Talk:Polyclinics in England

Bias

The original article presented only the government's views on polyclinics; the article now presents almost exclusively negative views of them and does not mention the severe criticism of the BMA in organising "Save Our Surgeries". It would be helpful to present both sides of the argument. The best and most neutral article on polyclinics I have read was in the [Independent] (click to read).

I'm very happy to rewrite or contribute when I have the time. What do others think?

Millstream3 (talk) 10:38, 23 July 2008 (UTC)

I accept that recent edits, which are largely mine, present the 'opposition' view to polyclinics, and I agree a more balanced view is desirable. The problem we have in getting there is that there is a good deal of evidence that they don't work, both from leading healthcare figures and from a handful of studies, and none that I know of suggesting they work. Other countries in Europe which have used them in the past are now by and large phasing them out, and we in the UK have had them by another name in the past - "cottage hospitals". The Independent article is fine as far as it goes, but it doesn't contain any evidence for its claims - just quotes from the BMA versus quotes from ministers - and crucially to my mind it offers no evidence for the pivotal point in its argument that the BMA are biased. It's convenient to claim the BMA are opposed to polyclinics because they don't want to suffer another 'bloody nose', but there's simply no evidence for it - and that's a big problem with the article to my mind.

In making the edits, I tried to confine press criticism to the relevant section, with researched criticism standing against the DoH's claims about polyclinics. In particular, the King's Fund report is independent, freely-available, and presents the pros as well as the cons - being more interested in shifting the balance away from the default government position that they are going to be unutterably wonderful and transform primary care, I perhaps overlooked the positives. Anyway, can I propose that as a starting point for any rewrite?

I would also be keen to see referenced stuff left in - it takes some time to source these claims appropriately, and I would hate to see that work lost. Nmg20 (talk) 10:58, 23 July 2008 (UTC)

Most of the opposition is about "forcing" GPs to work together in new premises; but that is only one of several models and I think taking out the description of the different models could be misleading. In many areas, GPs are already working together and jointly funding "hubs" with additional facilities or, indeed, working together in "health centres". As far as I see it, adopting polyclinics as a policy extends and expands this trend. Whether or not moving GPs into new accomodation is a good idea or not (affordable, accessible, improved outcomes) is most certainly open to debate but that's only a quarter of the story. The existing references should definitely be kept in.

Millstream3 (talk) 11:25, 23 July 2008 (UTC)

First of all, I appreciate that we have significantly differing views on how these things will work out, and am glad that we're discussing changes here. I've covered your changes below.

Polyclinics as amalgamating existing GP services: I am unsure where your doubt on this matter comes from. Darzi's report explicitly condemns existing GP surgeries (p.87 item 4, "Practices are often located in cramped, converted residential spaces. This can cause difficulties for patients." He provides no evidence for the first point, and cites only a BMA study about disabled access for the second; as an aside, it's clear m'Lord Darzi doesn't feel that everything they produce is "BMA propaganda" as you claimed of the suggestion polyclinics will be larger buildings GPs will be forced to move to! Darzi continues: (this) "also prevents practices providing the extended services envisaged in the previous chapter". It is inconceivable that his model will allow practices which he claims are difficult for patients and too small to do what he wants them to to survive: funding will move to the larger practices in line with the policy. That's not just my POV; while I'm suspicious of anything that issues forth from the mouths of politicians, the Conservatives have recently claimed it could result in the loss of 1,700 existing GP surgeries. Darzi's "Key Proposals" under the "Future Models of Healthcare Provision" section (p.88, on the page following all that criticism of existing GPs) includes seven points, not one of which mentions retaining existing practices and the first two of which talk about providing more healthcare at home, and developing polyclinics to provide "a far greater range of services than can be offered by GP practices". The next item on that page is a graph titled "London has more small GP practices than nationally". He goes on to say (p.91) "GP practices will be based at polyclinics". About 100 GP practices have already been closed across several London boroughs. I'm at a loss as to how you can interpret all that to mean Darzi's proposals "at their simplest" are about networking existing practices. I will leave this as it stands at the moment, but I regard your position as pretty indefensible.

