Polyclinics: The story so far'

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• Polyclinics The story so far.
• Siobhan Gregory Hilary Shanahan

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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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What are polyclinics?

• Polyclinics
• Are a model of care or system, not just one
  building
• 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
• Fall between the current GP practice and the
  traditional hospital
• Will cover a population of 50,000
• Are different to the national initiative for
  GP-led health centres

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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. However, the exact
  services provided will
• be determined by local commissioners
• reflect local need
• be informed by appropriate local consultation and
  clinical input

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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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What are the benefits?

• Workforce development
• investment in staff training and development
• providing staff and GPs with the appropriate
  incentives to deliver the polyclinic vision
• Clinical quality and strong clinical governance
• Processes for ensuring continuous innovation and
  development of services
• Improved links across health and social care
  services
• Improved access to wider range of services open
  at more convenient times
• targeted at areas with greatest health needs
• prevention of unnecessary hospital or AE visits
• Focus on health and wellbeing, and patient
  experience
• Wholly integrated healthcare services, enabling
  better management of long-term conditions
• Focal point for information and services for the
  community and focus on prevention
• delivering a personalised service, customised to
  individual needs
• Value for money, delivering efficient and
  effective services

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Case study
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Where are we at with implementation?

• All London PCTs are signed up to the vision
  implementing through CSPs
• 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
• Expect further information in February following
  publication of CSPs
• 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

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Turning vision into reality

• What needs to be different to support
  implementation?
• Clinical leadership
• information technology systems and processes
• commissioning and integrated service
• governance arrangements
• communication with PCTs, public and clinicians
• developing local champions
• workforce opportunities
• estate usage

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Opportunities for nurses

• Input and leadership into the local co-design,
  development and implementation
• New types of care provision requiring different
  types of roles, enhanced skills and training
• Many services delivered within polyclinics will
  be provided by nurses and nurse-led
• 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

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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
• RCN London's members will always support
  improvements to healthcare services providing
  there is a need for the service and that our
  vital nursing and healthcare staff are not
  disadvantaged by these changes. The RCN now sees
  opportunities for a range of nurse led services,
  utilising the diverse, cost-effective range of
  knowledge, skills and experience that the nursing
  workforce has.
• Mr Bernell Bussue, Director, RCN London

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• What has all this got to do with me?
• Midwives
• Mental Health Nurses
• Acute Sector Nurses
• Nurse Consultants
• Health Care Assistants
• Public Health Nurses