GP referrals up by 300,000, statistics show

The number of GP referrals has shot up by nearly 300,000 compared with the same period last year, official statistics released reveal.

GP referrals made in the quarter ending 30 September have risen by 12.6 per cent, while other referrals have increased by 9.2 per cent.

Inpatients

The figures also show 91 patients for whom English commissioners are responsible waited longer than the 26 weeks standard for inpatient admission at the end of October 2008.

The number waiting more than 13 weeks was 40,800, a drop of 4.8 per cent from September 2008 and 36.4 per cent from last October.

Outpatients

Out of a total of 888,000 patients, 551 waited more than the 13 weeks standard for a first outpatient appointment following GP referral at the end of October.

Of these, 67 were English residents waiting for appointments in Welsh hospitals.

There was an increase of 13.9 per cent in the number of patients waiting longer than eight weeks at the end of October 2008, compared with last October, but the numbers dropped by 14.9 per cent from September this year.

Cancelled operations

During the quarter ending 30 September 2008, 13,100 operations were cancelled at the last minute for non-clinical reasons. In the same period in 2007, 12,500 operations were cancelled.

Of these cancellations, 3.3 per cent of patients were not treated within 28 days, compared with 5 per cent in the same period last year.

From:
gp_referrals_up_by_300000_statistics_show.html

GP commissioning costs lots and delivers little

A major study into practice based commissioning has found it to be an "expensive investment" that has delivered little in terms of better services for patients or financial savings.

The King's Fund is urging the Department of Health to use the "reinvigoration" of practice based commissioning announced in the next stage review to set out a "clear vision" for the initiative.

Primary care trusts should retain responsibility for strategic commissioning but with clinician involvement. High performing practice based commissioners should be rewarded with increased independence but should not become responsible for the entire healthcare budget.

Individual responsibility

Report author and senior fellow Nick Goodwin said it was essential that the government told people "exactly what the roles and responsibilities of individual parties are".

The report said even though GPs had received nearly £100m in incentive payments, few were commissioning new services, instead focusing on changing service provision.

From:
practicebased_commissioning_an_expensive_failure_kings_fund.html

Doctors will be offered cash incentives to prescribe new medicines

Doctors will be given extra cash when they prescribe newer, more expensive medicines under a pilot scheme aimed at accelerating the UK's slow uptake of new medicines compared with other European countries.

The plan is part of a package agreed by the labour government and the pharmaceutical industry yesterday that aims to reward drugs innovation in exchange for cuts in the price the NHS pays for drugs.

The pharmaceutical price regulation scheme will lead to a 5 per cent reduction in the overall medicines bill over the next five years, starting with a 3.9 per cent cut in February.

But the labour government has pledged to sweeten the scheme with measures to link the price of medicines more closely to the value that they provide.

Companies will for the first time be able to raise prices on medicines already launched if clinical data show they provide a greater benefit than originally believed. Any such increases will be exempt from the overall 5 per cent price cut.

Richard Barker, director general of the Association of the British Pharmaceutical Industry, the trade body, said: "This landmark deal marks a turning point for patients, the NHS and the pharmaceutical industry."

A new process will also be introduced to streamline, accelerate and make systematic the process of renegotiating pricing for medicines initially rejected as not cost effective by the National Institute for Curbing Expenditure (NICE), the medicines advisory body.

This will help the government's attempts to limit the number of expensive new drugs that patients have to pay for because the NHS refuses to fund them.

The Department of Health, in consultation with Nice, has already approved a handful of such "risk-sharing" schemes, whereby drug companies reduce the NHS bill through discounts, free products or reimbursement for patients for whom the medicines do not work.

Incentive payments to doctors- which already exist to stimulate testing for certain diseases and encourage generic prescriptions - could prove controversial, and may also need to be supplemented by additional funding to primary care trusts.

From:
http://www.ft.com/cms/s/0/d38e92b2-b6a4-11dd-89dd-0000779fd18c.html

Labour's organ donor fiasco grows

A change in the law on organ donation may yet occur, in spite of an expert advisory body rejecting the idea.

The UK Organ Donation Task Force said that moving to a system where people are presumed to give consent to their organs being used for transplant risked damaging the "vital relationship of trust" between doctors and patients at the end of life.

It admitted that the arguments for and against an "opt-out" system were "finely balanced".

But it concluded that a "presumed consent" system would be complex and costly and would require a secure IT system - at a time when public trust over the security of labour government held data has diminished.

However, Gordon Brown, the prime minister, said he was "not ruling out a further change in the law".

From:
http://www.ft.com/cms/s/0/08e63c6a-b512-11dd-b780-0000779fd18c.html

Health Direct’s view of the the UK Organ Donation Task Force’s report is that they are barking.

Commonsence predicts that if over half of the population wants organ donation to be an opt out process then far more organs will become available for transplants in the future when a mandatory transplant system is introduced.

To additionally use the excuse of the £12 billion NPfIT white elephant as an example of data insecurity is a damming indictment of the Department of Health’s incompetence- who fund this quango.

Levels of public trust are much higher for doctors than labour politicians and nhs bureaucrats. Trying to shift the blame onto medical professionals is plainly incredulous.

Even ditherer Brown ought to realise that there are financial savings to had from more transplants in reducing NHS costs and greater economic benefit from sufferers returning to work.

Doctors do not back cervical vaccine choice made by labour ministers

The wrong vaccine against cervical cancer has been chosen by the labour Government and doctors would give their own daughters the alternative jab, a prominent doctor has warned.

GP and broadcaster Dr Phil Hammond, said he and most doctors he has spoken to have opted for Gardasil, rather than Cervarix, for their own children as it also protects against 90 per cent of cases of genital warts as well as cervical cancer.