Moving of King's Fund report: this is not opinion, it is a thinktank report into the rationale behind polyclinics: this is why I originally included it after the government-line rationale, and I believe it warrants a place there. I will restore this to its earlier position.

Retitling of the "Criticism" section: the majority of these references are outright criticism, and I believe they merit a section titled as such. There are currently eight references there from sources opposed to polyclinics, the two in favour which you've added in your last edits, and the supposedly-neutral independent one. The section is still overwhelmingly criticism, and I will retitle it as such. We can have a section for supporting views if you'd like to move the two other references to it.

50% of Londoners support polyclinics: I will get back to you on this, but I believe this "consultation" was one of the most expensive per response ever conducted, and the actual numbers of responses were pitiful. I'll leave it for now.

Selective citing of RCGP article: it's synthesis to quote the RCGP out of context in the way that you do when you attempt to paint their opposition of polyclinics as inconsistent. Removing the boundaries between primary and secondary care is something it is perfectly possible to do without a wholescale reorganisation of primary care; indeed the document itself was published in response to Darzi and explicitly sets out an alternative method to deliver improvements in patient care without the destruction of primary care: "Teams without Walls endorses clinical innovation, leadership and learning as the primary method of improving patient experience and outcomes within the NHS, and this paper provides examples of successes in implementing this way of working. This approach may challenge some of the recent NHS reforms, but promises to be a more sustainable solution to some of the entrenched problems the NHS must overcome if it is to succeed in the long term." That is on page 1 of the document, so to attempt to use that paper to suggest it's somehow inconsistent of the Royal College to oppose polyclinics is at best exceptionally careless.

Toynbee Guardian article: that is from the Guardian's "Comment is free...but facts are sacred" section. It is thus not a news article, but rather - as it suggests - a comment piece, and it is misleading to present it as an official Guardian comment on anything. I will rephrase this.

Perhaps the most balanced newspaper article: says who? This is either WP:Weasel or it's point of view - take your pick.

Look forward to your comments. Nmg20 (talk) 17:51, 14 August 2008 (UTC)

I've just made extensive changes to the latest set of edits. Rather than put them in edit summaries, where they're harder to look at as a set, I'm including my rationale here.

Lead - the claim that they will offer "a far greater range of services" is pure POV, and worse it's POV inserted while removing the prior reference which gave some detail on what services would be offered. I've amended it accordingly.

"Variety of models": I've explained in detail and using direct quotes from the report above why Lord Darzi's alternative models all involve the closure of existing GPs. I would like to see chapter and verse here on where in the report other editors feel he outlines other models, and have fact-tagged this line pending that.

Polyclinics vs. GP-led health centres: It may be convenient for Lord Darzi to distinguish the two under questioning in the Commons, but there is ample evidence that plans are already underway to impose them across the country without consultation. Wikipedia is not a place to take the politically-motivated claims over newspaper reports to the contrary.

Removal of closures from lead: the issue of whether these polyclinics will result in closure of existing GPs is absolutely central, as evidenced by the numerous political and news reports on exactly this topic. Shunting hard data on GP closures down to the criticism section is a total misrepresentation of what the news story says - that item is simply data on closures already happening because of the polyclinic model, and it belongs exactly where it was. I have restored it.

"Some have claimed...": the insertion of the "Some have claimed..." nonsense is weasel words and, given that it was provided despite the evidence I had already provided of GP closures, I'm struggling to continue to assume good faith.

History section: the old version ran through the history of polyclinics in this country. Opening the "Polyclinics in England" article with generic information - including an alternative spelling! - on polyclinics in other countries is absurd: that belongs in polyclinics. As with so many of the recent changes, the only references included in the whole rewritten section were the ones I put in months ago, and even those references have been selectively amended: saying the attempts by Russia to replace polyclinics with GP practices may be strictly factually true, but the article also reveals that the GP model has taken hold in the private sector, implying polyclinics are not good enough for those with money, and the article concludes with a string of possible problems using the model in the UK (none of which I included), ending "The introduction of a foreign model is more complicated than having buildings erected, equipped, and staffed. One man's meat is another man's poison.".

