Farewell to the family doctor?

What is the Government proposing?
Over the next ten years or so it wants to set up around 300 'GP-led health centres', or 'polyclinics'. These would be staffed by 25 GPs and a range of other specialists - dentists, nurses, mental health experts, midwives, to name a few - who could provide up to 50 per cent of the outpatient treatment (X-rays, ultrasound, blood tests, minor surgery) now carried out in hospitals. They'd be open from 8am to 8pm during the week, offer weekend appointments and, in theory, enable patients to see a doctor more quickly, possibly without an appointment. Patients could collect prescriptions, get screened for diabetes, have an eye test and so on... all in the same building.

What was the spur to this proposal?
The Government has long wanted to get resources out of hospitals and back into the community, with more emphasis on early prevention and less on emergency repair. (At present the nation's 8,500 GP practices do 90 per cent of NHS work, yet hospitals take 80 per cent of the cash.) Another motive is to get a grip on the minority of GPs (as many as 15 per cent) judged seriously inadequate. The latter tend to run single-handed practices in shabby premises in poor areas, and are concentrated in London. Hence initial plans for polyclinics were confined to London, which is to have 150. There are now plans for a further 150 to be distributed across England, roughly one for each Primary Care Trust outside the capital.

How did the polyclinic idea originate?
It owes its inspiration to Christoph Wilhelm Hufeland, a 19th-century Prussian doctor who once treated Goethe. In 1810 he founded a polyclinic where patients from poor families could see doctors, get treated and go home, so avoiding the exorbitant cost of a hospital bed. The system, increasingly associated with Socialism, was banned by Hitler, but flourished in communist eastern Europe and in countries such as Cuba which, though one of the world's poorest nations, has excellent healthcare. More recently, however, it has been gaining ground in the US, France and Germany. The latter has some 400 polyclinics, offering minor surgery for conditions such as varicose veins and hernias as well as standard primary care. "Doctors, all plugged into the same computer system, can swap information on patients," says Rainer Jeniche of Germany's polyclinic association, who