Writing online in the British Medical Journal, he said the issue has been overlooked because genital warts 'never made it to the front cover' of newspapers, but if it were breast cancer instead there would 'marches on Downing Street' to campaign for the choice of vaccine to be made available on the NHS.

There are two different cervical cancer vaccines on the market, Cervarix and Gardasil, which protect against the human papillomavirus which causes the disease.

The Government has chosen to offer Cervarix as part of a national vaccination programme for all girls aged 11 and 12 with a catch up campaign for older girls.

There are over 100 strains of HPV and Cervarix protects against the two which account for most cases of cancer whereas Gardasil works against an additional two strains so protects against other sexually transmitted conditions as well.

Gardasil remains available but only privately even though most other European countries have chosen it for their own national programmes.

Dr Hammond wrote that with 100,000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50 per cent, the far safer option is to vaccinate with Gardasil.

But, although Gardasil is available privately to parents, at a cost of £350 to £400, most will not be able to afford it, he added.

The vaccine choice could be a false economy because of the estimated cost of treating genital warts is £23m a year and vaccinating with Gardasil would have begun to pay off within three to four years, he said.

According to Hammond, who is a vice-president of the Patients Association, with the current cost of treating genital warts estimated to be £23 million, the government's decision may be a false economy. Within three or four years the use of Gardasil would have begun to have a considerable financial payback.

The NHS offers no information about Gardasil, raising serious questions over patient choice.

The Government's vaccine advisors said that if both vaccines were offered to the NHS at the same price then it would recommend using Gardasil because of the extra protection and because Cervarix, made by Sanofi Pasteur, has been chosen it seems the decision has been made on the basis of cost.

Both vaccines are listed as costing £80.50 in the book of licensed medicines but the details of the discount offered by GlaxoSmithKline to the NHS in order to get the contract, remains 'commerically confidential'.

From:
Doctors-do-not-back-cervical-vaccine-choice-made-by-ministers.html

Litany of surgical blunders revealed

Cases of 14 brain surgery patients who were the victims of catastrophic errors when neurosurgeons operated on the wrong side of the head are to spearhead a government drive to make operations safer.

Sir Liam Donaldson, the Government's chief medical officer, will highlight the cases at the launch of his annual report today when he will announce the establishment of a new clinical board for surgical safety to reduce errors and eliminate "wrong site" mistakes.

About 7.9 million operations are performed in Britain each year, nearly 10 times the number of births, yet surgical safety attracts far less attention than the safety of maternity care.

In 2007 more than one operation a month – 16 in all – was done on the wrong site. Examples include knee replacements on the wrong (healthy) knee, cochlear implants – surgically implanted hearing aids – in the wrong ear, removing bone from the wrong foot and wrong incisions to gain access to organs in the abdomen.

One patient a day was listed for the wrong operation in 2007, and there were 1,136 errors involving operating lists, including mistaken surgery, wrongly identified patients or operations performed in the wrong place.

The 14 brain surgery patients had suffered head injuries causing bleeding in the brain leading to increased pressure in the head. The standard treatment is to drill holes in the skull to release the pressure, but in the 14 cases the "burr-holes", were drilled on the wrong side. A second set of burr-holes then had to be drilled on the correct side. The 14 cases, all in the UK, were reported to the National Patient Safety Agency over the past three years.

Sir Liam told The Independent: "The procedure of drilling burr-holes can be life-saving and you could say that it is a low number [drilled on the wrong side] in the context of all neurosurgical cases. But many people would be incredulous that it could happen at all, let alone be repeated. It is a challenge to our ability not just to reduce error but to ensure these sorts of error do not happen. They should be 'never events'."

In all, almost 130,000 errors involving surgical procedures were reported to the National Patient Safety Agency. In most cases involving operating lists, the error will have been detected before the surgery was done so the true number of errors is likely to be under-reported.

Sir Liam said: "Most surgery is safe but errors do occur. Many are minor but some are serious. Some should be 'never events'. We really should be able to consign wrong-site surgery to the history books."

In a second example highlighting a different problem, he will describe 14 deaths and nine serious reactions among patients having hip replacements related to the cement used to fix the artificial joint.

Hip replacements are among the commonest operations in Britain but in rare cases the cement causes globules of fat to be forced out of the bone into the blood, triggering a heart attack. In the UK, half of all hip replacements are performed using cement; in Canada just 3 per cent are. Guidance about the risks of cement had been issued to surgeons in the UK, but practice had not changed as quickly as it had in North America.

Sir Liam said: "No one knows what causes this reaction."

Two weeks ago, NHS Review by Lord Darzi, the surgeon and Health minister, called for the safety and quality of health care to be placed at the heart of the NHS and said urgent steps should be taken to eliminate "never events", serious incidents which harm patients and damage public confidence in the service.

The new clinical board will be established by the National Patient Safety Agency and include the Royal Colleges of Surgeons and Anaesthetists and patient organisations. Its first task will be to tackle wrong-site neurosurgery and fatal reactions to cemented hip replacements.

Sir Liam will also call for safety tests based on a checklist to be piloted in all UK hospitals. Surgeons and nurses will run through the checks before each operation in the same way pilots check their aircraft before take-off. The Surgical Safety Checklist was launched by the World Health Organisation last month.

About 20,000 patients die after surgery each year in the UK but it is not known how many were preventable. An estimated 2,000 NHS patients die each year as a result of errors in treatment, and an inquiry by the National Audit Office in 2005 concluded that half of all incidents could have been avoided if staff had learnt the lessons of previous errors.