David Cameron: why is it relevant to say that Cameron is not opposed to polyclinics in principle? No one has been opposed to them in principle (cf The BMA, RCGP, etc), and he is commenting not on a theoretical document but on government proposals to implement them in practice and on the repercussions of that decision for primary care across the country. His speech is relevant to this article only in that it includes the results of research on precisely how many surgeries will be shut by these polyclinics. I note also that again the government position is parroted without any reference at all ("The government, however, denies..."). Not good enough - reference it or don't put it in.

Polly Toynbee: I've included a separate blog piece from the same section of the Guardian to illustrate exactly why I dislike these as references - they're free from editorial control and so can be completely contradictory, they don't advance the research position for articles one iota, and in my opinion they should be treated as blogs and excluded as sources.

Discussion of these issues is needed on this page before further edits. I am not opposed to amending the article to include more of the government position, but that must be supported by references and it must be balanced by the inclusion of the wealth of journalistic evidence, some acquired under the Freedom of Information Act, showing the divide between the blithe government claims and what is actually happening on the ground. That is not happening at the moment. Nmg20 (talk) 13:27, 18 August 2008 (UTC)

Nmg20 - I don't think your draconian editing is appreciated. You clearly have a view on polyclinics and it is colouring your judgment. Several of us have taken a great deal of time over the weekend to address the bias in your original article. You certainly should not remove cited sources and valid examples. Here are some comments in detail on your previous edits, which I have reverted. Grateful if you'd discuss here before you obliterate the article again.

• Lead - "far greater range of services". This is what is proposed for London; it is not POV.
• Variety of models - again, see the 4 different structures proposed in a Framework for Action.
• Polyclincs vs. GP-led health centres: it is a matter of *policy* that polyclinics are for London only. I have not said that there *aren't* any. Please feel free to list them if you wish.
• Removal of closures from the lead. The lead should be a summary, this does belong elsewhere.
• "Some have claimed". This is correct. There have been claims in both directions. There are a great number of GPs in favour of polyclinics. For example in Camden, it is GPs who are proposing them and the PCT is assisting.
• History section - happy for the alternative spelling to go.
• David Cameron - agreed, this should probably change.
• Polly Toynbee - the page says that it is a comment piece. What exactly is your problem?

Millstream3 (talk) 14:05, 18 August 2008 (UTC)

I'm quite sure you don't appreciate my editing, but as I said above, if you wish to edit the article you must provide sources to support your point of view. You're quite right that I have a view on polyclinics, but I can assure you it's not colouring my judgement any more or less than your view on them is colouring yours.

You are also prone to exaggeration. Two editors, you and Hauskalainen, made edits over the weekend to address what you feel is bias in the original article. The other edits were typographical and stylistic typos (check the diffs). In addition, I am glad you agree that you should not remove cited sources or valid examples - I am curious, then, as to just why your revert of my edits has removed, at a rough estimate, half a dozen? Be consistent, please: the same rules which apply to me apply to you.

Lead - I assume you're referring to point 18 on page 11 of the Framework for Action document (it's helpful to provide that level of detail), and it is POV, albeit Darzi's. With inclusion of the evidence against the proposals in the lead section, I am happy for this to remain; without it we're making the lead section a propaganda piece without any basis in implementation and fact. I am not happy for the lead section summary to be interpreted as "whatever the government claims it intends".

I would also point out that Darzi does not say, as your edits do, that any of these services are "in addition to traditional GP services". The reason for this is quite simple: GPs have always provided urgent care in the form of 24-hour cover by individual practices until the contract negotiations a few years ago, and in the form of regional organisations like SELDOC in South-East London since then, "healthy living services" have always been their domain as evidenced by their providing the majority of the targets in the recent government review of GP pay, and they are heavily involved in social services and community mental health referrals both when they initiate them themselves and when they pick up in-hospital referrals of their patients.

