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Camden News - by TOM FOOT
Published: 29 May 2008
Warning that patients will face hospital trip to see GP

Doctors fear polyclinic plan will rock health service by swallowing up small surgeries

THOUSANDS of patients who need to see a GP for everyday complaints such as flu face a trip to hospital under radical new plans.
A New Journal investigation has found 10 doctors’ surgeries could be forced to close their doors and move to one of Camden’s two main hospitals.
The disappearing GP practices are a consequence of plans to introduce the first polyclinics in London, one at University College London Hospital in Bloomsbury and another at the Royal Free Hospital in Hampstead. Both sites are under serious consideration by Camden Primary Care Trust.
Health chiefs want to open the supersized centres to bring GPs and hospital outpatient services under one roof, effectively hoovering up local surgeries. The plan would mean patients having to travel to the surgeries – within the hospitals – to seek help for everything from a minor skin rash to contraception.
Doctors have told the New Journal the proposals are fraught with possible pitfalls and that long-standing relationships between GPs and their patients, fostered over generations, could be lost for ever.
“It will be like doctor X seeing patient Y,” said Dr Ali Alibhai, who has worked at the Gower Place practice in Bloomsbury for 25 years.
“This may be satisfactory in terms of speeding up waiting times but it will sacrifice the knowledge of generations of doctors. It is a retrograde step. The whole health system will be rocked by polyclinics.”
He said the UCLH polyclinic would swallow up four small surgeries in Bloomsbury, including his own. The others likely to be merged are the Museum Surgery and practices in Bedford Square and Gower Street.
About 20,000 patients would be affected by that merger alone.
Dr Alibhai said: “They would be transferred lock, stock and barrel into the hospital, which is the last thing a patient wants. If a polyclinic is in a hospital the whole ethos will change. Doctors will be under pressure to refer patients to the hospital.”
He added: “This is the fundamental flaw of the plan. What people do not understand is that 95 per cent of patients that come to a surgery are not referred to hospitals. That is because we make difficult decisions based on patients’ history. It follows that a large number of patients are leaving the surgeries satisfied.”
Under the plans, patients walking into the hospital’s accident and emergency department with minor ailments would be redirected to the polyclinic.
It is not just the damage expected to be done to patients’ relationships with doctors that is affecting morale at smaller surgeries in Camden, staff jobs are possibly on the line as a result of the squeeze.
Dr Alibhai added: “There are many admin staff, counsellors, receptionists and cleaners from the four practices who will surely not be able to be accommodated in the new surgery.”
University College London Hospitals’ chief executive Robert Naylor said he was “very keen” to develop a polyclinic at the hospital’s central London campus.
He told a seminar hosted by the Civitas think tank in November last year: “Being first at the trough means you get the biggest slice of the cake with a lot of money earmarked for this kind of development.”
A similar scheme is proposed for the Royal Free in Hampstead, where six surgeries could be asked to join forces at the Pond Street hospital.
The local surgeries certain to be brought into the scheme include Hampstead Group Practice in Fleet Road, The Parliament Hill Surgery in Highgate Road, and the Park End Surgery in South End Green.
The running of both polyclinics will be put out to competitive tender, inviting bids from the private sector. It’s a move that has already raised fears that firms like UnitedHealth could gain further footholds in the NHS in Camden. The American giant outbid local doctors for the contract to run three surgeries in south Camden in April.
NHS London, part of the Department of Heath, has claimed it has public support for polyclinics after 51 per cent of people responding to a survey said they were in favour of the scheme. It has not gone unnoticed by campaigners that just 134 patients responded to the consultation in Camden and there is an increasing worry that patients are in the dark about such big changes to the way they access treatment.
Camden PCT chief executive Dr Rob Larkman told a board meeting last week: “It is a narrow majority. But let’s be clear, we are not talking any more about putting all GPs into one polyclinic with 50,000 patients. There is now an infinite variety of polyclinics. We are looking at the fully federated ­model.”
The federated polyclinic, also known as the “hub and spoke” model, would see patients attending a supersurgery as their first port of call, before being redistributed to other surgeries across Camden for specialist care. Unlike the polyclinics proposed for UCLH and the Royal Free, nearby surgeries would remain on patients’ doorsteps.
Dr Stephen Amiel, who is chairman of Camden Local Medical Committee, has applied to NHS London to merge the James Wigg and Caversham Group practices in Kentish Town as a “federated” polyclinic.
He said: “The UCLH and the Royal Free sites are both likely to involve many doctors from the practices near the hos­pitals. It will mean the loss of the local, accountable and intimate nature of GP surgeries.”
He added: “Patients are generally quite fearful of hospitals. If a GP is in a hospital it is going to change the nature of the service itself.
“A polyclinic at James Wigg and Caversham would be perfect. It is in the centre of Camden. We have a long history in supplying all types of treatment. Crucially, their relationship between patients and doctor would not be lost.”
With the possibility of tens of thousands of patients being forced to travel around Camden to find a doctor, Camden PCT fears the burden on the transport network has not been properly examined.
John Carrier, chairman of Camden PCT, will tell a meeting of all the London Primary Care Trusts next month that Transport for London should be properly consulted on the changes.
PCT non-executive director David Metz said: “I would not exaggerate the travel issue. People will be prepared to travel to get specialist care as long as they can see their GPs locally. It is sustaining high-quality care that is paramount. Discretion on whether to set up a polyclinic must remain with the PCTs at a local level.”

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