Plans for new polyclinics will meet stiff local opposition, a primary care adviser to Lord Darzi's health service review has warned.
Professor Mayur Lakhani, a Leicester GP on the primary care board of the junior health minister's review, told the King's Fund annual conference: 'It's the idea of the moment and said to be the way to deliver integrated care. But politically the idea of patients having to travel to scaled-up polyclinics is very difficult.'
Lord Darzi's October interim report suggested procuring new health centres in easily accessible locations, offering all local people a range of convenient services, even if they chose not to register directly with GPs in those centres.
This has been widely interpreted as a bid to create polyclinics with a range of services under one roof.
Professor Lakhani, who is immediate past chair of the Royal College of GPs' council, said most patients did not need extended services.
He said: 'Ninety per cent of the stuff I do can be done without recourse to investigations, x-rays and so on.'
Rather than creating new polyclinics, he would prefer practices collaborating to give patients access to diagnostics and other services in community settings when needed.
'This might be through a federated structure or a social enterprise,' he said. 'We need to consider how this can be supported and encouraged. Should there be rewards and incentives for this way of working?'
He also confessed to some dismay at the current debate over generalists versus specialists - which comes down to the role of the GP versus that of the consultant.
He said: 'I hear that specialism is good and generalism is bad. If you look at the eight workstreams [in the Darzi review] they are all disease-focused specialist inquiries. There is no workstream for primary care.'
But he said the evidence was that health services with a strong generalist primary care input had better outcomes. 'You have to develop primary care and generalism.'
He also made a plea to keep the GP gatekeeping role. 'If you have open access costs will rise hugely.'