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.

The NHS Confederation, which represents local health service managers, said in a report published last week that the IT system would make it difficult to share patient information between primary care, social services and the independent sector. Sharing information across a range of departments is essential for polyclinics to work.

However, the NHS Confederation director of policy Nigel Edwards said there had been a “knee-jerk” reaction to the proposals. He said: “While it may sound like the polyclinic system will not resemble the service currently provided by family doctors, in reality it should build on what is best in general practice.”

NHS pay deal may be cut if offer is rejected

Health workers may have their pay offer cut if they refuse to accept the three year deal which Gordon Brown and labour ministers are offering.

Unions have warned that unrest among nurses and other NHS staff over the settlement could still lead to industrial action.

The proposed increase is worth 8.1 per cent over three years and is part of a new set of public sector pay agreements Gordon Brown hailed as ground breaking and vital to ensure wage stability.

Unison’s health officer, Mike Jackson, told a health workers’ conference in Manchester that the deal, worth 2.75 per cent this year followed by rises of 2.4 per cent and 2.25 per cent, plus extra for the lowest paid staff, was the best that could be achieved.

But in a stand-off with Alan Johnson, the Health Secretary, his department’s officials have written to unions saying the Government reserved the right to stage or even reduce the pay offer if it is not accepted.

Mr Jackson said the only way the deal could now be changed was if “effective” industrial action were taken.

Unison’s head of health, Karen Jennings, said there were “huge risks” in accepting a long-term deal but she described the offer as “balanced”.

The conference will decide whether to recommend acceptance of the three-year deal to Unison’s 500,000 health workers.

Another union, Unite, which represents 12,000 members including health visitors, mental health nurses and some pharmacists, has already recommended that staff reject the deal.

Peter Allenson, a spokesman, said: “This deal is not sufficient for us to be able to recommend acceptance.

“We have reservations that the re-negotiation clause, which should come into effect in situations of rising inflation, is not strong enough and in a climate of economic insecurity, it is not at a level sufficient to meet members’ needs.”

A Department for Health source said the Government considered the proposal to be “generous”.

“We are certain the majority of health staff will be happy with this deal and we hope the unions put it to a full ballot of their membership,” he said.

“If that happens, we are confident we will win. If not, we can not guarantee the eventual settlement will be as generous as this offer.”

Gordon Brown has repeatedly said he is determined to keep public sector wage rises down to tackle inflation.

Last year, police staged an unprecedented march through Westminster in protest at being awarded a 2.5 per cent increase, below the level recommended by the independent pay review body.

Teachers from the National Union of Teachers have staged a series of strikes over their award, the first industrial action in schools for 21 years.

College lecturers walked out on the same day over their demand that their pay rise by six per cent, to the same level as teachers.


Health Direct warns that the Labour bullies are up to their old tricks by attempting to blackmail hard working NHS staff to accept the DOH’s meagre offer.

GPs could face fee if patients use A&E

Family doctors GPs could be charged when their patients go to accident and emergency units if they could have been treated at the local surgery.

The move – aimed at giving GPs an incentive to provide longer opening hours while reducing inappropriate use of casualty and minor injury departments – is being considered as part of Lord Darzi’s “next steps” National Health Service review, due for publication in the summer.

The Department of Health confirmed yesterday that it had commissioned the NHS Confederation and NHS Employers to examine how a tariff, or fixed price, might be introduced for visits to walk-in centres, minor injury units, and for treating temporary residents. A draft report from the two bodies was being examined, it said, after the Health Service Journal disclosed the proposal.

David Stout, director of the confederation’s primary care trust network, said GPs were paid to look after patients on their registers, but when alternative services such as walk-in centres were created “arguably that duplicates what general practice is already being paid for, so we end up paying for it twice”.

NHS Employers have examined the system in New Zealand. Chris Ham, professor of health services management at Birmingham university, says patients there are charged for each GP visit, but the government can claw back money from family doctors if patients use other facilities, such as casualty departments, for what should be primary care.

