Alan Bullion, Sevenoaks Lib Dem parliamentary spokeseman, reports on the latest government initiative apparently designed to destabilise communities:

"Dozens of GP surgeries are being culled to make way for polyclinics. This could affect patients in Sevenoaks and other parts of West Kent shortly.

Nearly 40 GP surgeries are set to close in just one North London PCT area in a dramatic illustration of the effect on local general practice of the government's drive to introduce a network of polyclinics.

Patients in Haringey, north London, are taking to the streets this week in protest at plans to consolidate 57 existing surgeries into 20 health centres – which came as NHS London formally decided to press ahead with its polyclinic plans across the capital.

Haringey PCT plans six polyclinics and 14 larger practices, with the ‘hubs’ set to handle 25,000 to 35,000 patients. But its own consultation document admitted there was a ‘trade-off’ between the advantages of ‘one-stop shops’ and the disadvantages of longer travelling times and damage to the doctor-patient relationship.

Patient groups in the area have launched a campaign against the proposals, which they claim will lead to the closure of as many as four out of five surgeries.

The PCT admitted its consultation had revealed ‘no clear consensus’ in favour of polyclinics, with concerns continuity of care would suffer and increased travelling times ‘would disadvantage older and disabled people’.

There were also fears ‘people from deprived communities would not be served well’.

But the PCT is forging ahead, saying its model ‘would involve a trade-off between patients having further to travel and a wider range of quality services in better premises at more convenient times’.

Dr Anouska Hari, vice-chair of Westminster LMC, reacted with alarm to the plans: ‘The concerns are it might cause general practice to dissolve – that it would be swallowed up. It seems that may already be happening.’

Meanwhile, a Pulse survey reveals nationally PCTs are pushing ahead with polyclinics without even the barest assessment of the likely impact on existing practices.

A survey of 28 PCTs found more than two-thirds had failed to carry out any official impact assessment of Lord Darzi’s network of GP-led health centres.

Tameside and Glossop PCT said it had not undertaken an impact assessment because ‘the initiative was not optional’, and the ‘impact depends on patient choice’.

Yet 72% of trusts said they expected the new health centres would take patients from existing practices. Mid Essex PCT admitted: ‘Existing practices are likely to lose patients from their lists as a result.’

GPC deputy chair Dr Richard Vautrey said consultation had been ‘tokenistic’.

Consultation sham?

PCTs may not have the purest of motives when deciding how to consult with patients.

Patient engagement appears to come a poor second to ducking controversy and avoiding legal action, according to one document obtained by Pulse.

A document from Heywood, Middleton and Rochdale PCT’s polyclinic proposals says: ‘If the proposals are, or become, contentious, then it would be prudent to increase the planned level of engagement/ consultation.’

It adds: ‘A full public consultation exercise would insulate the PCT from criticism under its statutory duty (although it may not necessarily be a good use of resources).’

PCTs are particularly wary after a case in north-east Derbyshire in 2006, where the High Court ruled the duty to consult applied to a tender for provision of GP services to two villages.

Lib Dems are opposed to polyclinics. We say that patients are best served by a doctor's surgery close to their home, not miles away from where they live."

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