Variety of Models: do me the courtesy of providing exact quotes supporting your claims. For a template, you might use my comment on polyclinics amalgamating existing services above in which I quote directly from the report about five times giving page numbers at each point. It's far too easy otherwise to say "Darzi was once a lion-tamer in Bognor Regis" citing the entire report when that's not actually in there. In an article like this, I'd suggest separate refs to the report with page numbers within.

This is important because it means we can pick up when other editors are misinterpreting the report rather than citing it directly. Polyclinics are one model, not one idea with several models under it. See:

• p.10, "Models of healthcare provision", item 18 - polyclinics are one of the seven models proposed
• p.88, "Future models of healthcare provision" key proposals (I already gave this to you above) - polyclinics are again one of the seven models
• p.89, as above
• There are about two dozen further references to models in the document. I haven't read them all, but I've read enough to know that you don't understand the proposal properly in how it relates to polyclinics and that you didn't read it even when I pointed you to the relevant section in my post of 14th August.

Polyclinics vs. GP-led health centres: interesting distinction, but this is an article about polyclinics in England, not about what Darzi thinks about them. If they are being implemented across the country, then the article needs to reflect that, and not a nuance of his wording in the original report. I will include something to the effect that he didn't explicitly suggest rolling them out nationwide, although that is probably something better situated in his article.

Removal of closures: as in the previous item and as per my previous post here, whether they replace or supplement existing services is absolutely crucial to the article.

Polly Toynbee: my problem is that these are to all intents and purposes blogs, and so fail WP:RS - however, if you include Toynbee, I will insist on the inclusion of the other two "comment pieces" from the same site which your reversion removed without explanation. As I said at the outset, you can't have it both ways - either Comment is Free pieces are valid or they're not.

I'm glad you agree on some other areas, although your latest revert doesn't address them, and you have yet to address my first post above.

Accordingly, I'm reverting to my text which at least attempted synthesis of recent edits pending proper discussion here. Nmg20 (talk) 15:52, 18 August 2008 (UTC)

Hmm... I have a fundamental problem with your current approach to the article. There are currently 0 "polyclinics" in England. What we have are policy proposals from Darzi and specific proposals from PCTs (who have the final say on all of this, despite what the DH may think). As such, we must either reference Darzi's proposals or PCTs'. Anything else is your or other people's conjecture. You are correct that Darzi does not say that polyclinics are "as well as"; simply because he can't. What we do know is that every PCT in London has been asked to commission one and that every PCT outside London has been asked to commission a GP-led health centre. I'll revise starting with you current draft, although you have destroyed several hours of other people's work over the weekend by simply reverting to your last edit: that is arrogant as well as opinionated. Please try to remember that this is supposed to be a neutral article; it is not a forum for you to dispense your own personal view.

• Variety of models - I'm afraid I ignored your previous comment about this because it didn't really make sense. Please see "Polyclinics and GP services – three options for organisation", p. 93, A Framework for Action and p. 41 Consulting the Capital. There are clearly at least 4 models of polyclinic. They would provide different scales of service and therefore function differently. However, Darzi also says that what services go in a polyclinic will depend on what is required in each locality. There is therefore no prescribed model.
• Polyclinics vs. GP-led health centres - if you're going to say they are being developed across the country, please provide citations. It is otherwise conjecture.
• Removal of closures - again this is conjecture without specific citation. There have been no closures.
• Polly Toynbee - fair enough.

Millstream3 (talk) 18:04, 18 August 2008 (UTC)

That is not all we have, in fact: as well as Darzi's policy proposals, we have extensive reports and comments from a whole host of think-tanks, medical (and particularly primary care) leaders, news reports on the pros and cons of the proposals (at least one of which you yourself added to the article), reports in the scientific press of how polyclinics have fared elsewhere, and reports in the British national press of how Darzi's proposals are being implemented already, like the extent of the cuts in existing GP services in London.

So here's my fundamental problem with your current approach to the article: you only seem to think the Party Line is worth including in the lead. That's nonsense: this is an encyclopaedia, not a propaganda vehicle.

Variety of models: Thankfully, my last point on the variety of models made enough sense that you've taken it on board to the extent that you can now source that in the article. These are not models as Darzi terms them ("Different types" in the Consulting the Capital document, "Options for Organisation" in the Framework for Action document, although they at least use the term model in the caption to the diagram), but it's a reasonable gloss given that there's no conflict with Darzi's use of "models" in the article.

