A question of balance
One of the unintended consequences of Shipman’s notorious activities
has been the reduction in the number of single-handed GP practices. Doctors
working in isolation, accountable to no one but themselves, are now perceived
to present a risk to patients.
So the move to gather more and more GPs
and services under one roof, reconfirmed last weekend with health minister
Lord Darzi again arguing for polyclinics to be established all over England,
should have been welcomed.
However, a number of patient and professional
groups, including the Royal Pharmaceutical Society, have reacted negatively.
The Society argues that aggregating local health services into polyclinics
could put at risk the public’s access to local pharmacies (since,
presumably, business will be sucked away and their viability threatened).
As the Society points out, 99 per cent of the population in England can
reach a pharmacy by car, on foot or by public transport within 20 minutes.
The
Society wants impact assessments to be mandatory if a polyclinic is planned
so that local communities are able to understand the effects
of any change.
GPs are concerned that working with as many as 25 other GPs will undermine
the long-term relationships that patients are able to develop with a
family doctor. And some clinicians are concerned that moving specialist
services from hospitals to clinics have not worked in the past and are
not cost-effective use of a clinician’s time.
The specialist will
see far fewer patients in a clinic based at a polyclinic — serving
a population of 50,000 — than in a hospital with a much larger
catchment area.
All these criticisms are valid, but The Journal wonders whether,
in some circumstances, polyclinics will provide better access to health
care
for many patients. Single-handed practitioners tend to be limited in
the range of services they offer since they are likely to be restricted
by space or staff available.
Patients, in these cases, can rely on these
doctors for most of their care but when they become seriously or chronically
ill, particularly when treatment is more technologically based, they
may end up having to spend much more than 20 minutes travelling for
appropriate care, when they are least able to manage it.
The question is one of balance: if patients will benefit from polyclinics
they will have a place in the health service; and there will be occasions
where single-handed practitioners and the supporting network are better
for the health of a community. There should be room for both. Back to Top
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The
Pharmaceutical Journal