Swedes & Australians enjoy the level of healthcare that they have not because of polyclinics, but because of the level of investment that healthcare receives in these countries. There is no escaping the fact that healthcare in the UK is significantly underfunded compared to that of many other developed nations. You cannot have a Rolls Royce service for Vauxhall money I'm afraid. Primary care (GPs) are almost certainly the most cost-effective part of the current NHS; secondary care currently squanders vast sums of money (without been able to readily account for how it is spent) with endemic inefficiency - perhaps rather than trying to get GP surgeries open later Gordon should be looking at extracting more out of hours from hospital services (not to mention discussing consultant salaries on a level playing field...).

And since when did caring about ALL my patients' needs make me inexpert? As for private companies in healthcare, only one thing that matters - shareholders, not patients

Dr Steve Rix, Swansea,

Unfortunately the government and the public at large have no idea what a GP's role is. We see over 90% of consultations in the NHS at a vastly cheaper amount than A&E or consultants (£20 compared to £300 at a hospital). Polyclinics will be the same. The worried well of the UK will be overinvestigated and overtreated for minor conditions that could have easily be dealt with by their own GP. It was interesting to see Gerry Robinson's comments on polyclincs in his "Save the NHS" programme. Money will be diverted away from patients who need treatment (ie. diabetics, the elderly, etc) and given to the worried well. The chronically ill will be very disadvataged by this as currently I know all my patients whereas in a polyclinic they will be seeing a new doctor each time and have to explain their problems again and again. Simple solution to this - HIRE MORE GP'S. Shame on this Labour government and shame on the selfish worried well of the UK.

Dr D Sartori, Swansea, UK

Last year the DoH contracted with private companies to provide diagnostic imagive by placing a "man with a van and a scan(ner)" on car parks.

The contracts with Atos and Care UK were both scrapped after a few months due to "failure to deliver".

The Government are claiming commercial sensitivity so we do not know exactly how much has been wasted, but I understand it was in the region of £84M !!!

This was untried, untested and ill thought out planning. Polyclinics are in the same vein!!

Dr. Tom Goodfellow, Rugby, Warks

What I find most depressing about reading this article and many of the comments, is that on the issue of health most people seem to trust the Governments propaganda. Do people really believe a privatised system (which lets face it is where we are heading) would be better? Polyclinics are being proposed for one thing only - saving money. Oh, if it came to a war, the sky is the limit with tax payers money but our health? No way. Similarly, with the next Government it would be all change again.... maybe the reason the service from our GPs is sometimes not what we hoped is because they are so busy jumping through the latest set of hoops - fundholding, GMS, PMS, PCG, PCT, advanced access, choose and book.....the list goes on. When will the bureaucracy end and GPs be allowed to get on with treating patients? This is yet another example of Government spin and I can't believe so many otherwise intelligent people are buying into it

Susan, Manchester, UK

All I really care about is getting medical care when I am ill. The day's of "family doctors" who knew the whole family and who made (angelic chorus in background) "home visits" have long since passed.

If "polyclinics" provide the service in an efficient manner, fine.

On the other hand, if this is just a scheme for medical science corporations to get the taxpayer to pay for fancy new facilities which they will then use to provide effectively private services such as dentistry (find me an NHS dentist I dare you) then my message is "on your bike".

Bob, Reading,

Mr Aaronovitch is very lucky that without medical training he uses his ''GP's practise as a way of'', ''accessing prescriptions that I have already decided that I need'' and that appears to be the only reason he sees his GP.

Prescribing is a privilege that we as doctors train for many years to acquire and continuously keep up to date. As a GP with 2 degrees, 2 Royal College Memberships and 10 years of hospital experience before becoming a GP reading an article like this reminds me of doctors' 'blind spot', which is the most dangerous part of practising, which represents the things that you don't know that you don't know.

Perhaps Mr Aaronovitch could save the NHS some money and look after his own health without ever seeing another doctor at any location be that a Polyclinic, GP Surgery, Hospital or Private GP. Having said that, he is always welcome at our surgery for free, up to date, dedicated care from doctors who view their job as a vocation as well as a science and an art.

Dr GP, London, London

Where does everyone think the GP's are going? These polyclinics will not be operated solely by specialists, you can bet everyone of them also has a GP group service on the premises. Patients will see a GP and then be sent down the corridor to see the relevant specialist. Surely this is better than waiting weeks or even months for a referral? My only real concern is that there wont be enough of them and small town and rural area patients will get second class services, I'm not too keen on American healthcare companies making a packet from our taxes either.

Derek, east yorkshire,

isn't it interesting that the people that say GPs are a waste of time, are the same people that keep arguing for better access to GPs.

Polyclinics are large expensive buildings, and like hospitals, will consume large budgets for less services. The people actually using GP services have said repeatedly, they prefer small local practices closer to home.

Most practices already provide a balance between same day access and advance access. Those of you that have GPs that leave at 5pm. If this is true, you don't need a polyclinic or extended hours, you need to change to the majority of GPs that are open for the current hours ie 6pm.
Most GPs already work 50hrs a week. There are a limited number of GPs in the country. an individual GP can only work a limited number of hours in the day. It follows therefore by extending the hours for routine appointments, there will be less GPs, and therefore less appointments, therefore more diffiult to book at any given time of the day.

Bruce GP, Bucks,

When will we wake up and realise that it is the system which is at fault?

Politicians, bureaucrats and patients bringing only an individual perspective are unable to work out if small surgeries, polyclinics or some mix is the best solution. Only the market, composed of tens of millions of individuals making decisions, can do that.

If I want an appointment with my company doctor I can make it for within 24 hours. To get one with my NHS doctor at an acceptable time (late or early in their working day) takes 3 weeks. I then have to encounter the rude staff at reception, who would be sacked for poor customer service if they worked in Tesco.

Why do we not just privatise? Then the GPs will have to serve their patients rather than behaving like snobbish Scargellites. There can be no better illustration of class division in this country than the fact that while Britain's industrial base is no longer subsidised the middle class professions get away with old-style selfish unionism.

Tim, London, UK

I suppose that the benefit of being a generalist goes something like this. I happen to spot the melanoma on my patients back when I am examining them regarding their cough they have had for two days. This happened last week.

