Polyclinics: The story so far.

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• Polyclinics The story so far.
• Dr Tom Coffey

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Background

• As the population grows and gets older,
  technology advances and peoples expectations
  increase, it is essential that we do not allow
  services to stand still
• A key challenge often raised by the public is
  that services do not fit together as well as they
  could.
• People with urgent or complex needs find it
  confusing to navigate their way around different
  services.
• People find they need to repeat information to
  different members of staff
• People want more care delivered closer to where
  they live
• People want to feel in control of their care and
  be able to make informed choices.

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Polyclinics case for change

• A national BMA survey found
• 75 of GPs felt their premises were not suitable
  for future needs
• 36 of practices can not be adapted to meet the
  Disability Discrimination Act requirements
• In a survey of over 7,000 Londoners, people were
  less satisfied with GP services in the capital
  than nationally
• Only 27 of Londoners are satisfied with the
  availability of GP care outside working hours
• Overall, there are fewer GPs per capita in areas
  of London with the greatest health need

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What Londoners told us Consulting the Capital

• Over 50 supported the proposal that almost all
  GP practices in London should be part of a
  polyclinic
• Over three-quarters thought it would be useful if
  GP surgeries were open in the evenings and at
  weekends
• 67 thought greater investment should go to
  community support for long-term conditions
• People wanted services closer to their home and
  there was good support for more outpatient care
  and minor procedures in the community

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Our vision for primary care

• Greater focus on prevention and promoting
  wellbeing
• Greater access to a broad range of
  servicescloser to home
• More integrated case
• management for people with
• long-term conditions
• Integration of health and social
• services seamless care
• More accessible services for
• people with a disability and
• other hard-to-reach groups

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How will the vision be achieved?

• The polyclinic vision will be achieved through
• Making a greater range of services available in
  the community in a polyclinic centre (hub) and
  networked GP practices
• Delivering patient-focused, integrated services
  based on the latest clinical evidence and best
  practice pathways
• Ensuring services and individual polyclinics meet
  the needs of the local population
• Developing a sustainable model of care which
  provides value for money, and will continue to
  evolve and innovate

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Polyclinic programme

• Is ambitious and provides a unique opportunity to
  deliver a step-change in patient care
• It is a new type of healthcare delivery model
  that aims to improve health outcomes and reduce
  health inequalities in London.
• Will be the setting where most routine health
  care needs are met and with which most people
  will have contact with
• Polyclinics will be designed and developed
  locally with significant involvement from
  patients, the public, clinicians, staff and other
  key stakeholders.
• This will include strong clinical leadership in
  shaping and commissioning services for the local
  population.

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Core goals of the polyclinic programme
Core goals of the polyclinic programme
Wider considerations
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What are polyclinics?

• Polyclinics
• Are a model of care or system, not just a
  building
• Affect London only
• Are commissioned locally
• Are a vehicle for implementing primary and
  community care strategies
• Will provide a greater range of integrated health
  and wellbeing services than can be offered by
  most GP practices, closer to where people live
• Fall between the current GP practice and the
  traditional hospital
• Will cover a population of 50,000

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What will polyclinics provide?

• Polyclinics are not one-size-fits-all
• There is a care list of the type of services
  that patients can expect.
• The exact services delivered will
• be determined by local commissioners
• reflect local need
• be informed by local engagement with the public
  and patients
• with strong clinical leadership and input
• Services commissioned will be integrated and
  patient centred

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Polyclinic services

• GP
• GP services
• - Consulting and procedure rooms
• - Dedicated child-friendly facilities
• - Core and extended GP services
• - Extended hours - 12 hours
• Practice nurse services

• Interactive health information services
• Smoking cessation
• Drug and alcohol information services
• Weight management
• Sexual health
• Dietary services
• Local services (e.g. social services, back to
  work services, and leisure facilities)
• Healthy living classes

• Community services
• District nursing
• Health visitors childrens services
• Midwifery
• Specialised therapies
• Outreach services (TB/HIV)
• End-of-life care
• Dieticians

• Diagnostics
• ECG, Pulse Oximetry, Spirometry
• X-ray, U/S and Vascular Doppler
• CTG
• CT, MRI
• Colonoscopy
• Haematology, microbiology and pathology

• Pharmacy
• Medicines use review
• Medicines management services
• Anti-coagulation services
• Dispensing services

• Long-term conditions
• Detection of undiagnosed
• Screening early detection
• Community matrons
• Management of disease registers
• Access to
• - Expert patient programme
• - Information prescriptions
• - Managers of complex needs

• Outpatient services
• Management of chronic illness (e.g. COPD, asthma
  and diabetes)
• Community paediatrics
• Consultant or PwS
• Mental health
• Audiology
• Chemotherapy
• IV transfusions
• Access to pain management

• Other healthcare professionals
• Optician
• Dentist
• Other health professionals

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Polyclinic model of care

• Polyclinics can be located in the community or on
  a hospital site

• A networked polyclinic
• existing GP practices link to a polyclinic centre
  to access a range of healthcare and wellbeing
  services such as blood tests, specialist clinics
  and health promotion services
• Single site polyclinic
• GP practices could provide services from a
  polyclinic centre, sharing many services, but run
  as different practices

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Case study
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Turning vision into reality

• What needs to be different?
• Using commissioning to ensure that the services
  delivered are integrated and patient-focused
• Adopting a customer focus approach so that we
  meet public expectations and raise our ambition
• Co-designing services with local people and
  clinicians through understanding and capturing
  patient experience and journeys
• Developing integrated information technology
  systems and processes so that people are only
  asked the same question once and to enable them
  to access services in a range of different ways
• Strong leadership and governance arrangements
• Harnessing and supporting the talents of staff
  and clinicians

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Where are we at with implementation?

• All London PCTs are signed up to the vision and
  implementing through Commissioning Strategic
  Plans
• Londons first examples Lambeth, Redbridge,
  Harrow, Hounslow and Waltham Forest
• All based on the networked polyclinic model
• Focus on local needs with strong community
  support and clinical input
• Located in some of the most deprived or
  under-doctored areas
• Four of the five based on existing developments,
  expanding access to GP services, diagnostics and
  outpatient appointments
• Working collectively to solve common problems but
  applying to local circumstances
• Implementation is rooted in ensuring an improved
  experience for patients and a quality service
• Co-designing an evaluation framework

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The future Loxford Centre, Redbridge

• Loxford is the first purpose-built polyclinic
• centre in London and will provide patients with
• ultrasound, blood tests, family planning,
• rehabilitation gym and more.

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Opportunities for midwives

• Input and leadership into local co-design,
  development and implementation
• New types of care provision requiring different
  roles, enhanced skills and training
• Some services delivered within polyclinics will
  be provided by midwives e.g. ante-natal care
• Better premises with co-location potential and
  improved support systems
• Patient-centred, seamless and joined-up care
  leading to the potential for care management
  roles and closer working with other colleagues
• Integrated service model that focuses on
  wellbeing and keeping people healthy
• Delivery of services in the community that
  traditionally would have been provided within an
  acute hospital environment

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How to get involved

• Provide your feedback today
• Find out more about what is happening in your
  local PCT in developing polyclinics
• The RCM believes that polyclinics provide a
  potential base from which midwives could work
  within community settings, with the advantage of
  facilitating interagency collaboration with other
  health and social care professionals.
• Royal College of Midwives response to Consulting
  the Capital
• We believe that this setting (polyclinics) is
  appropriate for the antenatal and postnatal care
  of women with uncomplicated pregnancies and their
  babies.
• Royal College of Obstetricians and
  Gynaecologists response to Consulting the Capital

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