Join the Socialist Party Join us today!

Printable version Printable version

Facebook   Twitter

Link to this page:

From The Socialist newspaper, 17 June 2008

National Health Service

Polyclinics - Stop this backdoor privatisation

IN MANY parts of the country, new 'polyclinics' are opening up, replacing established GPs' surgeries. JO SECHER warns that the government's new polyclinics are not "community based health care", and they are certainly not "GP-led surgeries". They are another salami slice being taken off the National Health Service.

FOR SOME years now, the government has been pushing through a series of what it terms 'health reforms' or 'NHS modernisation'. These have included the setting of strict performance targets for hospitals, rigorous financial budgeting, closure of what it deemed 'surplus' facilities and the establishment of an institutionalised two-tier health system that came with the advent of foundation hospitals.

But their latest, and perhaps most insidious innovation, must surely be polyclinics. Foundation hospitals were introduced via the passage of a highly controversial bill, but no such pomp and ceremony has heralded polyclinics.

From the government's point of view, that would be far too risky - we're talking about outright privatisation of GP services. The concept was officially the brainchild of Ara Darzi, a surgeon who has since been granted a peerage and appointed as an Under-Secretary of State for Health. Unofficially, it seems far more likely that polyclinics were actually conceived by a team of US healthcare advisers whom the government brought in some years ago.

In New Labour jargon, the general idea is that, as part of the government's overall 'rationalisation' programme, primary health care will be 'reconfigured', 'merging' local GPs' surgeries into 'one-stop shops' or 'super-surgeries' offering a number of services that only hospitals offered previously, thus 'bringing health care closer to home.' The tendering process to decide who will run these polyclinics will incorporate the principle of 'contestability'.

Sorting through the euphemisms, 'rationalisation' has most infamously been used in connection with the closure of some 3,000 post offices, but also in hospitals and prisons, for example.

The government realises that people now know that rationalisation means 'cuts', so they now tend towards words like 'changes' or, even better, 'reconfiguration'. 'Merging' means roughly the same thing - in this case it means that around ten GP's surgeries will be closed for every one polyclinic that opens.

'One-stop shops' and 'super-surgeries' are not exactly euphemisms but they are highly misleading. Amongst the additional services touted are diagnostic testing, minor surgery, dentistry and mental health care.

But fewer than 5% of would-be patients need these services - for the other 95% the GP surgeries already are 'one-stop shops'. The mass closure of surgeries will greatly inconvenience at least half of the patients, but possibly more, particularly as polyclinics will not be located where it would be most convenient for their clientele, but where the NHS happens to own land.

False consultation

THE PROVISION of these additional services serves two purposes. First, it enables the government to claim that it is 'bringing health care closer to home.' Don't be fooled - it is doing the exact opposite.

Secondly, and more disturbingly, it helps to remove patients from NHS hospitals, which are nowadays paid per patient. Do not be seduced either by the suggestion that polyclinics will have extended opening hours - many GP surgeries already have longer opening hours. Where these are not offered, there is often a consortium of GPs that offers out-of-hours services.

What little research has been conducted into polyclinics has produced unerringly negative results. A King's Fund report suggested that polyclinics could pose 'significant risks for patient care'. It also found that "there is... evidence that quality [of care] may be decreased in certain cases."

A British Medical Journal paper said that "patients in small practices rate their care more highly in terms of both access and continuity" and that these practices "achieved slightly higher levels of clinical quality than larger practices". The chairman of the British Medical Association's Consultants' Committee has claimed that the scheme "holds no water, has no benefit and no financial gain", and advised that the government should "dump the polyclinic plan". It is increasingly difficult to discern anything particularly 'super' about these surgeries.

Not that the government will lose much sleep over that. The purpose of polyclinics is not to ameliorate primary care - if it was they would have conducted proper, comprehensive research into their implications in the first place, not to mention full consultations with patients and the communities polyclinics are supposed to serve. They might even have had the guts to put it in a bill before parliament.

So what actually does motivate this "reconfiguration"? That's where contestability comes into it. It seems as though the government has finally decided that the NHS simply isn't 'efficient' enough for its liking. So they've decided to get rid of it - piece by piece.

They've privatised optometry, dentistry in most cases and cleaning and maintenance of hospitals (the letters MRSA spring to mind). When they decided they wanted to privatise primary care, though, they had a problem. Doctors already privately run their own surgeries - but these doctors are contracted out to the government. Polyclinics are the ingenious solution.

The tendering process is so convoluted and expensive that it would only be economically viable to formulate a bid for multiple polyclinics - naturally only large firms can afford to do that - not small groups of pesky GPs. Contestability indeed.

The way the government sees it, large firms such as the US's United Health will take over the running of GP services, pay as many doctors as they have to, lay off as many as they can get away with, and the government can kiss primary care goodbye.

Clearly there was no way that the government could sell a policy whose only real aim was to privatise health care - so they decided to sneak it in through the garden door. Everything about the implementation of this programme has been underhand.

The 'consultation' initially undertaken by Lord Darzi was never published, nor is there any public record of how many people were consulted or how many negative and positive responses there were. All we have been told is that "their views have helped shape this interim report".

