Adam Smith Institute

In our Omega Project report back in 1984, we argued that GPs - Britain's family doctors - shpuld expand their practices to include diagnostics (like x-rays), outpatient services, even small operations. Well, at last the politicians have got the idea. Suddenly, up are springing 'polyclinics'.

The belief is that groupings of maybe 20-30 GPs mean patients can enjoy longer opening hours, a wider range of expertise, and a more comprehensive service. Buildings and equipment can be worked more efficiently, and back-office costs spread more thinly across the larger number of doctors.

Many advanced countries have had similar arrangements for decades. It hasn't happened in the UK because our health system is so politicized and ruled by vested interests. Nobody can ever agree on change, so it doesn't happen.

It's happening now - though some of the new polyclinics are simply replicating the facilities of nearby hospitals, rather than replacing or rationalizing things. With any luck, though, the extension of private-sector money and management, creeping up the system from primary care into activities that have traditionally been done in state hospitals, will revolutionize things. At a Cambridge Health Network meeting on this the other day, it was amazing how many NHS stalwats used the word 'market' - and as something they should be following, not resisting. I'm not sure thay quite understand what the 'market' is yet, or how quickly the chill wind of competition can sweep away an existing order. But, just maybe, the wind is getting up.

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