Polysystems - opportunities or issues?

Announcements that across England there is to be a significant acceleration in shifting work from hospitals to primary care, with plans for GPs to take on new services as part of London-style ‘polysystems’, have received mixed reactions.

A meeting held at BMA headquarters saw GP leaders and key NHS workers rally against the proposed massive shift of hospital workload to primary care polysystems, with pledges to fight the proposals by organising a public campaign to try and stop the plans.

The strategy arises from the requirement of PCTs to make ‘efficiency savings’ as stipulated by the Department of Health. The proposals include decommissioning hospital services on a massive scale, with some PCTs introducing new ways of working for GPs under tighter managerial control.

Proposed cuts could see entire hospital departments closed with some transferring millions of pounds of work to primary care. Some trusts are reported to be drawing up plans for polysystems, with GPs set to work in corporate structures to manage more complex illnesses over larger populations.

Dr Michelle Drage, joint chief executive of Londonwide LMCs, is reported as predicting that all GPs will eventually be forced to work in polysystems and that it was imperative that GPs engaged with the agenda, to try and retain control over how they deliver services. She has also warned that failure to confront the changes could open the door for foundation and acute trusts to come in and run primary care in the future, which would threaten the traditional model of general practice. Dr Drage’s view is that the risk to GPs is vertical integration and that the opportunities are very few, and the only way for GPs to do this is to pull together, federate and be in control of the polysystem agenda.

Some GPs feel that this is history repeating itself and similar arrangements in the past led to uneconomic community clinics. On the other hand, others feel that it could result in GPs offering an improved range of services to patients from the GP practice site and see it as an opportunity to gain a pivotal role in delivering healthcare provision rather than being merely adjunctive to hospital-based care.

Londonwide LMCs will be hosting a conference on May 18 to help GPs stay on top of the proposals, which will include practical advice on how to get networks and federations going at practice level and retain control.

Birkett Long is able to advise and assist on the legal issues surrounding consortium and federation structures. Visit our Health & Social Care page for details about work in this sector.