The London Borough of Haringey would appear to be the guinea pig, in which the Primary Care Trust (PCT) proposes to 'merge' somewhere between 32 and 48 doctors' surgeries into five polyclinics. I say proposes - of course the decision has already been made - they received an 8 million windfall from the Department of Health specifically to implement the policy.

The characteristically farcical consultation process has, according to the PCT, already taken place. Publicly it claims that responses have been 'mixed', but its own website says that of the 123 responses it received, not a single one was positive. In Haringey the wheels are already in motion - Hornsey Central Hospital was condemned a couple of years ago, and a polyclinic is shooting up in its place.

We must put an end to the systematic, salami-style privatisation going on before our very eyes - or else before we know it, we'll find ourselves with the US system, in which those who cannot afford to pay are simply left to rot. And as the government knows only too well, that's not what we want.

Donate to the Socialist Party

Coronavirus crisis - Finance appeal

The coronavirus crisis has laid bare the class character of society in numerous ways. It is making clear to many that it is the working class that keeps society running, not the CEOs of major corporations.

The results of austerity have been graphically demonstrated as public services strain to cope with the crisis.

The government has now ripped up its 'austerity' mantra and turned to policies that not long ago were denounced as socialist. But after the corona crisis, it will try to make the working class pay for it, by trying to claw back what has been given.

  • The Socialist Party's material is more vital than ever, so we can continue to report from workers who are fighting for better health and safety measures, against layoffs, for adequate staffing levels, etc.
  • Our 'fighting coronavirus workers' charter', outlines a programme to combat the virus and protect workers' living conditions.
  • When the health crisis subsides, we must be ready for the stormy events ahead and the need to arm workers' movements with a socialist programme - one which puts the health and needs of humanity before the profits of a few.
Inevitably, during the crisis we have not been able to sell the Socialist and raise funds in the ways we normally would.
We therefore urgently appeal to all our viewers to donate to our special coronavirus appeal.

Please donate here.

All payments are made through a secure server.

My donation


Your message: 


In The Socialist 17 June 2008:

No! to racism: Yes! to decent jobs, homes and public services

No! to racism: Yes! to decent jobs, homes and public services

Unite and fight against racism

Protest at BNP 'hate festival'

Let AmDani stay!


International socialist news and analysis

Lisbon Treaty 'No' vote delivers major shock for political and big business Establishment

Socialist Party campaigns

Shell drivers strike

David Davis - sanity or carving a position?

Greater Manchester - save your post office

London protest over Rajapaksa's dismal human rights record

Stop big business polluting our environment


Stop New Labour's divisive school academy plans

Socialist Party NHS campaign

NHS: Polyclinics - Stop this backdoor privatisation

PFI - a very bad deal for the NHS

Reopen the battle on NHS pay

Socialist Party campaigns

End the occupations

Unison conference: Angry delegates attack leaders

Post office closures

Leeds: Stop Beeston post office closures

Socialist Party workplace news

National Shop Stewards Network Conference

CWU's link with Labour hotly debated

Victory against bosses at Keele

Workplace news in brief


Home   |   The Socialist 17 June 2008   |   Join the Socialist Party

Subscribe   |   Donate  

Related links:


triangleFund NHS and pay rise now

triangleNHS workers: "We deserve a fair wage" - 15% now!

triangleCoventry: scrap 'profit before people' hospital parking charges

triangleAngry health workers demand 15% now!

triangleUnder the microscope


triangleJohnson's schools social-distancing lie

triangleTory Covid chaos

triangleCapitalist profit and the race to develop a vaccine


triangleDispatches from the front: bosses prepare fresh attacks on NHS

triangleUS private healthcare system in meltdown

Reports and campaigns

Reports and campaigns


The Socialist

The Socialist: More than a newspaper



Coventry: Socialist Students is back



Liverpool Council must save care homes



Sussex: Hands off Peacehaven schools


Fighting Fund

Fighting fund: One week to raise 3,444



Workplace news in brief



Dispatches from the front - chaotic schools are not safe!


The Socialist

Selling the Socialist


Socialist Party

Why I joined the Socialist Party: Tories and Blairites only care about corporate greed


Young people

Covid generation says 'fund our future'



Coventry: scrap 'profit before people' hospital parking charges


National Shop Stewards Network

Lobbying for a lead from the TUC



Angry health workers demand 15% now!



Reinstate Richie Venton



Reinstate Tony Smith

triangleMore Reports and campaigns articles...

Join the Socialist Party
Subscribe to Socialist Party publications
Donate to the Socialist Party
Socialist Party Facebook page
Socialist Party on Twitter
Visit us on Youtube



Phone our national office on 020 8988 8777


Locate your nearest Socialist Party branch Text your name and postcode to 07761 818 206

Regional Socialist Party organisers:

Eastern: 079 8202 1969

East Mids: 077 3797 8057

London: 075 4018 9052

North East: 078 4114 4890

North West 079 5437 6096

South West: 077 5979 6478

Southern: 078 3368 1910

Wales: 079 3539 1947

West Mids: 024 7655 5620

Yorkshire: 077 0671 0041



Alphabetical listing

September 2020

August 2020

July 2020

June 2020

May 2020

April 2020

March 2020

February 2020

January 2020