Vulnerable populations will be hardest hit by the UK government’s plan to merge General Practitioner's services at walk-in centres with overcrowded Accident and Emergency units.
Labour’s Equitable Access to Primary Medical Care policy originally pioneered walk-in-type health centres, dubbed “Darzi centres”, to tackle inequality in access to health care.
These centres, open-all-hours to patients "walking in", were required to serve asylum seekers, refugees, substance abusers, the unemployed and the homeless.
Worcester Walk-in Centre, now closed, had previously treated at least 100 homeless patients.
The centres were geared towards serving patients who couldn’t understand English, offering translations.
One 2013 study found walk-in centres had indeed improved access to care for black and ethnic minority patients.
More walk-in centres are being closed, despite the fact that this could reverse equality gains, according to a study by health oversight body Monitor.
Most recently, conservatives have targeted walk-in centres in a frenzy of social services cost cutting.
Health care commissioners and hospitals are being spurred to both improve service and cut costs, with NHS Improvement conditionally offering a government grant.
The overwhelming majority of trusts in England have accepted these targets.
Plans being used to cut costs make it clear that NHS England intends to merge walk-in centre, GPs and A&E services.
These reforms, which NHS England is now mandating, were originally described in a 2013 review of A&E services by the current National Medical Director for NHS England, Sir Bruce Keogh.
NHS England has said it expects in the next two years 150 “integrated” urgent treatment centres will open and offer appointments that are bookable through 111 or GP referral.
If queues for urgent treatment centre services are merged with overcrowded A&E ward queues, it logically follows that those walk-in centre services may not be as easy to access.
Future commissioning guidance will decide for certain whether urgent treatment centre will let patients “walk-in” or merely make phone-bookable appointments.
This presents obvious barriers to care for those without phones or home addresses.
Other questions remain regarding the feasibility of the government’s strategy for the new facilities.
Siva Anandaciva, Chief Analyst at The King’s Fund called the plan 'ambitious' and asked whether there would be enough staff available.
He said: “Although hospitals are being given some time to develop and roll out these new ways of working, they are still expected to achieve their A&E waiting times targets, which many have been failing to do for some time.
"It is an ambitious request to expect hospitals to both sustain existing services and develop new services in the period of a few months.
“There is still a finite number of GPs and it is unclear whether enough GPs will be available to staff these new hospital-based facilities, and what the ultimate impact of an en masse move of GPs towards hospitals from their current practice locations would be.“
A select committee reviewing health care spending warned that if hospital cuts couldn’t be made, there could be implications for patient care.
It expressed 'grave doubts' over whether hospitals could afford new “integrated care” facilities given that most of the STF funding was going to cover hospital debts.
NHS Improvement is holding out the carrot of funding at the same moment hospitals are dealing with the stick of debt.
Nearly every hospital in England was in debt last year, or 131 of 138 hospital trusts, according to the BBC.
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Image credit: Ben_Kerckx