Although serious errors are rare, a study of 38 surgeons in 14 NHS hospitals in the British Medical Journal in 2006 found "most" had experience of operating on the wrong site.

"We should be able to make major in-roads into reducing surgical errors," Sir Liam said.

From:
litany-of-surgical-blunders-revealed-866894.html

Ban on NHS top up is cruel rationing, says BMA

Doctors believe patients should be allowed to pay for drugs that are not available on the NHS as they called for an independent inquiry into the controversial problem.

They warned that not allowing patients to top up their NHS treatment with private medication was a "cruel form of rationing".

In a close debate, doctors at the British Medical Association conference in Edinburgh voted in favour of a motion saying patients should have the choice to purchase non-health service treatments and medications if they wish and still receive the rest of their treatment free. The motion was passed with 62.8 per cent of the vote in favour.

The debate comes after a woman dying of cancer was denied free NHS treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle, 64, from Billericay, Essex, was receiving chemotherapy on the NHS, but she paid for the drug cetuximab to boost her chances of fighting bowel cancer. She was banned from free NHS care and died in May.

At present, patients who want a drug or treatment that has not been through an appraisal system or has not been licensed can have NHS funding refused by their primary care trust.

If they choose to pay for the treatment they have to have all their care privately. Many trusts are flouting the rules and allowing patients to purchase drugs which are administered within the NHS and continuing with their health service care.

But in a second motion, members of the BMA stopped short of demanding top-ups be introduced now by the narrowest of margins, 154 to 153, and have called for a Royal Commission to look at the issue further. The labour government has already ordered Prof Mike Richards, national director for cancer services to review the position and the report is due in October.

Some labour ministers claim that allowing private top up treatment would bring about the downfall of the NHS by allowing richer patients to pay for improved treatment, while drugs available to poorer patients may be limited.

At the highly charged debate, one doctor, Gordon Matthews, spoke movingly about his own wife with end stage cancer who wants to buy drugs. He argued that it was not ethical to exclude patients from the NHS because they had chosen to pay for drugs when they are 'clinging to their lives'. Another doctor said the worst moment of his medical career was hearing women screaming while undergoing abortions because they could not afford the anaesthetic.

Proposer of the motion Stephen Austin of the BMA consultants committee said the current rule is "healthcare rationing in its most brutal and cruel form" and that it placed patients in an "impossible" position.

But Dr Jackie Davis of the BMA Council said pharmaceutical companies would put pressure on vulnerable patients and insurance companies would be lining up to offer cover for drugs that the NHS will not pay for. Dr Kevin O'Kane, from the London region, said the motion was 'poisonous' and a 'nail in the NHS coffin'.

He added that the review of the NHS carried out by Lord Darzi meant the appraisal of new drugs by the National Institute for health and Clinical Excellence (Nice) would be speeded up and the postcode lottery in treatment ended, so there was no need for the motion.

Just over 70 per cent voted in favour of a Royal Commission to look into the issue and then supported supplementary motions that co-payments must not be a route to extension of NHS charges.

Commenting after the debate, Dr Hamish Meldrum said: “In principle doctors believe that patients should have the choice to buy additional treatment that is not available on the NHS, without being forced to pay for all their treatment privately.

“However, they stopped short of asking for co-payments to be introduced until there has been a wider debate with the profession and public and the evidence has been collected and examined. Doctors recognised that there were many potential problems with introducing co-payments and suggested a number of safeguards they would wish to see considered were they to be introduced.”

Ian Beaumont, Director of Communications, Bowel Cancer UK said: “We are concerned that while co-payments will enable some patients to receive treatments privately, those who can’t afford to pay will not be able to access them. Co-payments also give the Government, NICE and Primary Care Trusts an excuse to deny patients access to new, effective treatments on the NHS.”

From:
Ban-on-NHS-top-up-is-cruel-rationing%2C-says-BMA.html

Health Direct posts that people who can afford to opt out of the NHS completely and purchase private health care should be able to do so, and they do.

Any one who could afford to top up should be alowed to do so. People who can afford neither will still benefit from free health care from the NHS. Yes this is a multi-tiered health care system , but what is so wrong with that?

The idea that this would spell the end of the NHS is laughable, unless some factions of the BMA are so worried that all their members will do as dentists did and dump NHS practice all togethar.

Pharmaceutical companies cannot pressurise poor people because they are not permitted direct patient advertising as they are in the US. They could pressurise GPs, but you have to hope that the unscrupulous fat cat, pound chasing, sloppy GPs who would in turn pressurise patients are struck off.

Insurance companies will queue up to offer potential NHS blacklisted treatments, but again if someone chooses to invest in their future health provision why shouldn't they? It is no different than buying critical illness insurance. You buy it or you dont it depends on what value you put on it.

Maybe it is about time that people started to take more responsibility for their own health. The current government think it is a dirty word, but perhaps people should ASPIRE, to be in a better position when benefiting from healthcare; rather than aspiring to own a car they cannot afford or sinking 20 pints and smoking 40 fags that weekend.

It is these people, with skewed notions of aspiration i.e. to appear wealthier and more important that they actually (just like a celebrity) are who will ensure the demise of the NHS, not the ones who have chosen to invest in their health!

Gordon Brown is always battering on about choice, why not put your money where your mouth is then Gordo, give people the choice!

Banned cancer drugs better than NHS ones

Privately bought cancer drugs are proving to be up to five times as effective as NHS treatments, Health Direct reports on the suffering the co-payments ban is inflicting on patients.

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves.

One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the labour government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy.

The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care.

Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Recently the Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors.

John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about £2,200 a month compared with about £800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control.

