Not “costly duplication,” but a complementary service
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6849 (Published 30 November 2010) Cite this as: BMJ 2010;341:c6849
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As a doctor running a high quality practice along the corridor from a
Darzi centre, I would like to take issue with John O'Malley's comments that
such centres provide complementary services and not costly duplication.
It's certainly costly as our WIC is reportedly "over performing" on its
contract and costing the local health economy far more than planned.
Meanwhile the borough's primary care budget is being cut by the same
amount.
Dr O'Malley cites lack of access to GP services as a reason why
patients use Darzi walk-in centres. Yet our experience shows that even
with good GP access many patients are using the walk in centre. We are a
medium sized practice and have one of the highest ratings in our area (and
well above the English average) for access to a GP within 48 hours. We see
urgent cases on the day and seriously ill people without delay. We have a
well established "no quibble" policy of seeing children, whatever the
problem, on the day. Yet every day several of our patients go to the walk
in centre, many of them children. On each day there are unfilled urgent
slots in our practice. My review of recent attendances by our patients
shows they attended the WIC mainly for immediate access for minor self
limiting conditions. A review of this weeks' attendances shows colds,
minor skin conditions, resolved upset tummies, minor muscle sprains,
second opinion seeking. Patients were not prepared to wait even a short
time to see one of our doctors - they were looking for instant access
rather like when you pop into a shop for a pint of milk.
At a time of serious financial restraint I don't believe we can afford a
minor illness service that offers instant access at 45 pounds a time. We
are catering for "wants" not "needs". In fact people didn't really want it
but as it's there, and they have no idea of the cost, it seems they think
they may as well use it.
As well as the waste of resources, the WIC model of care undermines the
service we provide - because the WIC staff don't know our patients they
can't provide continuing or comprehensive care and in some cases this has
led to significant health risks for our patients or missed opportunities
to deal with ongoing issues.
There is an urgent need to renegotiate the WIC contracts. They should only
provide out of hours care and that should be integrated with other out of
hours provision. If some GP practices are not providing adequate access
for their patients that should be dealt with separately by proper
performance management.
Marie-Louise Irvine, GP
Amersham Vale Training Practice, Waldron Health Centre, London SE14 6LD
Competing interests: I am a partner in a practice in the same building as a Darzi centre. We have not suffered any loss of patients and are still growing so my concern is not motivated by personal financial interests but concern about the effect on the local health economy and on good general practice of the Darzi centre model.
Re:Darzi centres are a welcome addition
You may be jumping to conclusions about the reasons at least some
people are 'shopping around.' Most have never before had an opportunity
to weigh up different services; unlike in some other countries or in
private medicine in UK, people get what is given without being able to
exercise any real choice or compare practices. They may well be checking
out the WIC to compare services but without risking too much by initially
using it only for minor ailments. This is surely a sensible strategy. It
is true that most do not know the cost of using a WIC but neither do they
know the cost of funding GP services in general. The cost of a
consultation with a WIC only is declared. The government plans to pay 25
- 35 pounds per head to GP consortiums plus 2 pounds per head
administration, this is likely to be more advantgeous than running a WIC.
WICs will probably disappear after a while if they are not used enough but
so far they are proving popular in some areas because the service is good.
It is a bit patronising to compare peoples' health seeking activity with
buying milk from a corner shop, surely anybody would prefer to get an
ailment treated quickly and simply if they can, it is not always clear
whether something will be self limiting, it is a sensible enough decision
to seek advice.
Competing interests: No competing interests