Polyclinics and polysystems: evolving ambiguity, evidence required

Abstract

The current debate about healthcare system configuration is symbolised in the UK by the move towards delivery of primary care through polysystems.1 Polysystems are an extension of the polyclinic proposals originally outlined by Healthcare for London,2 and subsequently taken up across the UK under the name ‘GP-led health centres’.3 This Editorial aims to address two key questions: ‘What is a polyclinic/polysystem?’ and ‘What is the evidence supporting wide-scale implementation at a time when economic resources are scarce?’ GP-led health centres were conceived in 2007 for the UK as large buildings, to be located freestanding in the community or next door to accident and emergency (A&E) departments.2 A Framework for Action refers to increased diagnostic services, an expansion of the workforce (social advisors, consultants, and physiotherapists) serving a population of 50 000. GP surgeries would be located within the building, either as one large surgery or as a number of separate surgeries under the same roof. Another permutation, which received less media attention at the time, was for existing GP surgeries to ‘orbit’ the polyclinics, that is a ‘hub-and-spoke’ model. This last model was similar to the federated model proposed by the Royal College of General Practitioners,4 and it is this model that now prevails in Healthcare for London's 2010 plans for polysystems.1 The debate about polyclinics, which has tended to occur at clinical and academic levels, rather than at a planning level, has focused on their definition, with many arguing that the proposals were nothing new, having existed internationally and in similar forms within the UK.5 Such discussions arguably eclipse a more pressing question: how is primary care best configured? Two reports attempt to address this issue: Under One Roof, and Integrated Primary Care Centres and Polyclinics.