The double incentive – that GPs lose both a consultation fee and face a clawback if patients go elsewhere – “means that it is very easy to get to see a GP on the same day or the next day. GPs are open for quite long hours, as they lose money if patients go elsewhere”.

Dr Laurence Buckman, chairman of the British Medical Association’s family doctors’ committee, attacked the idea as unworkable. “Charging back costs if patients went to A&E; or elsewhere would not be an incentive, it would be a punishment and work as a disincentive [for family doctors] to work in areas with high A&E; use.”

Dr Michael Dixon, chairman of the NHS Alliance, a primary care grouping, said the idea might work where GPs held budgets, were responsible for commissioning care, and could thus shape services.

Applied in other cases, the risk was that funding for the most important part of general practice – handling chronic disease and long standing illnesses – could be cut if penalty payments were imposed where “worried well” patients, or those with very minor conditions used other facilities inappropriately.

Meanwhile, with political and health service opposition to the idea of “polyclinics” rising, the NHS Confederation has called for calm in the debate. Polyclinics would group GPs around facilities that could include X-ray, blood tests and other “one-stop shop” facilities, while bringing more out-patient and antenatal work out of hospitals. They have led, however, to fears that patients would have to travel farther to see a GP.


Operations halted by unfit equipment

Operations are being cancelled because of dirty or broken instruments sent back by private companies employed to clean them, the Royal College of Surgeons (RCS) informed Health Direct.

Hospitals used to sterilise their operating instruments on site but are being encouraged by the Department of Health to put the job out to private companies.

A survey of surgeons found that equipment was often unfit for use, damaged, or late – meaning that operations were cancelled at the last minute, often when patients were already

Two thirds of surgeons questioned by the RCS were unhappy with the availability and condition of instruments sent away for sterilisation.

The survey showed that 70 per cent of paediatric surgeons using outside firms were unhappy about it. The same was true for 82 per cent of neurosurgeons, 79 per cent of ear, nose and throat surgeons and 60 per cent of plastic and reconstructive surgeons.

Decontamination of instruments is essential to prevent the spread of infection.

Thirty-two per cent of plastic surgeons were not happy with the level of sterility, as were 30 per cent of ear, nose and throat surgeons, 28 per cent of neurosurgeons and 28 per cent of paediatric surgeons.

When it came to equipment being maintained in good condition, 70 per cent of paediatric surgeons were not happy with the service along with 85 per cent of neurosurgeons and 84 per cent of plastic surgeons.

Surgeons using in-house decontamination services were not satisfied with some aspects of this equipment care.

The RCS said that although private firms largely succeeded in sterilising kit, too much came back late or went missing. Sensitive, expensive tools were being broken, a statement said.

“Without the equipment to do the job, surgeons are forced to cancel or abandon operations – sometimes when patients are anaesthetised and prepared.”

Prof Richard Ramsden, who collected the evidence, said: “Operations are delayed because vital tools are not available. Surgeons working with on-site instrument cleaning facilities are getting a better service, enough to warrant an urgent reassessment of what’s best for the NHS.”

Bernard Ribeiro, the RCS president, said: “This is yet another example where something that looks good on paper in Whitehall gets rolled out without adequate professional consultation and piloting.”

A Department of Health spokesman said that more than £200 million had been invested in improving decontamination services since 2001.


Clot drug Pradaxa could save 25,000 live a years

Wider use of a new blood thinning drug to stop clots could save thousands of lives a year, says a charity.

Some hip and knee surgery patients are to start being given Pradaxa, which is available as a daily tablet and needs less monitoring than other drugs.

Lifeblood wants more action to cut the 25,000 deaths related to blood clots each year in English hospitals.

It wants all hospitals to improve their risk assessments for blood clots in patients when they are first admitted.

Many patients are at risk from venous thromboembolism, where blood clots form at the site of the surgery and then cause problems when they break up, moving to block blood vessels elsewhere in the body.