You see, I do it all. Medicine, surgery, paediatrics, gynaecology, urology, dermatology, psychiatry......the list is endless. Do you think the respiritory physician would have spotted the melanoma?

Anybody suggesting that I am inexpert is either willfully misleading his readers or ignorant.

David Aaronovitch, I strongly suspect you have not got the first clue what I do. If you want to find out though - e mail me. Come and spend the day and I will blow your mind.

Chris, Portsmouth, England

Fear of the polyclinic is based on ignorance: they have worked extremely well in Sydney for decades. People incorrectly assume you would have to give up your "family GP" (wrong) and polyclinic GPs are inherently inferior to NHS GPs (wrong). People can see their "family GP", physiotherapist, etc. at a polyclinic when they are sick, not when it suits the clinicians & you can get a prescription filled immediately afterwards even if that is at 3am. There is only 1 pharmacist in central London that open after hours. Londoners, why do you cling onto & celebrate such appalling services? The NHS is NOT free. You pay for it through NI and you pay again, with your health, if you do not access timely treatment. Sharon of Brisbane, who criticised the "foreign" drs who cared for her, when presumably the "Australian" drs were busy sleeping or at the pub, should count herself lucky. Do not deprive other people of medical care just because they value their health more than you & are willing to pay.

Monica, London, UK

Actually I don't think GPs should get too worried about any threat to the doctor-patient relationship from polyclinics.

The Government spent over £12 billion on an IT system for hospitals which still hasn't actually appeared. They'll probably waste a load of money building new clinics which will never actually open.

Patients will vote with their feet - a study published in the British Medical Journal in April last year showed that opening walk-in centres didn't reduce the demand for GP appointments, probably because people who went to the walk-in centre then went back to the doctor they trust to check things out afterwards.

Lord Darzi has admitted what the government wants when he said "we need to separate that fantastic relationship between the doctor and the patient".

Ian Williams, London, UK

The reason GPs get a lot of flack is because they are generally ineffective, and in some cases downright lethal (Shipman, tar brush possibly?). Referrals are usually based on what the Primary Care Trust will allow, eg physiotherapist over an osteopath or chiropractor. And most referrals only come about after repeated requests by the patient. It would be nice to see a doctor on more than the alloted 3 days a week most practices have for taking non emergency appointments and to be allowed to make the appointment in advance and not be forced to make it on the same day you call (which invariably leads to time more time off work than is necessary as you fail to beat the other 300 callers to obtain an appointment that day).

Heres to the modernisation of a backward, class entrenched, opaque and selfish system. Most GPs are good but are shackled by such a system and most patients will never know how good they are.

jack, cardiff, uk

To call GP's "inexpert" is the most offensive thing I've ever read in a newspaper of any sort. They are the last true generalists. Who do you think decides which specialist you need to see? Would you trust a journalist to say whether your chest pain was reflux or a heart attack?
Gp's are getting a lot of flack from the government at the moment. They don't need people like you with your uninformed vitriol.
(coi: I'm one of those supposedly omnipotent "specialists")

Michael Gale, Derby,

excellent article. Its infuriating having to book to see a doctor who you know will take a 2 minute check on a problem before sending you to a specialist (with a couple of months waiting in between). so much time is wasted. Those who have vague symptoms should still be able to see GPs, but for more specific issues we should know where to go by now.

Neil, London,

Jay typifies the issue with a list of demands on the health service. This selfish me, me, me attitude is at odds with the reality of a health service with finite resources

In any systems with finite resources (was the GP contract not changed due to a catastrophic fall in recruitment & retention?) but potentially infinite demand, there has to be a degree of prioritisation. GPs out of hrs = less GPs during the day for the truly sick people. Simple.

The DoH recently quoted 6 million patients as being unhappy with access to GPs. Are these 6m a new spin on the 16% of patients who weren't happy with GP access in a recent survey costing the Dept £11m which also indicated that 84% of patients were happy? If so, the DoH is guilty of gross manipulation of data to further political ideologies

Having worked in pre-hosptial emergency care, I would challenge your commentators to get a proper understanding of what GPs actually do before jumping on the politically & jealousy driven bandwagon

Colin, Glasgow, UK

David Aaronovitch misses the point when he mocks someone "sniffing" about Lord Darzi being a surgeon. The point is that Darzi is not, and never has been, a GP, so has no insight into what general practitioners actually do. So he's in some ways a lot like Mr Aaronovitch, then. GP are experts at sifting the wheat from the chaff, the worried well from the ill. They also have expert knowledge of which specialist is best for which problem, IF that is the appropriate route to take. Others have pointed out that Australia is not full of polyclinics. Nor is Canada, where the personal family doctor is the norm, even if he or she works in a group. British general practice isn't broken (despite the best efforts of this government). Leave it alone!

Docianc, Fife,

I seem to remember that Dr Laurence Buckman was once a stand-up comic. GPs are self-employed and their committee of the BMA is a private sector contractors association.

At the start of the NHS, GPs, Dentists, Opticians and Pharmacists came on board wiht contracts substantially similar to sub-Post Offices.

This model is hopelessly outdated. We can do better. The challenge to GPs: Are they going to lead, or sulk?

Alan JI, Forest Gate, LONDON, UK

One still needs doctors who generalise to be able to sift through the complexity of presenting complaints. Clearly a broken arm goes to an orthopod, a heart attack to a cardiologist. but who will see the patient who complains of vague and non-specific symptoms eg 'tired all the time', non specific abdominal pain, weight loss with no obvious cause.
Interpreting these symptoms and investigating appropriately is a skill for which GPs are trained and spend years of their working lives developing. In this respect as in any specialty experience is a major benefit to the patient and is tuned to a set of patients of which a GP has intimate knowledge built up over a long period of time. In that time a GP becomes aware of the many factors physical,psychological and social that might influence a presentation and affect the management and outcome.Patients still prefer to make an appointment with their GP of choice who develops a reputation for good and empathetic practice. It's not so simple

Dr Michael Adam, Huddersfield, West Yorks

You wrote:
At the moment I tend to use my GP's practice as a way of getting referral to specialists and accessing prescriptions that I have already decided that I need.
Translated = I am a deluded egomaniac who believes a career in journalism equates to a GP's 9years training and years of experience; give me what I want- Now!
Thankfully you are not my doctor, though you are doing your best to harm the health of many other patients with your arrogant nonsense. Your petulance at being denied what you want, not what you need is at best unedifying and at worst culpable.

