Opinion  

The war of words stepped up a gear last week as the BMA handed over its petition against the clinics and GPs roundly denounced the plans at their conference in London.

But where do nurses stand on the issue? The RCN has, so far, been broadly supportive of polyclinics, and many nurses feel they may provide better terms and conditions than some GPs do currently.

It is likely that they will offer opportunities for nurses to take on new and expanded roles. Advanced nurse practitioners will also, no doubt, have a key role to play and most nurses support the idea of moving services out of hospitals and into the community, which the DoH says polyclinics are key to.

But the BMA has valid concerns. Every PCT must have a polyclinic, but while they may work for inner cities, they may be unpopular in rural areas if patients have to travel further.

Health secretary Alan Johnson has said no current practice will have to shut to make way for the clinics, but this is not the case. Plans put forward in Birmingham and Haringey in London would see a number of practices close.

The DoH seems to be assuming that polyclinics will deliver better services everywhere. But, as the King's Fund pointed out in its highly critical report, there are other models, such as 'virtual' polyclinics, which could enable the NHS to provide more services in the community, without centralising GP services. Surely all of these should be evaluated, then PCTs could select the option that meets local need?

The BMA and the DoH each have their own reasons for their views on polyclinics, but the King's Fund is a respected, independent body with no axe to grind or members' interests to represent. If its researchers think polyclinics could worsen access, increase costs and damage care, perhaps it is time to pause and take stock rather than rush headlong into this new model, as the government seems intent on doing.

emma.bower@haymarket.com