Patients known to be at risk will often be given drugs to thin the blood, making clots less likely.

The prevention of blood clots with blood thinners after surgery is not done well in the UK. However, the number of deaths linked to blood clots still accounts for one in 10 of all those in hospitals in the UK.

Some experts believe that only 40% of patients at risk are getting preventative treatment, and only a third of newly admitted patients are assessed for their risk of clots.

England’s chief medical officer said in 2007 there was “significant room for improvement” in preventing blood clots.

A report by Sir Liam Donaldson said there was no “systematic” approach to identifying and treating them.

‘Attractive alternative’

Lifeblood’s medical director, Dr Beverley Hunt, said: “The prevention of blood clots with blood thinners after surgery is not done well in the UK. The need for and potential impact of a generally well-tolerated oral anticoagulant that does not require monitoring is profound.”

The advantage of Pradaxa is that it is available as a daily tablet and does not require the same level of monitoring as drugs such as Warfarin.

This means that patients can take it after being discharged from hospital – a time when they are often still at high risk from clots.

At £4.20 a day, the drug costs roughly the same as existing treatments – Warfarin is cheap but has to be taken for a month and heparin injections are a similar price.

Initially, Pradaxa has been licensed only for NHS use in hip and knee surgery patients.

Professor Simon Frostick, from the University of Liverpool, said that the earlier discharge of many patients following operations meant it was vital to have a way to reduce clot risk at home.

“Pradaxa will be an attractive alternative to other regimens currently used to prevent venous thromboembolism in patients undergoing hip and knee replacement surgery.”

A spokesman for the British Heart Foundation welcomed the arrival of the new drug.

“A safe and effective anti-clotting medicine which does not require regular monitoring will provide a significant step forward in improving care for patients at high risk of developing a blood clot.

“We look forward to seeing how Pradaxa may benefit patients who have had orthopaedic surgery, and hope that it will prove to be useful for a wider group of patients.”


23m have not seen a dentist for two years

Almost half of Britons have not seen an NHS dentist in the past two years, it has been claimed.

More than 23.1 million people received no dental care on the NHS in the two years to last September, according to statistics obtained by the Tories.

This represents an increase of 4 per cent, or 840,342 people, since the labour Government introduced the controversial contract for dentists in 2006.

The figures also showed that as the number of people routinely seeing a dentist has decreased, the number of hospital admissions for dental treatment has risen.

Last year almost 240,000 were admitted to wards, an increase of six per cent, figures released by the NHS Information Centre showed.

The labour Government hoped the new contracts would give more patients the chance to register with an NHS dentist and encourage preventive care.

Instead of being paid per treatment, dentists were given a flat annual salary and were encouraged to undertake more preventive treatment.

But there is growing concern that the reforms have led to a worse service as many dentists have since rejected NHS patients and are providing less complex treatment amid fears that their income will be affected.

Some specialists have left the NHS to go private because they are not paid well enough for the amount of work done.

Andrew Lansley, the shadow health secretary, said: “We know that there are people out there who are pulling out their own teeth because they can’t find an NHS dentist.

“These shocking figure are proof that Labour can’t negotiate a contract with NHS professionals. Some patients have no option but to take their problems to hospital A&E;, a service which is already under great pressure.”

Michael Summers of the Patients Association said: “This really is a scandal. People tell us it is almost impossible to find an NHS dentist in many parts of the country.

“They either have to pay for private treatment or go without check-ups and treatment for years on end. There are real dangers in that, because one of the objects of regular check-ups is to identify infections or signs of oral cancers.”

GPs set to lose income guarantee

The minimum income guarantee for family doctors is set to be scrapped, in a move that could open up health services to more competition.

A recommendation to scrap the guarantee is to be made by Lord Darzi’s “next steps” review of the NHS.

The move has been widely expected, as primary care trusts complain that the guarantee can double their costs when they introduce new primary care providers – but then have to continue to pay existing GPs a minimum income, even if large numbers of patients leave an existing practice.