Gareth Richards, Ipswich, uk

Anu Mitra:
" My point is: why should non-emergency problems ie., the preserve of General Practice, suddenly have to be managed 24/7, on tap". That is because your BMA closed shop has turned off the after hour services by the GPs. Blame them. If I have genuine emergency, I would not go to an Aand E department, where i have seen doctors not washing their hands. Want to see a white coat in A and E. Come to our hospital in Manchester!! Since when the hard working A and E busy doctor has time to read posting here and reply. I rest my case.

Yong, Manchester,

There may be a place for these in cities? But where I live, in Frome, will we have one? Or will I have to travel to Bath or Bristol - surely we cannot afford on in every town, so why is the government (who are truly incompetent at spending are money, and ALWAYS do the opposite of what the people affected by any decision want) insisting on this - I assume that a lot of companies who fund them will benefit, and or that more PFI disasters will be inflicted upon us.

Time to go (you too, David - remember, you don't believe a word this government says, do you, after Iraq, so why bother writing about them?)

Jeremy Poynton, Frome, Somerset

Having read a lot of the posts on this I suspect a lot of the negative views are coming from infrequent users of the GP service, or the worried well. I've seen countless minor complaints that common-sense would cure - FACT.
On the whole 84% of the public are happy with the service we provide (FACT). But you cant please all the people all the time. If you strive for that in the NHS it will become a private system of health care in this country, payable by the consumers, i.e. us all. The fact is, it isn't, so lets all help out this failing system. The money is limited and time and time again it has been shown that GP's are cost effective and SAVE the NHS millions (FACT), which is available to spend on patient care (or yet another 10 million pound survey!).
What would free up my time to treat the ill is common sense when it comes to minor ailments, turn up for your appointment on time, let the doctors have a say in healthcare provision, because thats what we do, and do it very well.

Dr A Ryan, Torquay, UK

I’m sat at work with what I think is an eye infection – it hurts and a want to see a doctor. I commute into London so I’m an hour and a half away from my GP. They shut a 5pm, which means if I want to see my GP I need to take time off work. Probably a half day off for a 10 minute consultation and a trip to the chemist. I don’t want to do that. I don’t care who I see, I just want to see someone who can fix the problem. Bring on the Polyclinics. I just hope one is built somewhere close to where I work and I can make an appointment to see a doctor within a day or two.

George, London, UK

The writer assumes that he will see a "specialist" rather than a GP in the polyclinic. He is more likely to see a nurse practitioner or health technician rather than a properly qualified doctor. The polyclinics will be funded by private enterprise but this will reduce the amount of money available to the local hospitals. It is not the polyclinic which will see you when you have your trauma or your heart attack it will be your local hospital- this will have closed because of underfunding thanks to all the polyclinics. Beware- if you want a 24 hour A&E dept near you then support the D'Arzi model. I for one dont want it.

Dr.E North retired hosp doc, sutton, surrey

What remains a mystery to me is why, after so much extra money is being spent and so much 'improvement' implemented, I am forced to tolerate a situation that is so much worse than what I experienced forty years ago.

If I was ill the GP visited me - and always popped in on his rounds until I was well again. I never had to wait days to see one, and then have to sit waiting long after my appointment. The service was so much better and more personal.

And this was not just a one-off. I had such experience of GP's in a Durham mining village, a London suburb and a London 'overspill' town in the 1970's.

It must take a real talent to throw so much money at a service and result in such a deteriation.

Mike Poulsen, Reading, Berkshire

Tom you, and others, have a very misguided opinion of GP's thinking we only work 9-5. That maybe when the surgery doors are open to patient, most of us are there 7am - 7pm. If you only had an appreciation for the paperwork and burocracy we have to do you may well understand our profession. After ringing patients back, arranging tests and referrals, following up abnormal results and informaing patients of these, filling in pointless government surveys, reading hundreds of hospital discharge slips and outpatient notes, training staff, updating my skills, dealing with complaints, having meetings relating to the business etc etc how dare you sit there and say we are over paid.
For your information my calculated HOURLY rate of pay is LESS than that of a plumber or electrician for the hours I put in!!!!! Think about that the next time you miss or are late for a doctors appointment................!

Dr A Ryan, Torquay, UK

GPs are overpaid, and only serve to protect their own self-interests, hence the threat of polyclinics to them. Only in England can GPs be paid more than hospital doctors (the specialists) earn when all they do is work 9-5 and are closed all weekend and evenings. How can they justify earning so much when they are merely referring anything remotely difficult to hospitals?

Tom, Luton,

I am a retired GP.
Before retirement I sold my practice premises to a private developer and using a private finance initiative demolished the old surgery and built a brand new one for £1.5Million. The department of health is now locked into a contract paying him over £100.000 per year for 20 years to use those premises. There has been little change in the provision of service - just a new building. Hardly a profitable deal but encouraged by the government.
There is a failure to build new hospitals because of the long term costs of such initiatives at at a time when resources in the NHS are being squeezed.
Where is the money to come from to pay for these polyclinics? They will be extremely expensive if they are to have full diagnostic facilities. It will come at the expense of depriving some other part of the NHS budget - usually community mental health services or community nursing services from my experience. It is unaffordable and unnecessary. Let's have some commonsense!

Dr Michael Adam, Huddersfield, West Yorks

"Does this mean that GPs, being consumers themselves, can have the right to demand that washing machine repair men, window cleaners, furniture delivery men, builders etc., extend THEIR working hours to evenings and Saturdays too?"

The A&E doctos fails to grasp the simple fact that these tradesmen are not working under a state monopoly umbrella like GPs and doctors do in NHS. They operate under a free market of skills. If my builder fails in the quality of work he does I can sue him. Try this on GPs who in numbers fail their patients.