Country-wide rollout: I already have provided citations David Cameron's speech discusses 600 local surgeries across the country, and The King's Fund report discusses this in detail. To those you can add, from a quick google search like the one you use to suggest polyclinics exist in Africa and Asia, comments fromThe Telegraph, Andrew Lansley in the House of Commons, Ben Bradshaw talking to GPs in Bristol, Norman Lamb who noted of Alan Johnson's attempt to distinguish 'polyclinics' from 'GP-led health centres' that "They look to most independent observers very much like the same thing", Darzi himself in an interview with Andrew Marr, and crucially information obtained under the Freedom of Information Act showing plans in at least 25% of PCTs country-wide including Birmingham, Cumbria, Lincolnshire, Rochdale, Cheshire, Essex.

Removal of closures: again, I have already provided these citations - from the Evening Standard, the David Cameron speech, the Pulse articles.

I'm going to leave the article as-is pending your comments and other editors' contributions, but you seem intent on culling sources in an attempt to remove criticism of what is actually happening on the ground in favour of making the article purely Darzi and the DoH's opinion on what they are and what they'll involve. That's propaganda, not an encyclopaedia. Nmg20 (talk) 20:26, 19 August 2008 (UTC)

Hi Nmg20. Overall, I'm more interested in evidence than opinion; and until there is a body of evidence about polyclinics in the UK, it is my view that more credance should be given to concrete proposals than others' opinions about how they haven't worked elsewhere. Fair enough?

• Variety of models - I still think this is true. There is no "recipe" for a polyclinic and Darzi has said specifically that PCTs must decide on the right composition for their area. As there are currently 0 polyclincs there is no evidence to the contrary, only opinion.
• Country-wide rollout - You've cited some good stuff there; please can we have this in the article itself? Note - my objection is to cite David Cameron without the stuff behind his comments. Your stuff here goes some way towards that. I ready recently that Birmingham is considering the radical proposal to commission every GP service into a polyclinic. That should certainly go in the article. [A quick Google just now reveals that Birmingham has scaled back its plans.]
• Removal of closures - Need to wait for consultations to finish first. Also, I think it's disingenuous to say that "closures" will happen. PCTs commission services. They can commission what they like (not quite true, but bear with me). If GPs want to provide the required services they can. So GP practices will only close if GPs don't want to move with the times. It's up to them. In Camden, the move to polyclinics is actually being led by groups of GPs who recognise that they can make a lot more money of out polyclinics than they can from their practices.

Happy to discuss further but please put in those additional references you found.

Millstream3 (talk) 09:31, 20 August 2008 (UTC)

Hi. Yes, there are currently 0 polyclinics in this country; where we disagree is on what constitutes opinion. Darzi's report is as much opinion as anything released by the BMA and more opinion than, for instance, the King's Fund report which is a disinterested party (I accept what you say about the BMA having an interest in polyclinics, although we disagree as to the nature of that interest; by the same token the government have an interest in presenting their plans in the best possible light). So I do not think it fair enough that a policy document should be given more weight than an independent report into that proposal. I'll discuss the reports from elsewhere in the new section below if I may.

Variety of models: I should have conceded this point rather more graciously than I managed midweek. I should have read the document more thoroughly; you were right. The proof of the pudding will be in the eating here, but this should stay per your terminology.

Country-wide rollout: thank you for acknowledging the sources here; I will include them shortly.

Closures: I don't think we do need to wait for the consultations to finish. GP services are already being cut in the capital and there is research suggesting the scale of closures will be far greater than currently. Yes, that research is politically-motivated, but so is the policy document - really this is just Labour opinion vs. Tory opinion, isn't it?

Do you have a source for that claim re: Camden? And are these groups of GPs setting up as private companies as in Camberwell?