“We would definitely like to see it go, and we have said as much to Lord Darzi’s review,” said David Stout, director of the NHS Confederation’s primary care trust network.

Lord Darzi’s report, expected in June, is still at early drafting stages. But one health minister said: “I would be very surprised if this does not happen.”

The Minimum Practice Income Guarantee, which costs about £300m ($592m) a year, was the result of a last-minute change to the GP contract in 2003 which pushed more money into payments for achieving quality targets, but paid GPs less per patient they took on.

As a result, some practices faced big potential drops in income. To get the contract through, ministers promised that no practice would face a lower income from the new deal than under the old one.

However, the effect of the guarantee has been to perpetuate historic inequalities in funding between practices, say both the NHS Confederation and the British Medical Association.

It also reduces the impact of payments that give GPs more money for taking on patients with greater needs – a formula intended to reflect workload and help those in deprived areas.

“The guarantee undermines the principle of fair funding,” Mr Stout said. “And it undermines choice to some extent because GPs can lose a lot of patients from their list but still get the same income.” This also discouraged primary care trusts from bringing in new providers because they would still have to pay existing GPs a minimum income, he said.

Dr Laurence Buckman, chairman of the BMA’s family doctors committee, said it too had little enthusiasm for the guarantee. “We would like to see it phased out over time,” he said.

Putting the cash into basic payments for GPs would work for many, Dr Buckman said. But a proportion of practices, perhaps 10 per cent, “would be such serious losers that many of them would probably have to close”.

Mr Stout acknowledged that “getting rid of the guarantee overnight would cause a lot of disruption. But we do need to find a way of phasing it out”.

Dept Of Health is frustrating to work with claim private companies

Three more independent sector treatment centres were finally given the go ahead as Ben Bradshaw, health minister, celebrated the private sector’s treatment of the millionth National Health Service patient under the health department’s centrally procured contracts.

But business leaders said delays in the programme sent a signal it was “hugely frustrating” to work with the Department of Health.

Of three centres to get the green light, all to be run by Care UK, two are in Manchester, one in Southampton. They are together worth about £50m a year.

As these contracts finally crossed the finishing line, however, three more schemes, already far smaller than envisaged in 2005, were devolved to NHS strategic health authorities to sort out – postponing further their approval.

A scheme for London that began mainly as provision for waiting list surgery will become a very different, and appreciably smaller, deal negotiated with a strategic health authority, the government disclosed yesterday. Negotiations for two other projects, in Hertfordshire and Essex, will be taken over by the East of England strategic health authority.

Work persists on another scheme for the Avon area, but Mr Bradshaw hoped it could be signed off soon.

The fate of these four deals are now all that remains to be decided from the original 27 contracts for a second wave of independent surgical centres. Eleven of these have been cancelled, with only 12 going ahead.

Mr Bradshaw said private provision was providing fast access to services, offering more choice, cutting waiting times and “galvanising the NHS to raise its game”. The government was committed to private sector involvement where it met local needs and offered value.

But Neil Bentley, director of public services for the CBI employers’ body, said the message to private providers and investors was clear: to do business with the department of health was time-consuming, costly and hugely frustrating.

It was baffling that decisions on some projects had taken more than three years when the health minister himself said independent sector treatment centres were a force for good.

The CBI had said for all seven schemes to go ahead would be a critical test of government commitment to more market-based NHS reforms. “The verdict on the remaining schemes will demonstrate whether the local NHS is capable of seeing these reforms through,” Mr Bentley said.


Health Direct notes that once again it is the poor and infirm who are the victims of labour’s dithering about future health funding.

Patients told- only one illness at a time, please

Family doctors have put up signs in surgeries banning patients from discussing more than one ailment per appointment.

The aim is to hurry along consultations so that GPs can meet government requirements to offer patients appointments within 48 hours.

Doctors argue that appointments run behind schedule when they are confronted with the “worried well” reading out lists of sometimes frivolous medical complaints, often researched on the internet.

