Struck off: One in five surgeries faces closure

Tories claim plans for bigger clinics will transform the patient-doctor relationship. Tomorrow, David Cameron takes the fight to Labour in what he says is an attempt to save the traditional family practitioner. Jane Merrick and Nina Lakhani investigate

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.

Government proposals to create a new generation of polyclinics will lead to the closure of 1,700 practices, the Tories claimed last night. 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 will tomorrow claim that the traditional GP surgery is at risk and only the Conservatives will save it. The Tory leader is to deliver 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."

Mr Cameron will deliver his speech ahead of campaigning for the 1 May local elections in Coventry and Bury where he will meet doctors and patients.

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 poly-clinic 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 £6.8bn 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."

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