Before the election, the Labour Party in the UK promoted neighbourhood health centres, based on a system being introduced in Australia. These centres offer walk-in services seven days a week for urgent but not major emergencies.
This emerged as one of the key planks of Labour’s policy, with a pledge to ‘Trial Neighbourhood Health Centres, by bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists under one roof’.
Commenting on these proposals, the Secretary of State of Health and Social Care, Wes Streeting, said: “I want the future of the NHS to be as much a neighbourhood health service as a National Health Service. I think this model will save patients’ time, save taxpayers’ money and fix the front door to the NHS.”
But is this a new idea, or a case of recycling policy?
The appointment of Lord Darzi to lead the independent investigation into the performance of the NHS raised the possibility of the return of “Darzi Centres” or polyclinics trialled in London and elsewhere with the review’s recognition of the need to expand primary and community health services.
.As Virginia Berridge wrote in response to the Darzi clinic proposal, “…a look back into history shows that the idea of the polyclinic is hardly new. Rather, it is resurfacing an idea with a long and interesting history in London and national policy in the 20th century.”
The idea of polyclinics sits alongside a raft of other policy ideas and developments stretching back to the 1970s, including community health centres, primary care centres, walk-in clinics, urgent treatment centres, and integrated services such as some of those in the Vanguard programme. Some have a long pedigree, such as the Peckham Health Centre and Bromley-by-Bow Centre.
We should also remember that Aneurin Bevan also proposed local health clinics in the post-war period to deliver primary care, a proposal fiercely fought by doctors.
In recent years, we have seen the re-emergence of urgent treatment centres, which, like the Australian model, are led by a senior clinical lead, often a GP. These centres already work alongside other parts of the urgent care network, including primary care, community pharmacists, ambulances, and other community-based services, to provide a locally accessible and convenient alternative to emergency departments for patients who do not need to attend hospital.
The development of neighbourhood centres will require substantial investment in primary and community health services, as is occurring in Australia, especially given the underinvestment in these services in recent years. The new government has acknowledged this, but it is not clear what funding will be made available or when beyond initial promises about general practice.
The costs of establishing neighbourhood centres could be considerable.
The Department for Health and Social Care (DHSC) has estimated the running costs to be nearly £2.4 million a year per hub, although presumably, some staffing costs would constitute savings from other budgets. If the centres involved building new premises, then an additional £20 million would then have to be found. It may be possible to build hubs based on existing community estate, but the provision of primary and community health care services are delivered in a real patchwork of buildings and locations, some GP owned, some NHS financed, much in varying states of condition, and possibly not suitable for the new hubs.
Location and accessibility are also complex issues to address, particularly in rural areas but not without problems in large urban areas.
Evaluations of the development of polyclinics in London found many problems in implementing the policy in practice with service planners and commissioners, highlighting the difficulty in reconciling local organisational realities with imposed policy expectations (Peckham et al. 2011).
Should polyclinics once again emerge as a policy option understanding that we have been here before and these are simply “instruments for service delivery with some common features, but diverse in nature and dependent on their local contexts”. (Jones et al 2009) rather than a policy blueprint.
References:
Berridge V. Primary care: Polyclinics: haven't we been there before? BMJ 2008;336:1161–2. 10.1136/bmj.39583.414572.AD - DOI - PMC - PubMed
Jones, P., Hillier, D. and Comfort, D., 2009. Primary health care centres in the UK: putting policy into practice. Property Management, 27(2), pp.109-118
Peckham, S., Wilson, P., Gosling, J., Osipovic, D. and Wallace, A., 2011. Community nursing in systems reform: the London polyclinic experience. British journal of community nursing, 16(6), pp.293-297
This blog represents the findings from independent research commissioned by the Department of Health and Social Care and carried out by the Policy Research Unit in Health and Social Care Systems and Commissioning (PRU HSSC, previously PRUComm) and is a collaboration between the University of Manchester, the London School of Hygiene & Tropical Medicine and the University of Kent. PRU HSSC is funded by the National Institute for Health Research (NIHR) Policy Research Programme (Ref: PRU-02-07). The views expressed are those of the authors and not necessarily those of the Policy Research Programme, NIHR or the Department of Health and Social Care.