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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.

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In The Socialist 17 June 2008:

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