A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan.

Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added.

Erbitux, costing about £3,000 a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

A former fireman who developed liver cancer after 25 years’ service has been told that if he pays for the only drug that can treat his disease his NHS care will be withdrawn.

Barry Humphrey, 59, from North Walsham, Norfolk, was told by NHS doctors that the drug Nexavar was the only available treatment for his advanced liver cancer.

However, consultants at Addenbrooke’s hospital in Cambridge said the drug was not routinely funded by the NHS and told him that if he paid for it he would be billed for the rest of his NHS care.

Humphrey believes his cancer is linked to his time as a fireman. His cancer was caused by cirrhosis of the liver after he contracted hepatitis C. He believes he caught the virus from a casualty while on duty.

Research presented at the American Society of Clinical Oncology found patients with advanced liver cancer survive for an average of 11 months if they take Nexavar, while those denied the drug live for just eight months.

Humphrey’s wife Hazel, 58, who also worked in the fire service, said: “Doctors said this would ‘not be viable’ because we would be deemed as opting out of the NHS and would need to pay for everything.

“I think it is absolutely disgraceful. When people are terminally ill, they want to spend as much time as they possibly can extending their life expectancy.” She said the couple know the drug will not provide a cure but should have the right to spend their savings to prolong her husband’s life.

They plan to sell a flat that they have been renting out to raise the cash for the drug, which costs about £3,000 a month. Humphrey, who has four children, six grandchildren and helps to care for his elderly mother, said: “I think this is morally wrong and indefensible.”

Cambridge University Hospitals NHS Foundation Trust, which runs Addenbrooke’s, said: “We are complying with the national guidance which says we cannot allow co-funding.”

The public’s view

A poll for The Sunday Times shows strong support for allowing co-payment in the National Health Service, with 89% saying that people who buy additional cancer drugs should continue to get free NHS treatment.

Only 5% think allowing co-payment would create a two-tier NHS. Until now this has been the position taken by Alan Johnson, the health secretary.

Ministers had feared that allowing co-payment would upset less well-off patients, but the YouGov poll of nearly 1,800 people shows strong backing across the social spectrum and supporters of all three main parties.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4138237.ece

Polyclinics threaten 600 GP practices, say Tories

More than 600 GP practices are under threat because of labour Government plans for "super surgeries" despite overwhelming public opposition to the proposals, according to the Tories.

Hundreds of family doctor surgeries across England have been identified by local health Trusts as being in the same catchment area as proposed new polyclinics.

The Conservatives have compiled the list of practices across the country, named in plans for polyclinics drawn up by Primary Care Trusts, which they say could be killed off by the scheme.

They said the list showed practices which could be forced to shut because they would lose patients to the new clinics if they went ahead and warned that the final figure is likely to be much higher as many Trusts are still compiling plans.

Doctors who found their name on the list would now be "even more concerned than they were already" about the possibility of closure, the British Medical Association (BMA) said.

But the labour Government insisted that there was no suggestion in the documents that any of the practices had been earmarked for closure.

Recently, more than 1.2 million patients signed a petition protesting against plans for polyclinics, which was delivered to Gordon Brown.

Doctors' leaders argue that the new surgeries will destroy the relationship between patients and their GP family doctor and force them to travel much further to see a doctor.

GPs are also worried that polyclinics could "cream off" younger, healthier patients who help to subsidise their practices to treat those with more complex medical problems.

But ministers insist that the clinics, which could house up to 25 GPs as well as extra services such as dentistry and minor surgery and will open during evenings and weekends, will provide a "world class" service.

The Tory research reveals that 608 practices in almost half of all Primary Care Trusts outside London -where ministers insist that the "GP led health centres" will be in addition to existing services - have already been listed as close to proposed new clinics.

If this were replicated across the rest of the country including the capital as many as 1,700 practices could be under threat.

The Tories said the implication was that polyclinics would threaten the viability of the practices listed, even if not all of them would be forced to shut.

Andrew Lansley, the Conservative health spokesman, said: "The Government needs to explain why these GP surgeries are being named if it's not because polyclinics pose a threat to the local doctor.

"It adds to the huge weight of evidence now building up that polyclinics are not the additional services as Gordon Brown has claimed. Patients and family doctors are right to be worried about losing a valued local service. It's time Labour faced up to their concerns and called a halt to their unpopular polyclinics scheme."

A spokesman for the BMA said that the publication of the list would worry GPs already concerned that their practices could shut.

He said: "We have always had concerns about the viability of practices that are close to these polyclinics.

"It is inevitable that they will lose resources because of the new development, even if they are not actually dragged into it.

"Ben Bradshaw [the Health Minister] has said that some patients won't have to deregister with their GP to use this service, but that is not really the point.

"There is only one pot of money and if it is all going into polyclinics then GP surgeries will have to cut back on services and many could be forced to close."

He added: "GPs who find themselves on this list will be even more concerned than they were already."

An official spokesman for Mr Bradshaw said: "There is no suggestion from any of those PCTs that these surgeries are marked for closure."

Within London, where ministers insist plans for polyclinics differ from the rest of the country, around 100 practices have already been already earmarked for closure, to make way for the new surgeries.

From:
Polyclinics-threaten-600-GP-practices%2C-say-Tories.html

A million patients battle against polyclinics

More than one million patients have signed a petition protesting against plans to close hundreds of GP practices to make way for polyclinics.

The signatures, collected by the British Medical Association (BMA) in just three weeks as part of its "Support Your Surgery" campaign, was presented to Gordon Brown at Downing Street.

