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Doctors warn against London healthcare plans

Proposed changes to healthcare in the UK’s capital city – especially setting up polyclinics – could result in damaging fragmentation and fail to produce predicted cost savings or care improvements, according to the British Medical Association (BMA).

The association was responding to a review of healthcare in London by health minister Lord Ara Darzi.

The BMA said there was a case for changing the way some NHS services were provided in London, but Government proposals did not build on the best aspects of the health service.

Setting up polyclinics, a key component of Lord Darzi’s plans, would require considerable “up-front” investment in new buildings, equipment and staff, and it was hard to see how they would be cost-effective, the BMA’s response said.

There were already community hospitals providing intermediate care services, GPs with special interests who were able to treat more patients in their surgeries, and many consultant-led community health services based in premises outside of hospital.

BMA Council chairman Dr Hamish Meldrum said: “Despite the Government wishing to provide more care closer to home, it is likely that for most people in London, the polyclinic would actually be further away than their existing, local GP surgery.  

“It would be much better to invest in existing GP services, and where necessary district general hospitals, rather than imposing costly, unproven polyclinics.  

“The suggestion that private companies could run polyclinics would, in reality, destroy the UK model of general practice and threaten many district general hospitals,” he said. “Both are respected throughout the world and are highly valued and trusted by patients.”

The BMA’s response did recognise that care could be enhanced by moving some services away from hospitals into the community and by centralising some aspects requiring more complex care.

However, it said these changes must be based on good evidence and decisions made in partnership with clinicians in both primary and secondary care, and in consultation with the public, to ensure patients were seen in the appropriate locations by appropriately skilled and qualified clinicians.

Dr Meldrum added: “There is evidence that the centralisation of some services would benefit certain patients – for example, trauma patients with significant injuries.

“However, for other critically-ill patients, such as those with a severe asthma attack, anaphylactic shock or choking, there may be a detriment in having to travel significantly further for urgent care.

“If the Government is serious about engaging with clinicians, it must start listening to the views of London doctors and patients who have expressed many fears about how Lord Darzi’s proposals would adversely affect patient care and potentially cost lives.”

Proposals to establish academic health science centres were supported, the BMA’s response said.