre clinics, comprising both generalists and specialists, and with impressive on-site diagnostic and treatment facilities, have been in place for years and have worked very well. It is a pity that the owners of the animals that are benefiting from that kind of one-stop, integrated care are still waiting for something similar to materialise in the NHS.
Other health care systems around the world have, of course, been using the polyclinic model for years. The polyclinic proposal is far from being the untried, untested, experimental model of care that many in the media have claimed. As the NHS Confederation has stated:
The principles behind the idea of polyclinics are in line with the way in which healthcare is developing across the world. The design rules that underlie the idea of polyclinics appear to be fairly uncontroversial.
The case in favour of polyclinics is, in fact, unarguable. They provide an unrivalled opportunity to create larger groupings of primary care professionals, and to create a critical mass that will allow an enhanced range of services to be provided. They exploit economies of scale to provide greatly extended diagnostic support with rapid access and turnaround, and a range of other services that are difficult to offer in smaller practices. They reduce the need for patients to travel to hospital by relocating high volume work that does not require hospital infrastructure. They will integrate services to break down the traditional barrier between primary and secondary care and provide opportunities for specialists to work alongside their colleagues in primary care. They will also create space for other services, including community health services and other related health, social care, leisure, housing and benefits services that patients, professionals and the community will value.
There is, of course, a range of issues around how, where and why polyclinics are to be implemented, but none of the concerns that have been expressed is insuperable. The idea that they will inevitably undermine the direct relationship between a GP and their patient, for instance, is wide of the mark. The Berlin polyclinic, Polikum, uses a web-based scheduling system to ensure that patients who want to see their own primary care doctor can do so. They may only be able to see their GP during certain periods of the week, but that is no different from how the current system works. As now, patients have to weigh up whether a familiar face is more important to them than speed of access.
Nor is it necessarily true that patients will have to travel further to see a GP. The hub and spoke model suggested in the Healthcare for London plans offers the potential to preserve local access while at the same time providing a community health care hub that offers a broad range of diagnostic and treatment services. In Liverpool, for example, the local PCT has set up a network of neighbourhood health centres and NHS treatment centres. Under that system, no patient is more than 15 minutes walking time from GP services while there has been a corresponding shift of services out of hospitals and into the community closer to where people live.
I suggest that the real issue is not whether the principle behind the polyclinics is the right oneI do not know of any serious commentator who fundamentally disagrees with thembut relates to their implementation, about which legitimate fears have been expressed. For example, the risk is that they could end up duplicating existing services provided in the community, and therefore waste money by creating overcapacity. If, however, their implementation is properly planned and managed and due regard is paid to current services, there is good evidence to suggest that they will help us make more efficient use of existing resources. Well-organised and integrated systems improve cost-effectiveness, reduce follow-up appointments and duplicated tests and improve the quality of care. The Kaiser Permanente model in the US shows us how this can be done, and provided that the polyclinic service contract is properly set and
monitored, there is no reason to think that the advent of new providers will impact negatively on the quality of care offered to patients. After all, GPs are, and have always been, independent, for-profit contractors operating within the NHS. Those are the rules GPs elected to play by when the NHS was set up. With proper debate and consultation and due care taken in the commissioning process, there is every reason to think that polyclinics can lead to substantial benefits in terms of the quality of care offered to patients.
Dr. Richard Taylor (Wyre Forest) (Ind): May I begin by declaring that I am a member of the British Medical Association and a fellow of the Royal College of Physicians? I am not speaking in order to give any official message from either of those organisations, however; I am speaking entirely on my own behalf, and on behalf of my constituents, local GPs and NHS professionals who have spoken to me.
The debate has produced a huge benefit already, in that we should all now know what we mean by a polyclinic and a GP-led health centre. To me, a polyclinic is a body that brings together GP services, investigative services, probably hospital consultant clinics and probably a headquarters for community services, as well as dental services. That could be perfectly satisfactory in certain areas, particularly in big cities, although I note what the hon. Member for Birmingham, Selly Oak (Lynne Jones) said about her part of Birmingham.
As for GP-led health centres, the Secretary of State has made it absolutely clear that they need only have three characteristics: they have to be accessible, to be open from 8 am to 8 pm 365 days a year, and to be able to accommodate drop-in patients and registered patients.
whether the decision to have a polyclinic in a primary care trust area is a decision to be made locally.
How primary care trusts...choose to configure or commission local primary medical care services is a local matter.
However, all PCTs have been asked to commission additional general practitioner (GP)-led health centre services and have been given additional funding to secure those services.
The key word there is additional. I met the chair and chief executive of my own PCT yesterday, and in their paper about their plans for future health services in Worcestershire they state that the Department of Health requires every PCT to establish a
new GP-led Health Centre.
To my mind, the difference between new and additional is vital, and I will return to it. I am a little confused about the reference to extra funding; is it really new additional funding, or is it part of the growth money already announced and passed to PCTs?
PCTs will decide after local consultation where and how these services should be provided and will carry out an open and fair procurement to secure the services they specify.
Deciding where and how is crucial. If extra hours and extra capacity are needed, some of the existing health centres around the countrythis is certainly the case in my areaare closed from 6.30 pm and throughout every weekend, so spare capacity exists that could be used.
In Worcestershire, the GP-led health centre is likely to be in Worcester, the largest town. If only the money for such services were given to the PCTs without strings attached, it might be feasible in Worcestershire to put in place three of these health centresone in each major town. That would spread the benefit of 8 am to 8 pm opening and the benefit of such centres being open for the entire weekend across the county, but, as it stands, only those who are near enough in the city of Worcester will benefit. Such an arrangement would almost certainly do away with the need for new premises, because that existing spare capacity could be used. That would lessen the worry about continuity of care, and about the lack of local knowledge and of previous knowledge about patients, and it could even mean a rotation between different practices within a given area. Such an arrangement would be ideal. I am asking the Government to get away from insisting that these must be new services, because they could be additional services in areas where there is the capacity to provide it.
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