The Department of Health condemned the restriction and said it should be withdrawn. It said GPs, who earn an average of £110,000 a year in England, were paid enough to make time to listen to patients who have more than one illness.

The department advised patients who encountered the restriction to complain to their local National Health Service trust: “There is record investment going into GP practices and the public who pay for the NHS rightly expect the service to respond to their needs and concerns.”

The Royal College of General Practitioners acknowledges that the restrictions are widespread. It is aware of surgeries putting up notices saying, for example, “One appointment, one problem, remember others are waiting” and has advised its members to take them down.

Sunday Times reporters found the restrictions in operation in Islington, north London, and Deal, in Kent. A member of staff told a patient at the Queen Street surgery in Deal that she should seek a second appointment if she had more than one ailment. The surgery could not be reached for comment this weekend.

James Whitticase, a GP in Poole, Dorset, said he disagreed with the policy and that patients should be allowed to raise all their ailments because they may not know which one is the most serious.

“A classic example would be a patient saying, ‘I have a rash on my neck, I have an ingrown toenail, etc, etc and, oh, I also have crushing chest pain’. We obviously want to focus on the chest pain but that is how patients sometimes present their illnesses,” Whitticase said.

“If patients are only allowed to discuss one issue, they may say the illness that is really bothering them at the moment is their ingrown toenail.”

Critics of the policy also point out that the role of the family doctor is to care for a patient’s health in general and not focus on single conditions.

The British Medical Association defended the restriction signs: “If they try to cram too much into one appointment it doesn’t work well for either the current patient or the later patients who may have to wait.”


Statistically speaking, 100% of us are fed up with dodgy data

The majority of 25 to 34-year-olds have sex three to four times a week,” Health Direct reads. There I am, minding my own business on the train and a statistic attacks. Four times a week?

I do some quick desperate calculations in my head. That can’t be right, can it? “For 35 to 44-year-olds, it’s more likely to be twice a week,” the article continues. Well, I’m 33. Which is nearly 35. But still . . . twice a week? Don’t any of these people have kids? Or jobs?

At work I search for a more encouraging statistic. The Durex website comes to the rescue. We, the British, have sex 55 times a year, it says. Even a GCSE mathematician will tell you that’s a snip over once a week.

This must mean that if the 25-44 age group are averaging thrice-weekly how’s-your-father, everyone else must be almost hanky-panky free. But wasn’t there a report out recently that said the over 55s were at it like rabbits? Someone, I conclude, must be lying – and my money’s on the 25 to 34-year-olds.

As of April Fool’s Day, all labour government statistics require a kitemark to show they’ve been approved by the new UK Statistics Authority.

Anything that stops politicians making things up is a good thing, but it still won’t rid society of all the non governmental statistics that hang around making all our lives a misery.

It’s not just sex. Men who eat four meals a day are half as likely to be obese as men who eat three meals a day (Men’s Health); women who give birth in their forties are four times more likely to live to 100 (Grazia); eating sausages daily increases your risk of cancer by 20% (Daily Alarmist, sorry Mail); and my own favourite, women spend as much on make-up as they do on household cleaning products. Honestly, ladies.

At lunch, apropos of nothing, a female colleague storms over and says she was right: she is a better driver than me. “What’s your evidence?” I demand huffily. She tells me about a new survey which shows that men are three times more likely to be convicted of a driving offence than women. “Big wow,” I reply, “but statistically speaking I have hit 100% fewer lampposts than you. Which means I am 100% better.” You see how we need all our statistics kite-marked?

Sex is off which is bad, given the statistics. My mood thickens further when I remember that only one in nine readers gets to the end of the average article. This is below average so what’s the point in finding child-abduction panic button installed at the end of every street so we’re all just that bit more paranoid and overprotective of our kids.


Health Direct reveals a small flaw in labour’s plans to restore trust in labour’s use of statistics. The new statistics website’s name-