Assessing the evidence on polyclinics

The key findings of our report Under One Roof: Will polyclinics deliver integrated care? are listed below.

• Setting up polyclinic-type facilities could offer a real chance to provide more integrated, patient-focused care in some communities. But it requires considerable time, effort and resources in the planning and development stages.
• Putting services under one roof is not, by itself, sufficient to encourage different teams and professionals to work together in innovative ways. New ways of working will need to be actively developed, and for this to happen there will need to be investment in change management as well as strong leadership.
• Commissioners will need to find new ways of commissioning primary and community services. Contracts should include clear quality standards.
• New approaches are needed to guarantee the quality of out-of-hospital care and support professional development. In particular there needs to be a much stronger framework for inspection and accreditation.
• Centralising primary health care services is unlikely to improve access for people living in rural areas in particular. A ‘hub-and-spoke’ model, with the polyclinic as a central base in a co-ordinated network of practices, may be a more workable model for some communities.
• Polyclinics must be located in natural transport hubs. Where this isn’t possible, services should be integrated within existing facilities rather than setting up a polyclinic in a less accessible place. Improved access by car cannot be assumed given local authority car parking restrictions on new developments.
• Polyclinics are unlikely to deliver a much cheaper service, at least in the short term. Costs for some services may actually increase, unless hospitals can cut their unit costs and commissioners can manage demand. Scheduling of services will need to be carefully planned to ensure that building space and staff time are used most effectively.
• The workforce implications of polyclinics are considerable, and need to be properly thought through.
• New developments should not just be a response to a new national target. They should be a well thought-out element of a longer-term plan that responds to local health needs.
• Any polyclinics developed should be fully evaluated to help fill gaps in the evidence base.