Healthcare reform – Should primary healthcare be available everyday and all day?


Can we reform our healthcare provision?

Can we reform our healthcare provision?

As some readers may know we are running a rolling set of polls looking at healthcare reform. You can see some of the previous polls here. And it would be great if you could spare just a couple of minutes to take part.

Today we would like to focus on healthcare availability.

From a UK perspective one of the things people find irritating about primary care (by which we mean family doctors, general practitioners[GPs] or PCPs) is that is seems only to be available when we are at work or our children are at school (ie not). It has been improving over the last few years but you can’t see your family doctor on Sunday afternoon pretty much anywhere.

So we were wondering if our readers help that it would be an improvement for healthcare provision in general if primary care was available 24/7 – rather like A&E (or ER for our US readers)?

There would be less waiting around and any conditions which needed to be seen early could be. It would take off much of the pressure on hospitals at the weekend so they could get on with their real jobs.

What do you think?

Why not take our poll below and have your say in the comments section below?

You may also be interested in how such a service might be offered in a restructured health service. Why not check out our previous blog on polyclinics?


Polyclinics – are they the future of healthcare?

polyPolyclinics are not a common phenomenon in the English speaking world but in many central and eastern European countries they provide a great deal of primary and outpatient services.

A polyclinic is in fact a very simple idea.  It is an attempt to provide a range of medical services outside the hospital environment.  These can include, but are not limited to, general practice (primary care), day surgery and a pharmacy.  Often they provide diagnostic facilities typically available in hospitals.  This can involve blood tests, x-rays and similar.  Typically they are based  in a large multi-storey building which is needed to house all their facilities.

The main reason for writing this blog is following a conversation with a friend last week.  A few years ago she lived in Sweden and had cause of take advantage of polyclinics.  When she had to take her daughter to their family physician (based in a Swedish polyclinic) she was able to have a complete diagnosis in around two hours of arrival.  In the UK she estimated that the same process would have taken a couple of months.

Obviously public health policy should not be dictated by a conversation over lunch.  However it does strike me that it is a strategy which may improve healthcare.

In fact in the UK (where I am based) there has been a brief attempt to introduce polyclinics.  In 2007 Professor Lord Darzi of Denham KBE produced a report for NHS London which argued for the limited introduction of a form of GP lead polyclinics.  In fact 7 polyclinic were opened in London UK providing a wide range of patient services including dentistry.  However, Andrew Lansley, the incoming Secretary of state for Health, decided in 2010 that polyclinics were not the way forward and no more have been rolled out since that time.

The rationale, in favour of polyclinics, given before 2010 was in my view a powerful one.   Essentially a polyclinic offers convenience to users of the service rather than to providers of healthcare.  Which in and of itself is pretty revolutionary as far as British primary health care goes.  It allows GPs and other primary health providers to work more closely with other healthcare professionals.  People with, say, diabetes and other chronic health conditions can be treated in a more efficient manner.  And, of course, it should take a fair amount of the burden off our already overburdened hospital system.

While implementation may prove expensive in the initial stages, it strikes me that cost saving could be large in the medium to long term.  But most importantly it provides for better and faster care for patients which is the core aim of any health provision.

The reason that the polyclinic roll out was halted was that there were concerns that at present it was hard for polyclinic to take on the overspill from hospitals.  Also that in fact it did not improve GP integration with other services.  However this may be the by product of how few polyclinics were actually created.

So what do you think?

  • Are polyclinics a good idea?
  • Is your current healthcare provider as efficient as you would like?
  • Have you ever used a polyclinic?  If so what was your experience?
  • Do they offer an opportunity for real healthcare and NHS reform?

Please feel free to add your thoughts and ideas in the comments box below.

Thanks in advance.