Robert Witrow, Liverpool,

If this Government and its fellow travellers are for it ,then it must be a wonderfull idea, ripe for the spending of vast amounts of money and the usual staggering incompetence to make it a faliure.
That this bunch of idiots have the gaul to keep spewing out new policies when the wreckage of every other initiative lies behind them is laughable.
The ideas proposed are not worthy of debate - any change will be missmanaged to the point of the usual expensive catastrophy burdened by number targets and the usual cheating to meet them.
Listen to a politician or a GP ? I know whos judgement I would trust.

robert everitt, wolverhampton,

It's not so much that Polyclinics are a bad idea per se. It's more that trusting this government to completely redesign healthcare is a bad idea however they choose to do it.

Daniel Lucraft, London,

This latest plan has obviously been hatched by someone in the Treasury with an MBA and close ties to the City.

Polyclinics will be larger units and therefore worth investing in by private - probably American - companies.

It's classic New Labour. The City comes first.

DickW, Aberdeenshire, Scotland

I live in a small village and therefore attend the small doctors surgery located in the village. I have not been a regular visitor over the last 6 years, but when I booked in to see my GP a few weeks ago at almost breaking point due to work related stress, she had time (25 minutes in fact) to sit and listen to me as I cried and tried to explain why I felt that my life was falling apart. And in a funny way, that in itself helped enormously.

Taking away the personalised touch that local GP's have means that those people with stress/ depression or any other non physical symptoms created by modern living won't have the opportunity to sit down with a familiar face who actually listens. GP's in small surgerys not governed by how many patients they cram into their shift to meet targets, and they provide so much more to their patients and the community than a polyclinic could ever do. Please leave our hard working GP's alone.

LT, Mayfield,

What is the precedent for national change? A survey costing 11 million which showed 80+% satisfaction?
If the survey they commissioned highlighted the need for improved services in major urban centres then good-focus attention there. Do further studies- look at different models .Darzi centres might be good in those circumstances but why implement the sudden national change without the precedent to do so.
By shifting the attention onto GP working hours they have altered the focus on what is actually happening. Contracts have already been awarded to oversees investors where local services-highly regarded by the communities they serve-are being over-looked.
This isn't about Gp hours and money , this is about opening the door to private health care provision in order to reduce the NHS budget. Gp provision is paid for by 20% of the over-all budget-it is good value for money-is the alternative, as provided by this government likely to be better?
By their record so far, I doubt it.

Dee, sheffield,

After reading many of these comments and an ill-informed Londonite journalist's perceptions of his own diagnostic ability, I am glad to be leaving England and its market driven philosophy that privatisation will improve everything

The English public will get what they deserve because they know the price of everything and the value of nothing - a cheap, watered down 'health service' that is significantly inferior to the current primary care model. Ive worked in the USA - health care there is appalling, even with 'insurance'. You don't value general practice service you get here because you view it as 'free', but it is incredibly cost-effective. When 28% of you, like Americans, have NO health cover, then you will be crying out for the 'old GP'.

Point out to me where privatisation has improved your services - are the railways, utilities and banks really giving you a better service than you used to have? Or are you paying hand over fist to line the pockets of a shareholder.

Alan Woodall, Telford, Shropshire

Generalists have an important role to play in all health systems, as of course do specialits and nurse practitioners.

To gain the knowlegde required to manage chronic disease and spot the early signs of serious illness GPs train for a minimum of 10years, gaining at least two bachelors degrees at Medical School followed by very long hours in hospital as junior doctors before finally setting postgraduate exams.

I am sure Mr Aaronovitch and his family are blessed by good health and for them the occasional visit to a polyclinic will do just fine, but for the millions of patients in the UK suffering with chronic disease continuity of care is vital.

GPs who know both their patients and how best to access the most appropriate local specialties/services are a valuable asset of the NHS.

If lost it will be a straight choice between a private GP you know or an NHS one you don't; I know which I would choose for the ongoing management of a chronic disease.

Robert J White, London,

Yong:

You've replied to my point by going off on a tangent and talking about other issues not directly related to it. My point is: why should non-emergency problems ie., the preserve of General Practice, suddenly have to be managed 24/7, on tap? If you have a genuine emergency, by all means come to A&E and you will be sorted out. But why expect the non-emergency arm of the NHS, General Practice, to suddenly start opening its doors during *emergency* hours? Does this mean that GPs, being consumers themselves, can have the right to demand that washing machine repair men, window cleaners, furniture delivery men, builders etc., extend THEIR working hours to evenings and Saturdays too?

A routine medical problem is, by definition, routine.There is a growing trend for some people to run to the doctor for trivial problems, diverting our resources from those who really need our help.

PS., you'd be hard-pressed to find any A&E dept which still allows white coats: because of infection control!

Anu Mitra, London, UK

GPs are valuable and should continue to offer their services to their patients who have, after all, been seeing them for several years (in most cases) and their health histories are well documented. When I worked in the USA I had an excellent GP who was able to refer me to specialists when I needed them - also sent me for my various xrays - eg annual mammogram, chest xrays, etc. Now in France I have an excellent GP who also provides the same service.
When I was in the UK, fortunately I was not in excellent health but on the odd occasion when I did have to see my dear old GP, Dr Jones, I had no problem popping into his surgery and discussing my problem, getting the medication I needed and on two occasions being sent to see a specialist.
Having a GP is absolutely essential and the polyclinics can provide the services to which a doctor refers a patient - not the general care needed by most people.

Chips Westwood, Sarlat La Caneda, France

The doctors brigade is trying to preserve thei r territory. One A & E doctor argues that ptaients should take of their health. I would do so if the A & E doctor washes his/her hands well so as not to spread MRSA. I often see so called dedicated A & E doctors wandering around in the cafeteria in hospitals, one even wiped his hands on the white coat after consuming some snacks!! These A& E doctors we hear often are the ones who send a child with high fever ,neck pain and vomitting home only later to find that they sent away a meningitis case to certain death. The doctors having lived under cosy NHS restrictive practices, find threatened if any new idea is aired. The close shop BMA is there to prolong their monopoly practices. If carried out elsewhere would attract scrutiny by law. I say bring publicly-supported medical issurance, like in France, hand over the choice to patients and the Internet is there to find a specialist, no rocket science. GPs know very few specilaists

Yong, Manchester,

I am not quite sure how 5 years of medical school is classed as a basic bachelors degreee, or the post-graduation years of rotations before moving into their field. The problem in this country is that we no longer respect doctors, not that we have too much respect for them.