The BMA is concerned that the new clinics will destroy the relationship between patients and their family doctor

The labour government cannot afford to ignore the level of patient concern over polyclinics, which have been dubbed "supersurgeries", doctors' leaders will say.

Ministers insist that the centres, designed to house up to 25 GPs under one roof along with other services such as minor surgery, will provide a better service for patients.

But the BMA claims they will destroy the relationship between patients and their family doctor and lead to more private companies running surgeries.

Analysis by the Tories suggests that 1,700 of the 8,700 GP practices in England could have to shut under the plans.

Around 100 GP practices in just eight PCTs in London, the first part of the country to roll out the policy, have already been earmarked for closure to make way for polyclinics.

Doctors will protest against the plans at the BMA's Local Medical Committees annual conference today, entitled "standing up for General Practice".

Dr Laurence Buckman, chairman of the BMA's GPs Committee, will tell GPs at the meeting that the petition "will deliver a stark message to the Prime Minister" about the true level of patient concern.

Dr Buckman will also say: "My message to Gordon Brown is this: Whatever you think of GPs, take note of what your electorate thinks. Work with us to improve the service, not against us, and ignore at your peril the wishes of the most important people in the NHS – the patients."

He will tell GPs : "If the government won't listen to you, their doctors, then surely it will listen to the 1.2 million men and women who call for a halt to the plans to promote the use of commercial companies in general practice.

"Voters don't want funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. They want to be treated as patients, not customers."

The petition calls on ministers to "continue to support our existing NHS GP surgeries" and "improve services to patients by further investment in existing GP surgeries".

But Neil Bentley, from the Confederation of British Industry (CBI), accused doctors' leaders of "ostrich-like denial" and said that the plans would extend opening hours and increase the range of services offered to patients.

From:
A-million-patients-battle-against-polyclinics.html

Doctors' anger at labour's cruelty to patients

The medical establishment is in revolt against Labour’s policy of denying National Health Service treatment to patients who pay privately for cancer medicines.

The outcry from eminent consultants and doctors’ leaders came as news emerged of two more patients whose NHS care was removed while they were dying of cancer.

Alan Johnson, the health secretary, faces opposition from the presidents of the Royal Society of Medicine and the Royal College of Surgeons, as well as British Medical Association consultants.

Baroness Ilora Finlay, president of the Royal Society of Medicine, said the issue went to the heart of the purpose of the health service.

“Can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?” she said.

Finlay’s intervention, in an article for The Sunday Times, comes after it emerged that a man dying of kidney cancer had to battle for NHS care because his family followed doctors’ advice to pay privately for a drug.

John Burrell, a retired financial adviser from the Isle of Wight, died last month aged 63. His daughter, Kate Tasquier, said: “The consultant told my dad he would be billed for all of his treatment such as blood tests and scans. My dad was so worried.”

Although she said the NHS eventually compromised on the fees, “he ended up being so scared that he was going to be billed for his care that he was scared to go into hospital and he delayed starting the treatment”.

It also emerged that Sandra Baker, a bowel cancer victim, died last year after being denied NHS treatment in her final months. When she paid £9,500 privately for drugs, she was hit with an extra bill of £16,000 for her treatment.

The Sunday Times revealed the case of Linda O’Boyle who died of cancer aged 64 after being denied NHS treatment because she paid for a drug. Bernard Ribeiro, president of the Royal College of Surgeons, and the annual consultants’ conference of the British Medical Association have also attacked the labour government’s block on NHS patients paying for additional drugs.

While Johnson insists cancer patients should not be allowed to pay for superior drugs because this would create a two-tier NHS, opposition parties have edged closer to supporting co-payments.

Norman Lamb, the Liberal Democrat health spokesman who is developing a new party policy on the issue, said: “When a clinician recommends a proposed treatment as having therapeutic value to the patient, it seems cruel and perverse to withdraw all NHS treatment if the patient follows that advice.”

Ribeiro said: “I would strongly oppose the denial of life-saving operations to patients based on decisions they had made about how they supplement their NHS care.”

Cancer specialists at one of the country’s largest hospitals have found a way around the ban. About 16 oncologists at University Hospital Birmingham NHS Foundation Trust write prescriptions for their patients to receive private cancer drugs at home.

Professor Nick James, one of the doctors, said: “There is no question of us turning away these patients. I believe that to do so is punitive and vindictive. We remain responsible for the NHS care of these patients.”

From:
http://www.timesonline.co.uk/tol/news/uk/health/article4087629.ece

Another question for Labour - how come these drugs are free in Scotland and that it's only Englsih patients who face this dilemma?

Polyclinics will not improve care, consultants tell BMA

Six out of 10 consultants say polyclinics will not improve patient care and 83 per cent fear privatisation of the NHS is detrimental to patient care and the service overall.

The survey, carried out by the British Medical Association, says that over half of respondents say they are prevented from innovating to improve patient care and seven in 10 lack adequate resources to support their work. The policy of patients having a choice over where to have treatment was supported by 69 per cent of respondents.

The BMA Central Consultants and Specialists Committee (CCSC) commissioned this survey on consultant opinion to gather information about consultant members’ views on labour government health policies, how changes are affecting consultants ability to care for their patients and to work to their full potential as trained professionals.

Consultant member views were gathered to ensure that members’ views were represented in future discussions on these issues. and to inform the BMA’s evidence to the review body on doctors’ and dentists’ remuneration (DDRB).

Key findings of the survey
* A total of 1,587 complete responses were received with an overall response rate of 31.7 per cent.

* Only 7 per cent of respondents remain on the pre-2003 contract.

