Click here to see the map of original proposed sites

Lord Darzi is undertaking a national review of the NHS and has already made suggestions for London. Judging by his preliminary report for the whole NHS, we suspect the rest of England will be following the London lead. The reports seek the establishment NHS Polyclinics, and sites have already been identified, including Hemel Hempsted.  These buildings are grouped GP surgeries with diagnostic, outpatients and day case surgery facilities in one place.  

• Lord Darzi interim report is here to download
• Lord Darzi Review, Our NHS is here
• Announcement
• We are no reactivating our plans following the announcment that there is it be Darzi Clinics in Hemel

Since 1999 Archway Development and Consulting has been trying to develop such polyclinic in Hertfordshire, and we put in a bid for two sites.  At the The the PCT opposed us.  Now the NHS wants what we proposed.

The essay below was written with Archway Surgery, in mind following local worries after we had obtained planning permission to use the surgery building as offices or flats.  This is of 2004-6 vintage, but since we were ahead of our time it remains relevant:

The Government suggested a new vision for General practice in 2005:

• The G.P. list goes completely (GPs no longer have out of hours).  There will be three levels of Primary Care:
• Tier 1 – non registered access  (i.e. walk-in centres)
• Tier 2 – registered access for LTC/serious episodes of care diagnostics treatments: typically 10+ GPs?
• Tier 3 – Access to a Specialist, diagnostics, outpatient attendance, pathology,  and  day-case surgery

This vision first seen on 10th March 2005 (see Jo Whitehead's presentation)
There is no room for small practices like Archway Surgery under such plans, unless they are part of larger consortia. We tried to form consortium in 2000 but we were bitterly opposed by the PCT at the time. Practices were leaned on not to join us. Two of those practices have since closed, two of the large national reduction in small practices that occurred over the last few years.  We did manage to form a smaller DASH grouping, but this only has three practices in it. It has helped us to continue to work in the current hostile environment.

A BMJ leading article on the lack of evidence that larger surgeries are better is here (June 2005)
 

Archway Surgery Bovingdon obtained Planning Permission for the building. We never planned to close the service.  Indeed we worked hard in the recent handover to prevent the PCT distributing the list on Drs Bulger's retirment from the surgery.
There is  planning consent to turn the surgery an office or into a residential a flat. This would finance a move to larger facilities should a site become available. These ideas are still in play now that Dr Omar Rahim has taken over the surgery building. Archway Sugery is not moving: It had nowhere to go as yet.

The Government has pushed forward many reforms, many of which were detrimental to smaller practices. A small practice, despite all clinical evidence to the contrary, was regarded as a “bad thing” by both the Government and Primary Care Trusts. l Dame Jane Smith (Shipman Report) ticked them all off for the unofficial policy to close small practices.  Two years ago two small practices were closed in Dacorum. The NHS Plan in 2000/1 singled out small practices for specific action without any evidence.  At Archway we saw that coming, and had already formed a grouping with two other small practices, working under new contracts called PMS.  This grouping of practices still exists.

The final Shipman Report were much more helpful to small practices than PCTs and ourselves expected. Until her final reports Dame Janet was expected to damn the smaller practices. The converse was true  However the Government is still moving on with its grander vision and Lord Darzi adds a surgical tilt to the vision. 

Archway Surgery is determined to provide our current services. We need to plan ahead and be prepared for the next round of Government and PCT initiatives. The way things are going at the moment, this building will have to be 100% office space simply to do the paperwork involved in the New Modern Dependable NHS!

Payment By Results, and the advent or return of Practice Based Commissioning is a further imperative to keep our options open. 

As from April 1st 2004, General Practice as we knew it was abolished:

• Patients no longer register with a doctor, but with an organisation; a practice or the Primary Care Trust itself.
• G.P.s are no longer be responsible for patients for 3/5th of the week: all weekends and after 6.30pm to 8am in the morning.  The new arrangements forbade small practices to do their on call.
• Many current services provided at the practice are no longer funded.
• Some services provided by G.P.s are now open to tender by any other organisation.
• The NHS will now let some goodwill of the patient base, to be owned by practices or commercial organisations.
• The new contract is target focused, so G.P.s will need to be feeding our computers more than ever.
• The NHS taking over the ownership of G.P. computer systems (nationalisation by depreciation). Over 4 years as parts are replaced, PCTs will own G.P. systems and running all services thought a central database system.
• Small practices are disadvantaged by the new contract. In Dacorum two small practices shut their doors last year  It is Government policy to close smaller practices despite the evidence that small practices may be better for patient care.  http://news.bbc.co.uk/1/hi/health/2753571.stm
• G.P.s will need to specialise and be accredited in various sub-specialties.
• G.P.s are expected to take on more hospital type services and take on practice based commissioning.
• The new three tier policy outlined above.

G.P.s will need to work together and share larger premises to provide all the services.   We believe this will have to be in the form of Polyclinics, akin to American Health Maintenance Organisations.   Already the NHS has been working with Kaiser Permanente see http://www.nhs.uk/nhsupdate/news.asp?newsid=746

G.P.s remain private enterprises and control expenditure.  Unless G.P.s keep our expenses down we have no take home pay.  So the money that goes general practice is unlikely to be wasted.

The Primary Care Polyclinic

• A clinic with good transport links, that can bid for NHS Services in Dacorum and good car parking.
• If no NHS contracts are forthcoming this can be entirely private, seeing patients on a private basis alone.
• G.P. services .
• Enhanced Services (those services being split from current general practice).
• Diagnostic Services (Ultrasound, echocardiography and X-ray)
• Walk-In Services, and Out of Hours care.
• Obesity and Healthy living clinics.
• Occupational health Services.
• Full Disabled Access.
• Added features such as chemist, dentist, optometrist, physiotherapy.

If such a service was developed and had a critical mass of registered patients it would be possible to run its own transport service bringing patients in.

We had two sites in mind. One on the A41 and another in Maylands Avenue. Click here to see the map

Archway surgery has planning permission to turn the current surgery into a residential flat or office. 

Informal discussions are taking place with other practices and landlords seeking long term solutions to increasing health care needs. If we develop larger premises with other practices it will be on the basis of one building and two or more practices sharing the building and resources, and keeping a local presence in the villages.

To create more space we purchased the flat next door, no 54 (the flat that also goes above the arch of the surgery). This gave us an extra car parking and a disabled bay.  In 2003 we obtained planning permission the ground floor of that flat as an office/storeroom, as an interim measure while we seek larger premises with other practices.

Dacorum Primary Care Trust was violently opposed to developing any polyclinics in  2003/4 so we invested our resources in areas witch had more forward looking, and advanced PCTs.  We  purchased a large surgery building in Kelvedon, Essex (click for pic).  Kelvedon Surgery web site is here  .  

In spring 2005, Dacorum and Three Rivers PCTs are conducting an Estates review. All things are possible again.  Since then the PCTS have merged and once again more reviews.

In 2007 the current PCT would seem to welcome the development of polyclinic and super surgeries.    Now the PCTs have disolved and we have a new PCT this year, West Herts PCT. so it is all change again.