And no, I am not a doctor, but I know many hard-working people that are doctors, including GPs.

Caroline Guest, Nanjing, China

Jan Thomas,

Please don't let facts get in the way of your rant. GPs work on average 45-50 hours per week, they already are under contract and in a survey, costing 11 million of tax payers money more than 84% of patients were entirely happy with access to their GP.
Polyclinics are the latest in a string of poorly evidenced government initiatives aimed at providing for the consumer and putting targets, quantity and politics before trust, quality and patients. They are aimed specifically to entice the private sector into the NHS at the expense of providing local high quality care. They will rely on patients information being available on an IT based system and we know how well the government look after peoples data.
The direction of travel is similar to that taken for Dentists, do you really want to have the same difficulty seeing an NHS GP as many have in seeing a NHS Dentist?
I just hope that realisation of the true government agenda happens before NHS GP is lost.

A Patient, Dundee,

If I need to see a specialist I am very happy to travel to see one; if I need to see a specialist, I do not want to be fobbed off with a GP pretending to be a specialist - A GPWSI or "gypsy" in the jargon, which is what these polyclinics are all about.

brummydoug, Birmingham, England

Where I live in the Thames Valley there's a health centre, which employs several doctors, in the next village to me. On the very rare occsaions I visit it (I'm not the sort of person who makes multiple visits to the doctor every year) I see a different doctor every time. It's been like this for the last 28 years. What's the problem?

ben o'donnell, berkshire,

GP)s are little better than nurse practitioners; they can deal(relatively) competently with everyday things but for anything demanding they have to pass patients on to specialists, before which they must figure out which specialist, which they do not always do competently.
GPs defend general practice out of self-interest and greed -who else with a basic batchelor's degree gets £115K a year for a 35-hour week? Who else can work hours that suit themselves but are useless to those who want to use the service they supposedly provide? Who else can employ a phalanx of receptionists trained to be rude and aggressive to deflect patients then if there's a complaint simply refuse to treat the complainant?
GPs have been overpaid, over-respected, over-powerful far too long; they should be slapped down, put on contracts, made to do shifts as nurses do, work where and when it's convenient for patients and should be regulated and inspected regularly.
Polyclinics are an irrelevant issue.

Jan Thomas, Nottingham, England

The simple truth is that people much prefer to see a doctor they know. No amount of fine-chopped logic will change that.

As an ex. time-and-motion wallah (sorry, Management Consultant) I know that cost savings and efficiency gains are important - but the last thing you do is cheapen the product, and that includes making it less attractive. Production-line General Practice is a bad idea.

Ken Leyland, Liverpool, U.K.

When Tony Blair and Gordon Brown use polyclinics then so will I.
You can bet they have their family doctor!!!!!
Just like the Queen....their own physician.
Why?
Why should the ordinary punter have a polyclinic?
Cause it is cheaper...
Joe Public does not deserve to have his own Doctor.
He can see any tom,dick,or harry....even a nurse acting as a doctor!!!
You don,t fool me Darzi!!

Joseph Watkins, Birmingham,

In France, ranked No1 in world for health care, there are a whole plethoria of options, small GPs, labs, dentists, specialists on most high streets, lots of polyclinics (Health centres) capable of minor operations and specialist check ups, + large general hospitals. If the UK system is to improve, and in my experience it is not that bad and in certain ways is better than the French system, the UK doesn't needs not a grand plan from Whitehall for a certain number of polyclinics, but freedom of choice for the patient and freedom for private organisations to provide services. This requires an insurance based scheme, paid for by general taxation with individuals paying basic fee for each service (but not for chronic ailments) to discourage waste. If you want this is privatisation of the NHS. Forget central planning, it doesn't work.

Jason White, Paris,

The role of GPs as "gatekeepers" & generalists, derided by Aaronovitch, is vitally important. It has been shown that health systems with strong primary care achieve better outcomes for better value for both the poor and interestingly, the rich. There are several reasons for this.

Aaronovitch thinks he knows which prescriptions or specialists he needs. This is something GPs learn from medical school and 5 years of postgrad training so the author's obviously a bright cookie.

Perhaps though, the author should stop his amateur medicine and get back to his journalism and do some proper research. He might find out that the majority of GP attenders are not pseudo-doctors, are vulnerable, and aren't well-informed. They need a good GP not a flashy cut-down hospital with evening sessions with anonymous disenfranchised health workers.

mal, london, uk

Mr Aaronovitch tells his GP what to prescribe and where & when to refer, he clearly is a very intelligent & knowledgeable man knowing intuitively what takes the average GP at least some years in training. Luckily some patients still value my opinion regarding treatment and referral , even though I don't always have the answer. Maybe in those cases I could write Mr Aaronovitch for advice ?

Peter, Doncaster, UK

My view. I have just moved from a health centre or polyclinic mark1 to a small local GP. The much vaunted health centre failed to spot a very serious illness on three seperate occasions which the much maligned GP spotted imediately. My GP saved my life the health centre almost killed me. I think the key is the quality of the staff. Lots of locums at health centres with no ongoing interest in the patients.

FB, London,

Everything about this article is depressing and wrong. I am a GP.

I value my longterm relationship with patients because they vaule it. It makes my job safer and easier and it reduces costs for the NHS. There is well respected international evidence that primary care in this country is very efficient financially and achieves good quality care for its patients. GP's hit well over 90% of the targets in the quality pay awards set by the government. Is there another public service with such high satisfaction scores? (and only waitrose amoungst the private sector has similar satisfaction levels according to a WHICH survey)

These changes are about political ideology and not about evidence based pateint care - that is why GP's are angry and why we want the plan stopped.

