Comment: clinical case

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Bringing several GP practices together under one roof, where they can offer longer opening hours and more services, makes sense. That is the logic behind "polyclinics", the Government's proposed solution for the failings of GP care in London. However, the consultation exercise we report today has revealed apathy or hostility towards the "bigger is better" concept. Some Londoners still enjoy oldfashioned service from GPs who know them and their family and are based close to where they live. But for many, this model no longer exists.

If bringing GPs together in networks or on single sites genuinely brings efficiencies and unlocks new resources, it would be a real improvement. Crucially, it would also provide much-needed improvements to out-of-hours and weekend services. However, much depends on the costs of moving diagnostic and other services out of hospitals and into polyclinics. Also, there is a formidable problem of transport for the chronically ill, elderly and mothers of young children. Where primary care trusts decide to replace surgeries with clinics, they must show that they have costed the changes properly, and have a strategy to help those who will have to travel further. Polyclinics are the way ahead - but they must be introduced with care.