Nmg20 (talk) 09:40, 24 August 2008 (UTC)

I sense that recent edits by Nmg20 are not aimed at increasing the knowledge about polyclinics in England but are just there to create a lot of noise which is in opposition to their introduction... a kind of "if enough people say its a bad thing, then it must be a very bad thing".. So lets get as much of that into the WP article as possible. It is of course fueled by newpaper reports which are habitually sensational in the UK. The inclusion of the Vautry quote is a case in point. Although that is a direct quote from the article referenced, Vautrey goes on to make it clear that he fears that the running of the centres will go out to competition which will be won by multinationals. If the centres are successful money will flow from existing GPs to the successful bidders and that threatens GPs (and Vautrey heads up a the BMA's GP committee, so he he is not exactly neutral). One has to understand the context and quoting out of context is misleading. That kind of editing is unbalanced and against the sprirt of Wikipedia. I just wonder what can be done about it.--Tom (talk) 15:53, 25 August 2008 (UTC)

With respect, Hauskalainen, what you "sense" about my edits is not a valid reason for altering your own editing of the article and in sensing that my edits are effectively rabble-rousing rather than a genuine attempt to increase knowledge about polyclinics in England, you are failing to assume good faith.

Newspaper reports are habitually sensational, yes, but they are also legitimate sources for inclusion in Wikipedia and given the huge numbers criticising the proposed introduction of polyclinics my inclusion in the article of a whole three newspaper articles in my edits since the 18th seems pretty reasonable to me. If you look at what those articles were in detail:

(1) directly quotes Ben Bradshaw, a government health minister, as saying that individual GPs would not close as a result of polyclinics. I added that to attribute a statement supporting the idea that polyclinics will not result in GP closures. The article includes directly reported speech from Mr. Bradshaw.

(2) an article from the Telegraph reporting on information obtained under the Freedom of Information Act outlining exactly how many PCTs plan to install polyclinics. If you want to criticise this as sensationalist, presumably you're suggesting the PCTs are breaking the law by lying about their implementation plans?

(3) an article from The Times which reports on the question of whether they will replace or add to existing surgeries. The article presents both sides of the argument, quoting both Darzi and Vautrey directly.

(4) I also added a BBC reference (which I have not included as a newspaper article) quoting Darzi as saying that funding would be in addition to existing primary care funding.

Three of those include direct quotes from involved parties and the other one reports directly on information obtained under the Freedom of Information Act. All three which include direct quotes provide them from government spokespeople; only one includes any sort of opposition opinion. For you to call them sensationalist and to imply they're anti-polyclinics is frankly laughable.

Your criticism of Vautrey's comments and the BMA are difficult to fathom. The BMA are certainly saying that polyclinics are a stepping-stone to privatisation; you claim they are doing so to try to prevent the process because if that happens money will flow "from existing GPs to the successful bidders", and that that "threatens GPs". First of all, if we believe the government, this isn't the case - funding for polyclinics is in addition to, not instead of, existing GP funding. Second, if you believe it is the case, do you acknowledge that the BMA have a right to protest against it? If not, do you acknowledge that the 1m+ patients who've signed the BMA petition against polyclinics have a right to object to their taxes, as you put it, flowing away from independent GPs towards private companies? GPs have to spend surplus government money on improving the service they provide to patients, private companies have an obligation to their shareholders to make money. Fundamentally none of this matters in terms of the article because your opinion of the BMA's position is irrelevant per WP:NOR, but I am interested as to how you can say that the BMA are wrong for protesting against something which threatens what Darzi himself has called the "fantastic relationship" GPs have with their patients, and how you can possibly think the part-privatisation of the NHS is a good thing. Nmg20 (talk) 19:24, 25 August 2008 (UTC)

If one takes the goverment at its word, then the funding will be new. However, if people opt through choice to use the polyclinic rather than the GP then GP's will lose income because of the way they are paid. The funding follows the patient which is broadly how it should be (IMHO). That is a different thing from the government deliberately cutting off funds from GPs to fund polyclincs. I agree the article and the links taken together do present the entire argument, but the weight of your editing has been to create a volume of argument against polyclinics. Is this deliberate on your part and if so does that mean I assuming bad faith by pointing it out? I'll not answer that but leave that for others to decide. Using headline grabbing words like CLOSING when what is really meant is CO-LOCATING is misleading. My intention is that the article should be balanced and present both parts of the argument and have plenty of sources and let the reader decide for themselves. Giving more weight to one side of the argument by including more text in support of that one side unbalances the article. WP is not a place for debate and I will not get into an argument with you about privatisation, though you have implicitly attributed to me an opinion which I have not expressed and do not hold.--Tom (talk) 06:51, 27 August 2008 (UTC)

