The press releases and planning guidance from the government on establishing Neighbourhood Health Centres (NHCs) make it seem that the new centres are a solution in search of a problem.
The claim that they would be available “on the doorstep” to “ordinary, hard-working communities across England” is not matched by the numbers of NHCs planned, let alone the small number (27) first-wave schemes due to open by 2027, with the promise of 120 by 2030 and 250 by 2035.
By contrast, back in 2007 a report by Lord Darzi recommended Greater London alone should establish a network of 150 “polyclinics,” with broadly similar services, each to cover the same 50,000 population. Back then these were estimated to have a revenue cost of £21m each – adding up to over £3 billion per year in London.
Despite efforts by health chiefs these plans were overwhelmingly rejected by GPs and failed to win any significant popular support: in the end only a few partial, short-lived attempts were made to establish polyclinics.
Ministers are doing themselves no favours in exaggerating the scale of these latest plans. It raises expectations, when most will see no change.
A more sensible approach
It would be sensible to begin by deciding a definitive list of the services that would be appropriate to provide in an NHC if not otherwise locally available. The fullest guidance published so far includes words like “ideally” which evades the question of what must be available.
Since establishing NHCs is supposed to increase access and provide additional appointments they are going to require additional revenue funding to pay for staff, equipment and supplies as well as any capital costs of renovation and extending existing buildings.
So to enable viable plans to be drawn up with minimal time wasted on unaffordable projects, government should make clear up front how much capital and revenue funding might potentially be available for each NHC.
Each Integrated Care Board should be required to identify areas of deprivation and inadequate local access to services that could potentially be included in an NHC.
This must run alongside a full audit of all the existing NHS facilities and property assets that might be suitable for adaptation to an NHC.
NHS Property Services have already said that in just the 43 priority areas for NHC provision at least 160 potentially suitable properties have been identified. This suggests that almost every area needing NHC-style provision could set this up without requiring any new build or private sector involvement.
Once the pattern of unmet needs and the available centres have been established, local NHS trusts could begin drawing up affordable plans to adapt buildings as necessary, and consulting with local authorities, local communities and with staff on the merits of different schemes and different possible locations.
Since adapting existing NHS facilities will be the norm, any developments should be publicly funded as Public Dividend Capital, plus a formula for funding revenue costs according to the numbers of treatments, tests or appointments.
NHCs should be managed and staffed by the hospital trusts which would otherwise potentially lose income (and staff) if a portion of their outpatient and diagnostic services are diverted to an NHC.
However, this type of process also highlights the need to restore the previous system of independent local organisations that are resourced and tasked with speaking up for local communities and their needs, as well as strengthening the links with local government
The feeble Health Watch bodies set up in the controversial 2012 NHS reforms (and set to close under the NHS Modernisation Bill grinding through parliament with little if any debate) lack the popular base and statutory powers of the old Community Health Councils that were scrapped by Alan Milburn alongside the establishment of foundation trusts in 2003.
Improving access to key services through affordable plans that involve local communities and NHS staff and reach more areas of the country would have much more positive and wider impact than ministers simply decided from top-down that an arbitrary number of undefined NHCs should be imposed on a sceptical public at some time in the future.
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