Dr J Ward, Burntwood, Staffs

I live in inner city Sheffield. Our medical centre has excellent facilities. There are over 10 GPs plus practice nurses, dieticians, counsellors etc. Everyone treats patients as individuals, listens carefully and makes you feel that they have all the time in the world. This means that you don't mind which doctor/practitioner you see - they are all great. The notion that you have to see only one doctor because they will know our grandmas is a nonsense. The practice has Pakistani, Yemeni, Somali, Afro-Carribbean, Polish, Roma and even Welsh patients. It is an area of transient living. Good caring, practice is what is needed and if that is from a Polyclinic then that is fine.

Sioned-Mair Richards, Sheffield, England

Polyclinics may be fine for urban areas, out here in Cambridgeshire there's precious little in the way of health services already, if what there is gets combined in one pile miles and miles from anyone the situation will become even worse.

Steve Dawson, The Fens, UK

If David Aaronovitch doesn't appreciate the importance of a strong primary health care system then he should read Robert Kuttner's recent critique of the American model in the New England Journal of Medicine. A model we seem hellbent on embracing.

He also makes the mistake of taking an overly egocentric view. Someone less fortunate in their health needs might well have a different view.

Mark Horner, Northumberland, UK

"When did illness stop being 24 hour? And since when was minimising discomfort regarded as being somehow un-NHS?"

I'd like to answer that with a question: since when did we as a nation stop taking responsibility for our own health? What is the problem with, when one has a cold or feeling washed-out from diarrhoea, waiting until the morning before deciding to seek medical attention?

There used to be a basic level of what I call 'medical common sense' which seemed to be passed down through generations, about how to manage minor medical problems and injuries at home, deciding to see the doctor only when these measures weren't sufficient. I certainly remember this when I was a child (I'm only in my 30s), but it seems to have vanished in recent years.As an A&E doctor I see a large number of patients who seem to lack the judgement that their problem could either wait to be handled by their GP, or in fact doesn't need a doctor at all.

The current attitude is a form of self-infantilisation.

Anu Mitra, London, UK

Forget GPs? So what do you want, direct access to specialists? So when young Mr Sharp Suit from the city comes to see his specialist complaining of headache he immediately gets a CT scan. and no-one thinks to ask him about his mother who is dying.

Or what about the middle-aged woman with chest pain who goes to see her physician and has enormous numbers of tests which just confirm her fears that there "must be something wrong" even though her results come back normal. Shame her specialist didn't ask her about her difficult relationship with her husband which she "had to get off her chest".

If the only tool you have is a hammer, everything looks like a nail.

The problem is specialists are just that: they specialise. They do not see the undifferentiated mass of symptoms that GPs in this country are so expert at dealing with.

GPs are good at sorting out what's what. Specialists treat after its largely been categorised. GPs tend to be holistic.It's cheaper and safer that way.

Ian Rubenstein, Enfield, UK

Anything that comes out of the mouth of Darzi has got to be suspect. I want MY GP to be able to provide all the blood tests, regular check ups and services within his/her surgery. I don't need a Polyclinic or cottage hospital and I expect MY GP to be given sufficient funds to put these services in place. I also expect to see MY GP present at the surgery and not off teaching or doing other extraneous activities unassociated with MY CARE.

I expect to be able to get an appointment at MY CONVENIENCE and not the GP's. I expect evening surgeries (until at least 7pm) and Saturday mornings so that as a working professional, I can get an appointment when I want. Why is this so difficult. Oh yes, it's because the NHS has wasted millions on IT projects that don't work and on administrators who also ..er..don't work instead of frontline services. But hey Darzi, it makes a good soundbite and may even get you another unjustified gong?

Jay, London,

A few points about 'polyclinics':
1) You will not be seen by an 'expert' . The main aim of these clinics is to save money or at least make money for some private company so you are more likely to see a nurse, paramedic or poorly paid doctor brought in from abroad. People are very deluded if they think they will be able to 'pop' in after work one evening and see a cardiologist and have there niggly chest pain fully investigated there and then. The service will be WORSE not better.
2) Care for patients with chronic medical conditions will be much worse. All the young people thinking oh how convenient I will be able to just pop in any time to have my runny nose 'checked over' at any time of the day or night will find that they wished they had kept a family GP in 20 years time when they develop heart disease or another chronic illness and have it managed by a nurse working to a protocol.

Tim Watson, Stowmarket,

Who would Mr Aaronovitch see in his polyclinic if he had non-specific chest pains then - a cardiologist (heart as a cause) a respiratory physician (lungs) a gastroenterologist (upper gastrointestinal) a musculoskeletal specialist (muscle bone or joint origin) or a psychologist for his stress/anxiety related issues? All these regions cause his pain. As there is already 4 to 6 weeks to see each of these specialists in my local area how long is he happy to wait to find the true cause to his malingering. As a heart specialist would have no training in lung problems is he prepared to go to the back of the queues to wait his turn only to be given a certificate saying he is fit for all work duties by his psychologist. No! I think us GP's with our knowledge of the whole person as a patient is the most experienced "specialist" to be dealing with these problems, as we have done for years. LEAVE US TO DO OUR JOB and pick on someone else for a change.

Dr A Ryan, Torquay, UK

Polyclinics are about turning doctors into employees of a system that will then tell them when to work and how and what to treat. It is Government managerialism on a breathlessly ambitious scale, and there will be no going back.

wilson, london, uk

Of course in the polyclinic, you wont get to see a doctor except by special appointment. You will see a dummed down 'Noctor' - usually a nurse - whose main job is to stop you seeing the doctor.

wilson, london, uk

GPs were created to block patients going to hospitals to seek specialist help directly. The hospital queues has been an instrument for contolled access to specialists. Polyclinics will have GP-approved specialists who may suit GPs but may not be good in the specialism. GPs have an inflated opinion of their skills and experience ( they never retrain) and anydisagreement is threatened with removal from their list and the patient has to put up with a bad GP. This is pure monopoly, Bevan had to swallow to create the NHS model Soviet style, while the BMA held a gun on his head. It suits only GPs, they can employ their wives or partners as practice managers, and yet we worship the model in a Taliban-like religious fervour!! Thanks to John Reid the GP gravy train has moved on with less work and more money for the monopoly practitioners. All the NHS model has done is driving more patients to places like India for cheap private specialist treatment! This model we all worship!!

