Leading article: From Dr Finlay to medical megastores

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The Independent Online

Our report today that one in five GP surgeries faces closure is not all bad news. Indeed, since Alan Johnson's appointment as Secretary of State for Health by Gordon Brown last year, the National Health Service has entered one of those phases where "no news is good news".

Let us therefore set the scene for the controversy over the plan to replace traditional small GP practices with polyclinics in which up to 25 GPs will provide a wider range of healthcare services. Remarkably, the end of the financial year in the health service passed almost without incident this year. After several years in which many NHS trusts spent the last few months of the accounting year desperately trying to shut down activity to cut costs, the NHS as a whole is now in what must be diagnosed as a healthy surplus.

The second important piece of good news is that the target of ensuring that, by the end of this year, patients begin treatment within 18 weeks of GP referral looks likely to be met. The sirens of doom have fallen silent, as people begin to realise that, although 40 per cent of trusts have not yet reached the target, they are almost all close to crossing the finishing line. Of course, an 18-week maximum wait, even calculated on this more honest basis (from time of referral, not from time of first hospital appointment) is not yet good enough, but it marks great progress from the position inherited by Labour from the Tories when 44,000 were waiting for more than a year.

That is the context in which the Conservative warnings about polyclinics ought to be seen. While there can be no doubting David Cameron's personal commitment to the NHS, there is an element of political positioning in all this. Memories of chronic NHS under-funding in the 18 years of Tory government run deep, even if the libel of "cuts" was unfair. It was one of Mr Cameron's priorities to begin to reverse that perception. But that should be cause for celebration rather than for charges of opportunism. That the Conservative Party wants to try to outdo Labour as the party of the NHS is an historic gain.

Polyclinics are also part of the drive, alongside that to cut waiting times, to make it easier for people to see a doctor. The thinking behind them is right, and in many ways they are the sensible next stage of recent NHS reforms, including NHS Direct, walk-in centres and more flexible GP surgeries.

But these reforms have been beset by problems. Many people have found it harder to get early GP appointments – as Tony Blair discovered to his embarrassment during the last election campaign – and doctors did themselves no favours by stinging the taxpayer for a generous new contract in return for less after-hours service.

Polyclinics must seem to ministers to be the solution to such difficulties. But Lord Darzi, Gordon Brown's surgeon-minister entrusted with the details of reform, should take care that they do not make them worse. This is where Andrew Lansley, the Tory health spokesman, sees an opportunity, because there is a danger that this reform will undermine many patients' sense of having of a personal relationship with their GP.

For many working people in big cities, polyclinics seem incontrovertibly a good thing, not least because their large, innovative GP practices have already moved much of the way in that direction. Such people are likely to accept readily the argument that the old single-handed GP practice, while it might be a comforting fiction of an older, simpler, more rural life, is hopelessly inefficient. For them, "continuity of care" sounds like an argument propounded by the country's most successful trade union, the British Medical Association, in defence of restrictive practice.

But Mr Lansley is on to something when he talks of the old or the chronically sick, especially in rural areas, who may have further to travel and who will be "lucky to see the same GP twice". That may not matter to the healthy, who rarely visit their doctor, but it is central to the experience of the NHS for many patients.

This is a tension that has run through reforms from the start. Concentrating care in larger units promises higher standards but makes the NHS seem more remote and impersonal. There is a suspicion sometimes that the centralising tendency is driven more by the interests of doctors and staff, who want bigger, better-resourced units, than by those of patients. So it is to be welcomed that the Tories, after a long period of apparently appeasing the producer interest in the NHS, have placed themselves firmly on the patient's side.

There is no reason why the whole of England should have a uniform provision of polyclinics where patients do not want them. Mr Johnson and Lord Darzi should listen to the Opposition for once, and look at ways in which they can give meaning to their rhetorical commitment to patient power.