* The average number of PAs included in the job plans of respondents on a full time contract was 11.3. 60 per cent of all respondents stated that the number of PAs accurately reflected the level of direct clinical care undertaken. The average number of SPAs included in the job plans of respondents on a full-time contract was 2.5. 55 per cent of all respondents stated that the number of SPAs did not adequately reflect the work involved.

* The average number of hours worked per week for respondents on a full time contract was 50.73 with almost one in five working more than 55 hours a week.

* There was overwhelming support for further change to the CEA scheme to improve its ability to reward excellence and general support for all awards being made available locally.

* 85 per cent of respondents indicated that there was a process in their Trust for consulting with consultants on contractual and human resource (HR) matters. This was for the most part via the Local Negotiating committee or through the job planning and appraisal process.

* There was overwhelming support for the view that consultants should be leaders and innovators in clinical practice. 52 per cent of respondents believed that consultants were actually prevented from innovation in support of patient care.

* Two thirds (66 per cent) reported that the numbers should be expanded in their departments, 31 per cent reported they should remain the same. 78 per cent of respondents reporting affordability as the reason for their response that consultant numbers should remain the same.

* 70 per cent of respondents reported that they did not have adequate resources to support them in their roles as consultants. Of those respondents who reported they did not have adequate resources 63 per cent of responses from respondents reported lack of secretarial support, 48 per cent reporting a lack of IT and a further 48 per cent a lack of managerial support.

* 60 per cent of respondents disagreed or strongly disagreed that polyclinics would improve the quality of patient care and almost two in five disagreed or strongly disagreed that polyclinics would improve patient access to treatment.

* 73 per cent of respondents reported that the direction of government policy to expand use of the private sector was detrimental to patients and the service as a whole. 83 per cent of respondents reported that privatisation of the NHS would be detrimental to patients and the service as a whole.

From:
http://www.bma.org.uk/ap.nsf/Content/Surveyconsultantopinion08

NHS scandal: dying cancer victim was forced to pay

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian O’Boyle’s husband said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but \ we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

NHS scandal of dying cancer victim was forced to pay

A woman who died of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

Three of the cases, involving women suffering from liver and bowel cancer, are expected to prompt a judicial review of the government’s ban on “co-payment”, as the buying of private treatment while under NHS care is called.

Some cancer drugs not yet available on the NHS can markedly increase the chance of survival. But Alan Johnson, the health secretary, claims that co-payment would create a two-tier NHS, with preferential treatment for patients who could afford the extra drugs. Last year he issued guidance to NHS trusts ordering them not to permit patients to pay for additional medicines.

Brian, O’Boyle’s husband, said he was appalled by the way she was treated. He recalled his wife as a woman with an infectious laugh who had given a lifetime of service to the NHS as an assistant occupational therapist. The couple, who had three sons and four grandchildren, lived in Billericay, Essex.

After she developed bowel cancer and began having chemotherapy, doctors told her she should boost her chances of fighting the disease by adding another drug, cetuximab. It is not routinely funded by the NHS.

When she decided to use her savings to pay for it, Southend University Hospital NHS Foundation Trust withdrew her free treatment, including the chemotherapy drug she was receiving.

The trust said yesterday: “A patient can choose whether to continue with the treatment available under the NHS or opt to go privately for a different treatment regime. It is explained to the patient that they can either have their treatment under the NHS or privately, but not both in parallel.”

Brian O’Boyle, 74, who worked as an NHS manager for 30 years running rehabilitation services for the mentally ill, said: “We were happy to pay for this drug, cetuximab, and to give the health service what it cost to buy it and deliver the treatment, but they said they couldn’t do that. That is appalling.”

He added: “When she heard there was something that could extend her life, of course my wife jumped at it. Linda was taking lots of other drugs that she had previously been given on the NHS but \ we had to pay for all of them.

“It was stressful enough for Linda having cancer without her having all this stress on top of it.”

He has the backing of John Baron, the local Conservative MP and a former shadow health minister. “The NHS was very wrong to deny care and treatment to Linda O’Boyle. She has been penalised by an NHS system that is grossly unfair. This is morally wrong,” Baron said.

David Cameron, the Conservative leader, said in a statement that it was “tempting” to allow patients to pay for extra cancer treatments that were not funded by the NHS.

The party has been reluctant to express an opinion on the issue, fearing that it could be portrayed as favouring middle-class patients who can afford to buy themselves extra treatment.

A group of nearly 1,000 NHS doctors, called Doctors for Reform, has raised £35,000 to fund a judicial review of the ban on co-payments.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

More consultant radiologists needed to meet rising demand, say BMA doctors' leaders

Around 1,300 extra consultant radiologists are needed in England over the coming years if the NHS is to meet the increasing demand for emergency interventional treatments, diagnostic imaging and screening, the BMA warned.

Recent Department of Health projections on workforce show there is a need for a focused and planned expansion in consultant numbers to meet the increasing demand for radiological services.

Although government figures on diagnostic waiting times published show improvements in waiting, this level of activity cannot be sustained with the current workforce levels.

The demand for ultrasound, CT and MRI scans is increasing year on year, and with complex imaging now being required around the clock, more consultants are needed to ensure the service can be delivered more quickly and at the highest standard.

The Healthcare Commission’s report on its investigation into maternal deaths at Northwick Park Hospital recognised that there was a shortage of suitably trained interventional radiologists and recommended all obstetric units should have urgent access to this crucial emergency treatment at all times.

The Royal College of Radiologists (RCR) supports the need for consultant expansion. Dr Gill Markham, Vice-President of the RCR and Dean of the Faculty for Clinical Radiology, said: ‘Demand for scans and complex imaging is rising year on year and is set to increase even further in light of recent developments with extra patients being referred from the Government’s planned extension of the Breast programme and Colonic screening programme.

