Primary care access centres are becoming a common early target for cuts, examples highlighted to HSJ suggest, as spending is squeezed and GPs take a greater role in commissioning.
Recent weeks have seen at least two examples of likely closures of existing centres and two of planned centres being abandoned. The moves raise questions about potential conflicts of interest, the future role of competition in primary care, and the early focus of GP commissioners.
The centres - generally known as “access” or “Darzi” centres - have largely been commissioned in the past few years with the intention of improving access. They open for extended hours, see walk-in patients and sometimes host urgent care or diagnostic facilities.
They also often have registered patient lists so were introduced as competitors to existing practices, with which they have generally been unpopular.
Commercial organisations are often involved in their running.
The reasons for the cases identified by HSJ are unclear but several point to GP commissioner involvement in decisions to ditch the centres.
That is despite the government’s insistence that primary care services be commissioned by the NHS Commissioning Board, instead of GP commissioners, because of conflict of interest concerns.
Last week NHS Havering withdrew its plans to start a tender process for a proposed polyclinic. That followed its announcement earlier this month that the proposal for the centre was being reviewed “further to a meeting with local GP consortium leads”.
The primary care trust told HSJ it was aware of the potential conflict of interest concern but wanted to involve clinicians in all significant service changes.
NHS South East Essex board papers show some GP commissioners in the area have raised concerns about proposals for two new primary care centres. They include the method of funding and “whether it was appropriate for the PCT to undertake an investment” while it was uncertain how this would affect the funding likely to be received by the new consortia, when they take over commissioning.
NHS Derby City is consulting on plans to close a GP led walk-in centre. A spokeswoman said the plan was not driven by GPs, and was a result of the need to save money. Lead GP Feroz Messenger said he believed it was being cut because it was the “point of least resistance”.
NHS Peterborough is at the pre-consultation stage for changes to primary care. Alma Road primary care centre Medical director Rupert Bankart said it was likely final proposals would include closing the centre. He said the reasons were unclear.
NHS Partners Network director David Worskett said the centres were “for the most part significant successes”, and “fill gaps in provision which traditional GP practices have not filled”.
He said: “Attempts to close them would fly in the face of everything the government wants the NHS to do… The real story here is why such an obviously misconceived possibility is even being talked about, giving rise to a worrying suspicion that it could be because comfortable, incumbent GP practices are threatened by new services that respond better to today’s patient needs.”