Polyclinics, a year on public perception still seems as reticent as ever, (at least in Redbridge!)
It’s nearly a year since the very first purpose built Polyclinic was opened at Loxford in Redbridge, with the ambition of providing greater access to a wider range of primary medical facilities, and basic diagnostics services and treatments. Although it has been successful in its’ remit, and more polyclinics are planned within the PCT, it is interesting that newly collated feedback shows local residents and potential patients still seem very wary of what polyclinics really deliver and are hostile to their introduction.
I had felt fairly neutral towards polyclinics; as a council candidate I understood resident’s views, yet balanced these with my own health care experience and the ideal concept of greater health equality – through extended clinic hours and faster accessibility to basic diagnostics. However, when I was invited by my MP to take part in a consultation with the local PCT regarding plans for another polyclinic, I quickly realised there were basic issues that the proposed Polyclinic representatives either did not have ready answers to, or in some cases actually said they had not previously considered. It was disappointing that these types of public concerns had not been adequately addressed before. Especially as public consultation and community engagement were highlighted as a key recommendation for new polyclinics, in a December 2009 review by Healthcare for London [i]
Canvassing, of local Redbridge residents (who were from of a wide age range and socio- economic distribution), showed that public information on polyclinics was insufficient and basic questions regarding the every day use remain unsatisfactorily answered.
Although this individual experience is not necessarily reflective of other polyclinics, I feel the points raised by the public canvassed could easily echo concerns nationally.
Many concerns were raised generally; however the key consolidated points were these:
- Financing: Perceived Effect on local health budgets – and what this could mean for previous health services.
Fees paid for building leasing alone seem to be high, especially where the building is purpose built – as at Loxford, with an annual rent of £900,000. Apparently £400,000 of this comes from Redbridge PCT and the remaining sums from contributions by the associated Diagnostic contractors, in-house pharmacy and cafes etc. One fear arising from this, is that a very close relationship could develop between the viability of the practice being funded and the number of diagnostic procedures having to be clinically ordered.
The high rental costs lead residents to worry the PCT is not getting value for money, especially when local hospital departments, including A&E’s, are currently at risk of closure. The urgent care centres claim they can take the strain off local A&E’s; however residents worry they will reduce A&E budgets and yet not provide adequate alternative Emergency care. Another point is that as the opening hours are 8am – 8pm, these are not usually the times of alcohol related presentations, which are a major burden in some A&E’s.
- Service provision: Residents fear External contractors could lead to stricter finance constraints and potentially influence care plan management.
GP services at Loxford will be run by an external company. Originally GPs were directly employed PCT salaried staff, – GP’s who initially came from local practices and bought their patient lists with them. In future in order to minimise GP costs an external provider, appointed through an APMS contract, will provide GP care.
This Contract has been won by a national provider, who operates other practices in PCT’s. Although they are obviously a reputable company, residents have fears that a monopoly could develop. Although the company provides other contracts and so must have a clear protocol and management track record, we were told that the ratio of full-time to locum GP’s compared to the number of registered patients was not available. This makes residents worry insufficient full-time staff will be appointed.
Although this concern may seem farfetched, it is a serious issue because it is promotes a negative attitude towards polyclinics. It shows that greater public information needs to be actively provided and disseminated
- Care provision: Residents fear services will not be patient centred and continuity of care will be reduced.
GP care will be provided by full-time GP staff and locum staff; however, the exact ratio figures were not available. Patients are worried this will mean less continuity of care and importantly possibly less experienced GP’s.
There is also anecdotal fear that GP’s may have to follow employers guidelines so very strictly, that their patient care management could be influenced by cost-effectiveness rather than be purely based on best clinical judgement.
If patients don’t have faith in their GP and don’t build up a good patient – doctor relationship, compliance could be reduced.
- Expectations, Limitations and Patient information: Only some polyclinics have Urgent Care Centres, – if patients don’t understand what services are available, mispresentations which lead to delayed optimum care are an increased risk!
The Polyclinic at Loxford doesn’t have an urgent care centre but most people do not realise this. Even polyclinics that do, are not able to deal with many emergency situations – including stroke, heart attack and trauma. With an aging population these are evermore important conditions, which can lead to long term morbidity and further socio-economic burden, especially if not treated quickly and adequately at appropriate hospital centres. Urgent transfer to hospital A&E’s would be necessary from any polyclinic for these conditions.
Some residents inaccurately thought Polyclinics could become small local A&E’s. (One of the reasons for this misunderstanding is because polyclinics have said they can help reduce the strain on Local A&E’s). This means the risk of mispresentations and delayed appropriate care is worrying. It is important that patient education is increased so people know where to present and when!
A question I highlighted at the consultation was if the Loxford polyclinic could have an Ambulance, in order to quickly transfer patients on to A&E if necessary. I was told that this had not been considered and no plans were in the pipeline. Considering the fairly basic requirements needed for an ambulance provision, I felt this needed to be re-considered. Especially as patient information on the limitations of the Urgent care centre were not well known and so the risk of mispresentations could warrant it.
- Suitable environment for all: Patient segregation was said by a PCT staff member to be an area still needing improvement.
Although zoning enables different facilities to be in different areas, some patients (especially those who are vulnerable) have said they’d feel uncomfortable attending regular appointments with walk-in appointments. This could be especially so if the surroundings become similar to the grim environment of many Hospital Emergency GP walk in clinics. It is important that regular patients attending GP follow up or monitoring appointments are not made to feel uneasy, as this could reduce necessary appointments and limit compliance. When I asked the Polyclinic PR Department about this, they said they had zoned services, but patient segregation still needed improvement, however, no immediate plans were in place and no patient feedback had been sought.
- Local community impact: If smaller GP practices are reduced because polyclinics are introduced, residents may have to travel much further.
Using some Redbridge data as an example; there are three GP practices in a half-mile area – which is located close to a high street and is easily accessed by public transport, walking, or private vehicles. Residents are worried a polyclinic could give them much further and longer journeys – this was a particular worry for older residents. Anecdotally, this has been a significant issue in other areas.
The information above has been locally collated, from residents with a wide age range and socio-economic group. It helps show reticence is not due to blind faith in the original system. It identifies transparency in polyclinics needs to be publicized, concerns need to be addressed sufficiently, and information needs to be positively promoted and made readily available.
Until concerns are taken seriously and honestly addressed, the public’s faith in polyclinics will not improve and patient lists may still struggle – potentially reducing their economic viability. If patients choose to ‘vote with their feet’ and not attend polyclinics, an alternative medical services has to be readily available; if not conditions may be untreated and the longer term burden increased.
Iseult Roche
Quality and Sustainability in Health – 2020health
[i] http://healthcareforlondon.steel-ltd.com/assets/Publications/Polyclinics/100121_Polysystems_evaluation_lessons_learned.pd
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