"We need a steady and sustained expansion in consultant numbers if we are to deliver this level of service to patients safely and to the high standards that patients deserve.”

The BMA recently launched a campaign to enhance the quality of care for patients by expanding consultant numbers across many specialities.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee said: “Although waiting times for diagnostics seem to be improving; this progress cannot be sustained unless capacity is expanded to meet future rises in demand.

"Ad-hoc commissioning of poorly integrated private providers is not a long term solution. The NHS needs to build its own sustainable infrastructure to deliver for the longer term benefit of patients.

“Focused expansion of consultant numbers will not only help meet the extra demands on the NHS, but as medical leaders and innovators, this will enhance the development of local services and provision of teaching and research.”

From:
http://www.bma.org.uk/pressrel.nsf/wlu/STRE-7ENBWT?OpenDocument&vw=wfmms

Nanny state bans children with no MMR vaccinations

Labour's latest nanny state wheeze to cover up their MMR vaccinations fiasco is to ban children from starting school until they receive the MMR jab.

Parents will have to provide proof their offspring have had a full range of vaccinations when they put in applications for primary schools.

The plan, designed to increase the take-up of the measles, mumps and rubella triple jab, has been drawn up by Mary Creagh, the Labour MP in charge of the party’s health manifesto for the next general election.

“Parents need to protect their children and science gives them a way to do that,” said Creagh. “We need to get that message across.”

However, doctors’ leaders warned that the idea was “morally dubious”.

Dr Hamish Meldrum, chairman of the British Medical Association, said: “A Stalinist approach like this would be likely to backfire.”

Andrew Lansley, the shadow health secretary, accused Labour of “playing politics” with children’s lives.

Take-up of the MMR jab fell dramatically after research – now discredited – appeared to show a link between the triple vaccination and autism.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3909515.ece

Health Direct finds the latest labour "thinking" plain incredible. The highest proportion of children who do not have the vaccine live in inner London, so labour's plans will compound the disadvantage that these children will endure.

Labour ministers ignored junior doctor recruitment warnings

Thousands of junior doctors had their careers thrown into chaos last summer because of "inept" decisions at the highest levels, according to a report by MPs.

Warnings over a new recruitment system and possible job shortages were ignored by the Department of Health, says the Commons health committee.

The labour government's failure to restrict the access of overseas doctors to training posts in Britain was also "inexcusable", it says.

The report also singles out Sir Liam Donaldson, the Chief Medical Officer for England, saying that confidence in his abilities among the medical profession has been "seriously damaged" by the debacle.

Doctors' groups said the report was a "damning indictment" of the Government's failure to listen to warnings from the medical profession.

Thousands of junior doctors found themselves in limbo last year when a combination of factors, including a new computerised recruitment process, left their search for jobs in disarray.

Hundreds marched in protest, which prompted an apology from Patricia Hewitt, the former health secretary.

From:
http://www.telegraph.co.uk/news/1936349/Ministers-%27ignored%27--junior-doctor-warnings.html

Polyclinics 'will hit most vulnerable'

Closing GP surgeries to replace them with "polyclinics" will hit the most vulnerable members of society and damage the fabric of local communities, David Cameron said.

The Tory leader warned that Labour's plans for health care could lead to the closure of one in five GP surgeries around the country.

Mr Cameron said local residents should have the final say on whether surgeries should be replaced and urged GPs to fight the changes, signing up to a petition opposing the planned reforms. Polyclinics, conceived by Lord Darzi, a health minister and consultant surgeon, will combine GP services with nursing and social care on one site.

The Government insists they will create more choice for patients and greater access to specialist care.

Opponents fear they will leave some patients with long journeys and destroy the personal relationship between patients and family doctors. In a speech to a health think-tank in London, Mr Cameron said amalgamating as many as 1,700 GP surgeries would damage the fabric of local communities.

He said: "Labour has already tried to bring about the end of the district general hospital. Now they are trying to abolish the family doctor service. Communities which have lost their post office, their local shops, their local police station, are going to lose their doctor."

People including the elderly, those with small children and those with long-term conditions would be worst affected, Mr Cameron said.

"Those are the people least able to get to a polyclinic, and least comfortable in a large impersonal institution. They like to rely on the doctor they know, at the end of their street, often in a building not much bigger than a house," he said. "They have a human relationship with their GP that they simply won't have with a member of staff at a polyclinic."

Instead of "imposing" the clinics on communities, Mr Cameron said ministers should make the changes subject to binding local consultation. He said: "Where they occur, they should occur naturally, as the voluntary combination of free agents, not as the latest structural reorganisation of the NHS.

He also urged GPs to join an independent campaign against the polyclinics plan. The petition, drawn up by the think-tank "2020health" in consultation with the Tories, calls general practice the "foundation of the NHS" and says doctors object to "being forced into polyclinics against our will".

The petition also includes a demand for freedom to determine surgery opening hours.

"We want to work in partnership with GPs, not in conflict with them as this Government is doing," Mr Cameron said. "So I urge GPs to sign up to this petition and ensure that the next Conservative government has the backing of the profession to modernise general practice in a way that works for the staff and patients of the NHS."

Alan Johnson, the Health Secretary, last night accused the Opposition of backing a "free-for-all" that would end a recent agreement for more surgeries to open in the evenings and at weekends.

"This is an astonishing admission by the Conservatives. They are now supporting a free-for-all on opening hours which would see an end to the evening and weekend opening which has just been secured," he said.

"Far from diminishing primary care services we are enhancing them, but it seems that the Tories are more interested in ingratiating themselves with certain elements of the profession than they are in improving access for the public."

