Proposals put forward by the Labour Party to develop a national network of ‘neighbourhood health centers’- should they win the next election, have raised big questions about how the idea would work and what it might cost
Impressed by the Australian model of polyclinics, Labour health spokesman Wes Streeting has announced his intention to replicate it, seeing them as a way to reduce pressure on A&E, combine services locally, and ease costs.
Is this a new idea?
Labour has not filled in the detail around this policy, but expanding community healthcare to find benefits in diagnosing and managing health problems is not a new idea.
It was the last Labour government that set about installing a network of 150 GP-led walk-in health centres after a report by Lord Darzi. In similar tones, they were sold to the public as “one-stop shops” offering extended opening. The first were launched in 2009, only for the Labour administration to abandon the policy in 2011 following a Department of Health review.
They were unpopular with patients, duplicated existing services, and created deficits – branded by GP leaders as a ‘huge waste of money”.
Like Darzi, the Streeting plan proposes multidisciplinary centres, handling urgent care but not emergencies – this time building one centre in each of the 42 commissioning areas in England.
How this would sit alongside the existing network of urgent care centres – around a third of which are sited in the community, is unclear. Areas like Bath ICB already have three local urgent care facilities, each offering care for fractures, insect and animal bites, minor cuts and bruises, and minor burns, and strains.
Confusion over which service to attend is a key factor in why the public turns up at A&E according to the Keogh review. The current Department of Health strategy – published in 2023 now favours urgent care centres to be co-located with emergency departments.
NHS England claims that 20% of emergency admissions can be avoided with the right care in place, but as the Royal College of Emergency Medicine points out the combined system of 111, urgent care centres, and GPs are overwhelmed and failing to stem the demand on A&E.
The RCEM reminds us that lack of staff in general practice, social care, and mental health are key factors undermining attempts to redesign services. The flaw at the heart of the NHS England emergency care recovery plan – which any Labour administration must address is the fundamental lack of capacity in a range of services. Reacting to the emulating the Australian model Royal College of General Practitioners chair Professor Kamila Hawthorne told Pulse”
“…new initiatives in the UK will need to be backed up by sufficient resources and more GPs so that they can be implemented effectively – and that they are properly piloted and evaluated before wider roll-out, so we know they are of benefit for both patients and the health service as a whole.”
Hub controversy
If Labour intends to merge and move existing GP premises they would be wise to keep a weather eye on the growing controversy surrounding existing proposals to merge GP practices into hubs
The Lowdown has already reported on a row over leaked plans in the North West London ICS to force through a wholesale reorganisation of primary care services that would exclude GPs from almost all provision of ‘same day’ GP care for over 2 million people across the ICS.
Objections have arisen about proposals to increase the use of non-GPs, with less clinical qualifications to make more treatment decisions. Local GP committees have been voting against this type of division of clinical tasks.
In South Yorkshire merger concerns are about patients being much further away from their GP, especially for those in deprived neighbourhoods.
Dr Dean Eggitt, Doncaster LMC’s chief executive officer, told Pulse “The new premises are very well known for causing financial difficulties and hardship for GPs….By moving the practices somewhere else, you add time and financial costs for the patients too and you are more likely to worsen patient outcomes.’
The trigger for private sector involvement?
The Labour Party’s previous ‘polyclinic’ model was a major move in the opening up of the sector to for-profit GP providers.
Initially, the introduction of the Alternative Provider of Medical Services (APMS) contract by Labour in 2004 ushered in the possibility of GP services being run by private companies rather than GP partnerships. The implementation of the Darzi plan nationally then created far more opportunities.
Contracts were won by companies like Assura (which became Virgin Care, now HCRG Care), Care UK (now Practice Plus Group), and The Practice Group (now HCRG Care).
These companies have had mixed fortunes. Some contracts we abandoned due to lack of profit, others struggled to get salaried GPs and relied heavily on locums.
Several GP owners have sold up to larger companies (e.g., AT Medics and Operose) and mergers have taken place, but despite a rocky road for many of the companies, private investors continue to be interested and invested in primary care.
Private-equity-owned HCRG Care is now the owner of Operose, the largest private company to work in the NHS GP sector with 60 surgeries. Operose itself was formed by the merger of The Practice Group and AT Medics, both companies set up by GPs and expanded via APMS contracts for GP surgeries and Darzi centres.
Overall though the proportion of APMS – commercially driven GP contracts, has fallen in recent years, Only 1% of GP contracts are APMS, typically signed with private companies.
They are now unpopular with GP leaders and some ICBs are moving away from them to provide greater stability.
Whether Streeting will be inviting companies to help out with his version of polyclinics is unclear. The private healthcare sector feels confident though about their prospects under a Labour government according to FT reporting. Private investors are optimistic that Labour would “kick-start” opportunities for their involvement in the NHS, “more proactively than the Tories were able to do.” according to Henry Elphick, deputy chair of the European Healthcare Investor Association.
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