Funding

I suggest we need a funding section. The question over whether the money for these things will be in addition to or instead of funding for existing services is self-evidently crucial, and there is already evidence that it's instead of. I'm holding off putting this in to allow discussion of other sources here. Nmg20 (talk) 18:08, 14 August 2008 (UTC)

Agreed. Darzi has stated that new money will be available for setting up polyclinics, although I am not aware if this has actually happened. Obviously, once they are set up normal commissioning rules will apply. The difficult for PCTs will be that they cannot favour any one particular provider; so they will need to have commissioned a polyclinic before they can provide set-up funding.

Millstream3 (talk) 14:21, 18 August 2008 (UTC)

International comparisons

The references to other nations and polyclinics is potentially misleading. Are we talking about the dictionary definition of a polyclinic (a place providing health services not needing an overnight stay), in which case it fits the same bill as the traditional health centre in the UK or the new proposal?

Or are we talking about the proposed beefed up health care/diagnostic centre?

If we cannot answer this question, the references to Australia, Russia etc are of little use.--Tom (talk) 13:56, 20 August 2008 (UTC)

I agree: what is proposed in the UK is not the same as what has been done elsewhere. For a start British GPs aren't running the polyclinics around the world; and we certainly have better funding than Russia. Nevertheless, I do think some comparison is relevant. The BMA and Nmg20 would have us believe that any failure elsewhere means that polyclinics will automatically fail here too. The protestations of the BMA (a trade union) could be interpreted as concern about GPs losing their "cushy" status as private contractors.

Millstream3 (talk) 09:14, 21 August 2008 (UTC)

I agree with you mostly about the political play in all this, but not about the international comparisons. How can we compare polyclinics in Russia or Australia to what the UK is aiming to do? I really am very unsure about this.--Tom (talk) 18:20, 21 August 2008 (UTC)

Well we can't directly, but I think it is relevant to say that others have tried to implement similar models and have not been successful. It would be helpful and balanced to go on to say why one can't necessarily draw conclusions about a British implementation from this.

Millstream3 (talk) 22:41, 21 August 2008 (UTC)

I disagree. To what extent are the models in other countries any better or worse than the existing hospital outpatient clinics in the UK or for that matter health centres? Nobody has produced any comparative data as far as I can see and I am not sure to what extent we can even begin to compare the performance of as yet non-existing polyclincs in England with so called polyclinics in other countries. So it cannot even be relevant and one certainly cannot say that "others have tried to implement similar models and have not been successful". Who are "others", and what basis do you have for saying that they not been successful? If we are replacing Health Centres and hospital outpatient clinics with polyclinics, does that mean that the UK's implementation of Health Centres and hospital outpatient departments has been without success?? It sounds baloney to me. --Tom (talk) 14:43, 22 August 2008 (UTC)

I'm entirely neutral on this point. I think that you and Nmg20 have both made good points. Nmg20 has cited sources saying that foreign "polyclinics" have been unsuccessful. However, it is true that these cannot be compared directly with what is proposed here. (I made a point earlier that foreign polyclinics are't run by British GPs.) Perhaps a salient point is that we're trying to improve a functioning system not build one from scratch. That should make our polyclinics more likely to succeed, wouldn't you agree? It makes this situation rather different from that in Russia. The BMA and Conservatives both have political reasons for criticising the proposals. A lot of the media have picked up on these faux criticisms. The King's Fund gave cautious approval. The NHS Confederation seems really up for it!

Millstream3 (talk) 14:53, 22 August 2008 (UTC)

First of all, I profoundly disagree that the BMA have political reasons for opposing these plans, and I will resist any attempt to insinuate that in the article.

