Polyclinics: risks and opportunities
We identified a number of risks and opportunities involved in developing polyclinics that relate to quality of care, accessibility of services and cost.
Quality
Developing polyclinics has the potential to deliver significantly improved and more integrated care, particularly for people with chronic diseases. But evidence suggests that in reality these opportunities are often lost. The benefits of polyclinics are not automatic. There is, for instance, no evidence that larger GP practices deliver better-quality care than smaller ones, although they may offer a wider range of services.
Opportunities
In theory, polyclinics offer:
- more integrated care through rapid referral and sharing of expertise between teams
- improved quality of care for people with long-term conditions
- services that are targeted more directly towards local health needs
- new or improved facilities for patients and staff
- a more normalised environment than the traditional health clinic.
Risks
- In practice, providing a wide range of services under one roof does not guarantee co-working or better integration of care.
- Although evidence suggests that quality of care for most services shifted out of hospitals is comparable, this is limited to a small number of specialties. There is also evidence that quality may suffer in certain cases.
- There is inadequate inspection and accreditation of out-of-hospital care, undermining quality assurance.
- Specialists working on a sessional basis across a number of community sites may feel isolated, which could undermine their professional development and motivation.
- Primary care services will need to be carefully planned to ensure continuity of care.
Access
Centralising primary health care services into polyclinics would actually reduce many people’s access to them. Evidence suggests that people’s use of primary care is more sensitive to distance than their use of outpatient or acute services. It may be that ‘hub-and-spoke’ models, with the polyclinic as a central base in a co-ordinated network of practices, are more appropriate, particularly for rural areas. Moving secondary services into the community is also most likely to benefit people in rural areas. But regardless of location, the benefits of greater access to secondary care services would largely depend on how good local transport links were.
Opportunities
In theory, polyclinics offer:
- improved access to diagnostics, specialist advice and treatment. This could particularly benefit people in rural areas and those with long-term conditions
- improved access through longer opening hours and better out-of-hours care, in particular for primary and community services.
Risks
- Many people may have to travel longer distances to access primary care services if their GPs move into polyclinics, particularly in rural settings.
- Potential gains in people being able to access secondary services more easily could be slight in urban areas, and may be lost altogether if polyclinics are located away from natural transport hubs.
- If a polyclinic provided specialist services, there would need to be careful planning to ensure efficient scheduling of specialist staff time.
Cost
Evidence suggests that there are important risks in terms of cost. The assumption that community-based services will be cheaper than hospital-based equivalents is not always borne out. Also, new community-based services often fail to reduce hospital activity, acting as additions to hospital care rather than substitutes for it.
Opportunities
In theory, polyclinics offer:
- potential cost savings, given the lower overheads of community-based services
- more cost-effective ways to manage patients with chronic diseases through facilitating collaborative, multidisciplinary working.
Risks
- In practice, evidence suggests that shifting services into the community can cost the same or even more, unless care pathways are redesigned and hospitals can reduce their unit costs.
- New community-based services may stimulate demand or lower referral thresholds.
- For some services, transitional funding will be needed.