Gerry Cain, Manchester,

Soviet polyclinics were much better than GP service (or what it is) here. GP practice here even worse than feldsher-midwife practice in rural parts of USSR. But the price is of space program. This is not a rocket science, just do your job as declared!

dave, london,

I have no problem with Polyclinics - indeed living in the Czech Republic I have seen the benefits. Need an x-ray pop upstairs, blood test results wait half an hour, need to see a specialist a simple phone call.
I dread the idea of coming back to the UK. Ok so you can argue that I am expat and I have life easy but fundamentally the health service is better than in the UK. The buildings may be a bit tatty sometimes but who cares if the hospitals are clean and it is quick to see a doctor.

Helen, Prague, Czech Republic

Aaronovitch is probably right about the 'Dr Finlay' argument, and possibly correct to suspect that these GPs are motivated by self-interest.

But he's lethally misguided on the 'generalist = inexpert' point. As for the hilarious comment: "I tend to use my GP's practice as a way of getting referral to specialists and accessing prescriptions that I have already decided that I need", one can only hope he is treated next time by a doctor with a similar level of expertise!

John Allen, Oxford, UK

I think we have heard Lord Darzi's argument before, back in the 1970s. In fact it even came to pass. Yhe only difference is that they were not called polyclinics they were, and still are, call Health Centres. In fact I work in one.

There is nothing new here, just a further circular and expensive reorganisation of the NHS similar to the management restructuring which has seen 4 massive changes in the past 10 years and returned to something very similar to that which existed 10 years ago.

All another massive waste of taxpayers money in the pursuit of ill-formed and seemingly random political ideology.

Dan, Kent,

The general physician in hospitals has all but disappeared due to a shorter and narrower training in specialisms. The GP has a broad based training enabling them to make appropriate referrals to secondary care. Many practices of 5-6 GPs care for 8-12000 patients. The problem lies in running in back-up diagnostic services such as blood tests , ultrasound and X-rays as we have a serious shortage of laboratory staff and diagnostic radiographers. This is because of the high entry standards to training and the relatively low financial rewards of a demanding career.. If we allow patients to attend specialists directly they may attend inappropriate doctors who lack the broad breadth of experience particularly with complaints such as headache, breathlessness, fatigue which have a myriad of causes best initialy assessed by a GP or that rare beast the true general physician. I should know I was the latter until I retired running an acute admissions unit and general clinics for many years

Maddoc55, Bradford, UK

I consulted my local and not particularly friendly GP practice (where I hardly ever have seen the same doctor on consecutive appointments) some time ago over a problem and was told that to assist in diagnosis I would require an ultrasound scan. My GP practice had not invested in an ultrasound machine. I had to be referred to another practice. The test took some 4 weeks to be completed and the test results conveyed to my GP. I spoke to a vet about this and he commented that it is common for veterinary practices to have an ultrasound machine as it is a basic diagnostic tool. No vet would contemplate waiting 4 weeks for the results of an ultrasound test. This is precisely the area where the current system in my view is so plainly inadequate. I would chose a practice which had taken the trouble to invest in skills and equipment. This is much more important than the alleged personal relationship with the GP which frankly no longer exists.

NM, Poole, Dorset

How about this for an idea, they should get lots of doctors together under one roof, offer a wide range of services and call it a hospital!

James, Cambridge,

Polyclinics in Australia? Really?

That is factually inaccurate.

I live here and healthcare is still coordinated by GPs. You cannot see a specialist in Australia without a GP referral.

You can see any GP you like, in any practice, but there is still the option of the "long term" GP. Most people prefer this.

Dave Tragen, Toowoomba, Australia

Did privatising the railways make the service any better or more efficient? I don't understand why people think privately run clinics will serve patients' interests.

Independent doctors can advocate for their patients. Doctors working for corporations have to follow company policy.

Ian Williams, London, UK

As a 30+ year refugee from Britain's "pride and joy", the NHS, but one who still has an aged mother and other relatives in the UK, I feed constrained to comment. In Australia, where I have lived and practiced as a cancer specialist for > 20 years, one can (via one's GP) see a specialist within 24 hours, access the latest imaging technology and pathology promptly. This is true whether privately insured or not, although if the latter one might take longer to get treatment. My mother, until recently, had to travel on two buses to two towns away to have her INR tested (she is on Warfarin). The GP could not do a blood sugar test in surgery - most diabetics do it at home. Another relative had chest pain in Bath and was told to return to Stirling for a stress test (budgets!). I understand that GPs in the UK no longer have any duty to patients out of hours, but merely suggest the local A&E.
Even in Tasmania, we have fantastic GPs who offer a personal service and CARE. Do you poor Poms.

JOHN W WARD, Hobart , Tasmania

As a budding hospital doctor, I must seriously disagree with david aaronovitch's argument. Hospital doctors do not train broadly, specifically because we rely on general practitioners being able to assess and refer patients appropriately. Asking a neurologist to see every patient who thinks they need to see a neurologist would unfortunately be not good for the patients. Apart from the fact that everyone with a collapse who was worried about it seeing neurologists would paralyse a scarce resource, neurologists wouldn't be the best at assessing all the patients who actually had a cardiological reason for their collapse (or a myriad of other causes).
I really think in the system above you'd have to train a truck load more cardiologists and neurologists (for example) and you'd get a poorer service.

Rodric Jenkin, London,

In a straightforward GP practice, my GP can recommend me to whatever specialist is best for me.

In a polyclinic she won't. The in-house specialist will get the business even if he's mediocre. In the contest between my health and the health of the polyclinic, we know which will win.

Jane Dinham, Oxford,

I too live in Australia and have seen something along the 'polyclinic' lines, although they tend to be called 'medical centres' which house several (maybe 10-15) GPs, a pharmacy, a blood-taking nurse and perhaps other specialists (especially dermatologists in this cancer-causing climate). I think they work very well, especially in addition to a long term relationship with a GP. I see 'my' GP (a single-doctor practice) for the majority of my healthcare but for simple easy procedures (e.g. pap smear, sprained ankle) that probably won't require much follow-up, I see someone in a medical centre near my work - I can see them after hours and on the same day I need them, much more convenient, especially if you have an unpredictable schedule and/or are paid by the hour.