Secondly, regarding the foreign comparisons: the article I cited originally (Ershova et al) was published in the Lancet and is about polyclinics in London. Frankly the Lancet is a better judge of whether these comparisons are valid or not than any of us, and unless citeable sources can be found criticising the Lancet for including it, I don't believe we've any business claiming the comparisons aren't valid.

Thirdly, I object extremely strongly to being lumped in with the BMA here. I resigned my membership of the BMA over their response to the MTAS disaster which was the government's previous attempt to meddle with a medical profession it didn't understand, and have no intention of resubscribing currently. In addition the BMA have to my knowledge made no comment on polyclinics elsewhere - that comes from an article in an extremely reputable, peer-reviewed scientific journal - and they don't appear to be cited in the article as saying anything of the sort. The gloss of their opposition is in the relevant section - they object to them because they believe "larger clinics were already emerging where needed, that forcing their introduction was wasteful and costly, and that they would undermine the value of a relationship existing between GP and patient".

In summary, I agree that comparisons to polyclinics abroad are a dangerous area, but not to my mind when we have a Lancet article drawing out precisely those comparisons. Nmg20 (talk) 17:56, 24 August 2008 (UTC)

No offence intended to you Nmg20. The BMA's "Save our Surgeries" petition campaign was protectionist at best. An editorial in the HSJ agrees with me, although I sadly can't find that edition and therefore haven't cited. The BMA may well believe that larger surgeries were emerging; they may have been. The idea of polyclinics is to blur the line between primary and secondary care and take trivial treatments out of hospitals. This is fundamentally different from what would have come about otherwise. Millstream3 (talk) 09:10, 26 August 2008 (UTC)

Closures

I don't believe that "relocate" accurately reflects the text of the Evening Standard article. The article opens, with 'axe' in the title, 'will close' in the first sentence, and 'shut' in the second. 'Relocate' only comes in when it's a direct quote from the PCTs, which have a vested interest in not using the more emotive term. I have not changed this, but it is to my mind using a politically expedient euphemism which does not represent the thrust of the article. The point it makes is a simple one: Darzi and the government have repeatedly promised that polyclinics will be funded in addition to existing surgeries and will not result in closures; it is rapidly becoming apparent that this is not true, and if you are "relocating" a surgery by, er, shutting it down and obliging the doctors there to work in a different building under a different professional arrangement, you are closing the surgery. Nmg20 (talk) 08:35, 25 August 2008 (UTC)

Whether practices will relocate or close remains to be seen. Both terms 'axe' and 'relocate' need to be in the article for balance. Do bear in mind, of course, that the Evening Standard comes from the same inbred stable as the Daily Mail. I'm not sure any of us would want to rely on quotes from that "paper". Millstream3 (talk) 09:03, 26 August 2008 (UTC)

Official consultation

Regarding the official consultation, currently referenced in the document as references 29 and 30. This is the consultation which by their own admission cost 1.1m, in exchange for which they got 4,372 individual responses and 359 organisational responses. That response rate of 0.05% is pitiful for the amount they threw at it, and a further 14m is now to be spent on the exercise, which has understandably been heavily criticised by patient groups. More to the point, that response rate is trivial, it is impossible to infer anything about the population view from it statistically, and its overall numbers compare pretty unfavourably to the 1m+ who signed the BMA's petition. I'd suggest that as it stands, without an indication of the tiny number of responses involved, it's misleading in the article to imply half of Londoners support polyclinics. Nmg20 (talk) 09:35, 25 August 2008 (UTC)

The response rate is low indeed, surprisingly so. However, it is incorrect to say that 0.05% of Londoners were consulted. All of us were. 0.05% responded. To say that nothing can be learned from the responses is also incorrect. Typically, with a central government consultation, those who shout loudest are those with a strong opinion. What we learn is that, of those with a strong opinion, there's an even split between those in favour and those against. We would need to see which organisations responded in order to infer a view from the population of London. I've reverted the text but please do work on this wording - the number of responses deserves to be in there at least. Millstream3 (talk) 09:00, 26 August 2008 (UTC)

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