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/22/nclinics122.xml

Health Direct points out that every new major spin that labour dreams up tend to turn to ashes- just remember tough on crime, tough on the causes of crime.......

One in five GPs surgeries faces closure in polyclinic plans

One in five GP surgeries in England is set to close, threatening to end the era of a family doctor in every neighbourhood, an analysis of NHS plans reveals.

Labour government proposals to create a new generation of polyclinics will lead to the closure of 1,700 practices, the Tories claimed. In their place will be a series of "super-surgeries" housing up to 25 GPs and offering hospital-style outpatient appointments, minor surgery and pharmacies. While ministers hail this as a vision of 21st-century health care, opponents fear it is the death knell for traditional patient-doctor relationships.

David Cameron claims that the traditional GP surgery is at risk and only the Conservatives will save it.

The Tory leader delivered a speech to the King's Fund, an independent foundation working for improved health, on the future of primary care as the next stage of the party's "NH-Yes" campaign. It aims to reposition the Conservatives in the centre ground and seize the health agenda from Labour.

Health minister Lord Darzi, personally appointed by the Prime Minister to oversee the introduction of polyclinics as part of a major reorganisation of the NHS in England, has said 150 will be needed in London alone.

The Government insists they would create more choice for patients, offering GP, nursing and social care in one place. They would offer extended opening hours, from 8am to 8pm during the week, and weekend appointments.

But critics say those with chronic conditions, who need to visit their GPs more often than the typical patient, want the continuity of seeing the same family doctor.

Having fewer surgeries would also mean elderly patients who rely on public transport would have further to travel to see their GP. In London, patients would have to travel an average of 1.5 miles to reach their nearest polyclinic, according to the Government's own figures.

There are 8,261 GP practices in England, including 1,546 in the capital. Tory research, based on the Department of Health's estimates, shows that 1,701 surgeries in England face closure. Some 1,091 in London may go – nearly three-quarters of the total. In the rest of the country, 609 – almost one in 10 – could close in the next few years.

The research is based on the average number of GPs per practice in each primary care trust, and assumes each polyclinic would be staffed by 25 GPs.

According to a poll in Pulse magazine, eight out of 10 GPs are against the blanket introduction of polyclinics, warning it will dilute the personal relationship between doctor and patient.

The British Medical Association says it risks commercialising primary care as more services are contracted out. Just 8 per cent of GPs believe their local area needs a polyclinic, according to last month's poll. One in three GPs said they would refuse to work in a polyclinic.

Dr Laurence Buckman, chairman of the BMA's GP committee, said the Department of Health had shown little thought on how the local health service would be affected. He added: "Rather than being forced to create polyclinics, PCTs should be encouraged to invest in their local GP practices and support collaboration between practices.

"What works in London is unlikely to suit the needs of a rural community."

Andrew Lansley, the shadow Secretary of State for Health, added: "The Government is pushing ahead with forcing polyclinics in areas where they may not be needed. We are not against the idea in some places, but not at the expense of the local family doctor and patient care. Continuity of care for patients is at risk if their local doctor is closed.

"Patients will have further to travel and will be lucky to see the same doctor twice. The current relationship between GP and patient is one built on respect and trust, for the Government to wilfully destroy that is unforgivable."

Last year Mr Cameron launched a campaign to save the NHS, pledging a "bare-knuckle fight" with the Prime Minister over plans to close maternity and A&E wards in local hospitals. It ran into controversy when some of the 29 district hospitals the Tories said were under threat complained to the party.

But aides say the "NH-Yes" strategy will be centre stage of the next Tory general election campaign. They claim Mr Brown is planning a series of "NHS cuts" – language borrowed from Labour attacks on Conservative management of the service. They warn thousands of nursing jobs, hospital beds and acute wards will go under restructuring plans.

Lord Darzi produced an interim report on the NHS overhaul last November. A full report on the plans is expected in June. According to the minister's vision, patients will be able to see a doctor more quickly, possibly without an appointment, collect their prescriptions, get their eyes tested and see a physiotherapist all in the same building.

Ministers argue that the traditional family doctor of the 1940s, epitomised by the 1960s TV series Dr Finlay's Casebook, does not suit the modern needs of the NHS. Super-surgeries will include services currently only offered in hospitals such as minor surgery, diabetes screening and sexual health clinics, as well as access to traditional GPs and practice nurses.

But critics fear polyclinics will attract large private companies who can outbid local GPs. Union leaders accuse the government of privatisation by stealth and are planning to fight the moves.

GPs fear for their relationship with patients, claiming polyclinics will employ more salaried doctors who are unlikely to stay and work in one place for as long as partners in a local practice, many of whom spend a lifetime attached to one surgery. And while younger, "healthier" people are most concerned about easier access to doctors, patients with long-term conditions such as diabetes, asthma and depression, place greater value on seeing a doctor they know.

Dr Anthony Halperin, chairman of the Patients Association, warned last week: "We are concerned the personal contact with a GP will be lost within a polyclinic because another layer of treatment is being introduced."

Chronically ill patients and the elderly, who are the biggest users of GP services, would prefer to wait a day and see a doctor who knows their history, argue patient groups. And older and disabled people could be unwittingly excluded from the new clinics because they are too far away and difficult to get to.

The British Medical Association has written to Lord Darzi warning against a blanket introduction of polyclinics across the country. But ministers have reportedly told primary care trusts that they have no choice in backing a polyclinic in their area, even if there is already a large health centre nearby.

Another concern is that the £12bn NHS IT system which has already been plagued by delays and technical glitches is not designed to meet the needs of polyclinics.