Rachel, Sydney, Australia

Why not both ? Personal GPs AND fast-service polyclinics.
People who want long term personal higher quality care, in a less efficient ,more time-consuming encounter, with their own GP can pay a higher co-pay at each visit.
Those wishing fast in-n-out , 24/7 ,and don't care about impersonal or nurse -delivered care , can go to the polyclinic walk-in and pay a cheaper co-pay.
Salaried Doctors at polyclinics will probably feel less motivated and a little cynical, but that 's what socialized medicine reduces them to.

wilfred knight, orange county , california usa

Ah - another zealot of the specialist is best view. Perhaps David's right but I suspect that the advantage of cradle to grave care is exposure to all manner of health (or ill health) related issues. This allows the generalist - perhaps we should call them consultant generalist to increase their "value" - to reach parts that specialists simple can't.

Paul Ablett, Howden,

So if you need an antibiotic or think you do you would have to travel a long way, wait probably a long time, to see a stranger who doesn@t know you ,and may think you are fussing, and can only see your history by reading it on the screen.
If one is feeling deeply rubbish one does not want to travel.
Also this separates the patient from the GPs main role which is to manage anxiety. If a polyclinic meant having a decent consultation time maybe, but it wouldn't would it it ? It would just mean a long journey when one was very ill. Illness is about the mind and not just the body.It doesn't surprise me that the promoter of the idea is a surgeon.

Jill, Tonbridge, UK

To the untrained, breathlessness is due to a chest problem:
but while it may be due to a respiratory disease, it could also be due to a cardiac problem, uncontrolled diabetes, kidney failure, a neurological problem, a psychiatric problem or an overdose (to name but a few). Equally, a blackout could be due to a simple faint, anaemia, internal bleeding, a fit, a heart rhythm disturbance, a brain tumour.... need I go on?

The advantage of General Practice is that the good GPs (and they are the majority) know enough to know whether to refer to a specialist, and to which speciality, and will make a much better fist of it than either the lay patient (or a specialist who only knows about his or her own area).

Most of the work carried out by the NHS is in older people and those with chronic illness: multiple pathologies are common, and the much-derided "generalist" is essential to co-ordinate and manage.

I am a hospital physician, not a GP, and not related to one either.

Dr A Neary, Leicester,

I can't wait for polyclinics. Anything that will give us a genuine choice. In my experience the majority of GPs have over inflated opinions of their worth and expertise. Appointments usually take two days and if you are unfortunate enough to fall ill on a Friday, Monday will be your earliest appointment and only from 9 to 5. That's what the BMA call a personal relationship. I call it a master and servant relationship. Try asking your GP for a second opinion if you dare. They always know best and any questioning of their superior intellect is taken as insubordination and will result in a lecture of how they will not be treated as mere chemists. The only way to improve any service is to give the customer a genuine choice. Something the BMA will do its utmost to stop. Unions always stand in the way of improvements when their members comfortable arrangements are threatened. The NHS needs a root and branch overhaul. The staff are under the impression they are the masters not the servants.

sid, Derby,

If one is interested in quick diagnosis, scans and treatment as most of us at one time or another want, you do not need polyclinics. Just copy the French or German model where the
patient determines who to see an 'inexpert' or 'expert' , when and publicly funded health insurance with a minimal contribution from the patient to take care of the costs. If polyclinics arrive, each will serve 10- 12,000 patients( about 7-8 GP surgeries combined). They are an extended NHS model with the same problems now around a cluster of GP surgeries in one place with experts thrown in. It was the Labour who with the BMA created the NHS model to serve a post-war period and the model was meant to enpower doctors-the GPs as gate keepers which BMA insisted at that time. In polyclinics still the GPs will be gate keepers with referral powers for specialist treatment. We need a radically new model, the French or German, which are working well.

Gary Smith, LONDON,

Didn't w have super GP units, sometimes called "Cottage Hospitals" until politicians scrapped them? I think this was called "Concentrating" rescources.
If I could find one GP who worked in the old fashioned way, no appointments for visits, just turn up and wait, who did home visits between morning and evening surgery, who turned out at night for emergencies, who visited his patients in Hospital, as my childhood Doctor did, I'd join him in a shot.

Richard Edwards, COVENTRY, England

Hear hear. Well said David Aaronovitch - I fully agree.

Let's not let the arrogance of the entrenched medical establishment get in the way of improving health care and comfort for one and all

Shane, Guildford, England

So, Dr Aaronovitch (I presume that you must be medically qualified since you say that you only seek "referral to specialists and accessing prescriptions that I have already decided that I need"), which specialist would you like to see first when you present with undifferentiated symptoms?

The person you will need to see first is a GP, who, contrary to your ignorant view that a ' “holistic” approach, is, in fact, code for “inexpert” ', is in fact an expert generalist.

That you miss this crucial point rather undermines your whole, rather weakly argued, thesis.

By the way, surely you mean "wouldn't" in para. 6?

Geoff Roberts, Oxford, UK

Polyclinics?
Weren't they called Cottage Hospitals before the 'think tank' lads rebranded them?
Same scheme - ten times the cost.

GJB, SLOUGH, BERKSHIRE

And what I would increasingly like from a practice is one I can actually access. That means open outside "office hours" (meaning hours shorter than those worked by people in offices - usually 9am (8.30am if one is fortunate) to 5pm or so) and the opportunity to use doctors in a convenient location, which means central locations near to places of work without the local health service bureaucracy insisting I register near my home. I usually need regular minor treatment and cannot afford the half day's leave required with the current arrangements.

Frankly the GP model is out of date and non-functional for the people who pay for it. 'Holistic' or 'inexpert' is much less important than available, something which is not provided at present.

John Scott, London,

I live in a major city in Australia and have never seen a polyclinic. Quite a few years ago some doctor entrepreneurs set up 24 hour clinics which supposedly did everything but they seem to have disappeared - probably because they overcharged and staffed them with an ever changing array of foreign doctors who just handed out emergency type medicine.
All the practices around my area are single or multiple doctor general practices.
It seems odd that Australia is being hailed as a prototype of these new clinics.

Sharon Hannah, Brisbane,