The Labour party’s manifesto chapter on health does not have a section on general practice.  Instead it has a section on “healthcare closer to home”, and featured within this is the promise to trial “Neighbourhood Health Centres”.  What will this mean should, as expected, the Labour party come to power?

It is disappointing that no explicit recognition is given to the current challenges general practice is experiencing.  This does not bode particularly well for any hoped for increases to the current GP contract.  That said, there is a promise in a manifesto that acknowledges the current state of relations between NHS staff and the government, “Too many patients have seen their treatment affected by strikes. Labour will reset relations with NHS staff, moving away from the Conservatives’ failed approach.”  Whether that means action to prevent industrial action by general practice, however, remains to be seen.

The “healthcare closer to home” section starts with this, “The National Health Service needs to move to a Neighbourhood Health Service, with more care delivered in local communities to spot problems earlier. To achieve this, we must over time shift resources to primary care and community services”.

We currently have “primary care network” and “place” within our health ecosystems.  Where “neighbourhood” fits between these two is uncertain, but the likelihood is it will be one of the two.  What is clear is that the current drive for integration, for bringing services closer and closer together, will continue under Labour.

The section closes with this paragraph, “The principle of integrating health and care services will improve the treatment patients receive. We know that more of this care needs to happen outside hospitals. Therefore, we will trial Neighbourhood Health Centres, by bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists under one roof.”

Back in the 1990s, when a “primary care led NHS” was all the rage, as a junior manager (obviously…), I was involved in an initiative called the Meadows Resource Centre, which was a new building in a deprived area of Salford called Weaste.  The aim of this was to bring together primary and community services under one roof (in something remarkably similar to the planned Neighbourhood Health Centres).  We had a GP surgery, district nurses, physiotherapists, art therapists, local voluntary groups like Citizens Advice, and more all either based in or providing services out of the building.

What I learnt from this experience was that co-location under one roof does not lead to integration.  I am sure the services have developed beyond recognition in the time since I left, but when I was there each of the services operated in isolation from each other.  They all had their own spaces or were booked into their own rooms, and the GP surgery in particular operated at one end of the building more or less in isolation from everyone else.

I am sure that if the goal of the centre had been explicitly to integrate these services, rather than have them all provided out of a single location, and some joint work on what integration could actually mean in practice had taken place, then more integration could have been delivered.  But we have many examples up and down the country where GP surgeries and community services share a base, and it is still rare for this to lead to any form of joint working.

Many of us will also remember Darzi centres, or polyclinics, that were introduced under the last labour government in 2008.  These were not popular in general practice.  They faced criticism for being expensive to run, and the programme was scrapped in 2011 by the incoming government because they were too expensive and had delivered little.

Whether the lessons of the past have been learned remains to be seen.  Ultimately, the integration of services requires good relationships.  Where these exist, more conversations happen, which in turn can lead to joint problem solving and more joined up services for patients.  Having services under one roof can facilitate stronger relationships, but it is not a necessary consequence (many GP practices can tell you that having all of their partners co-located under one roof does not mean that they all get on!).

So under Labour it seems very likely that PCNs will remain, even if they are rebadged as neighbourhoods.  The reality is there is not the capital funds available for the widespread construction of new neighbourhood health centres, and let’s hope we don’t see a rerun of the Darzi centre disaster.  But what we are likely to see is a continued push for much more joint working between primary and community care, which in turn may lead to bigger changes in the way general practice is contracted.