Opinion  

A vicious planning blight has descended upon primary care. The damage potential of the Darzi clinics is so great that it has rendered nearby GP practices almost incapable of action. Those situated near the planned polyclinics have been talking openly of losing half their patients. What practice will take on new staff, extend its premises, engage a new partner or replace a retiring one under these circumstances?

By opening 12 hours a day, seven days a week, the polyclinics will attract younger, working patients: these are the people who provide the overall profit for practices because their needs are relatively small.

In creaming off large numbers of normally healthy patients the Darzi clinics will leave the old-style practices with the double whammy of half their practice income and half their practice size (but very much the more difficult half at that). Traditional practices will no longer be able to afford enough staff to manage the high levels of morbidity in their remaining patient populations. Lowering of standards, increased access times, financial failure and practice disintegration will follow.

The combined threat of polyclinics, extended working, destabilising changes to the dispensing regulations and a pay rise that isn't (because it is absorbed into MPIG), is casting a long shadow. The future is uncertain. Senior partners will be thinking of retiring, both to withdraw their practice share while it is still worth something and to avoid future liability for staff redundancy payments, while a sizeable number of GPs in their fifties will plan to leave early.

Yet what new partner will buy into a practice knowing that a polyclinic suddenly placed on their doorstep would ruin their investment? Traditional general practice is now unattractive both as a vocation and as a business proposition.

Congratulations, Lord Darzi. You have wrecked the whole of primary care in the UK and have curtailed the supply of GPs, but at least the more perceptive managers are beginning to recognise the implications.

Chris Lancelot, a GP from Lancashire. Email him at GPcolumnists@haymarket.com