Threatened walk-in centres can relieve A&E pressure and foster competition

Elliot Bidgood, 12 November 2013

In June, I wrote that the NHS competition regulator, Monitor, was to launch a formal investigation into the recent closures of NHS walk-in centres, which could be exacerbating the growing A&E crisis and compromising patient choice. Since then, speculation over further closures has continued.

Monitor’s investigation, published this weekend, has noted that there was “some evidence” that walk-in centres led by GPs (known as Darzi centres, after surgeon and former Labour health minister Professor Lord Ara Darzi) in particular can stimulate local competition in primary care. Monitor concluded that further reforms to incentives, rather than mass closures, may be in the interest of patients.

Further, it has been noted that the threatened closure of walk-in centres is in spite of their relative popularity and the key role they have played in providing a convenient alternative to beleaguered A&E and GP services – walk-in centres often offer 7-day and evening services. It is true that centres in some areas have been underused. However, somewhat counter-intuitively, The Guardian has noted that some closures “appear to be the result of the centres being too successful”.

Monitor found that local commissioners tend to regard walk-in centres as “paying twice” (as an unnecessary expense when GP practices operate in the same area) and reported that 53 walk-in centres have closed since 2010 -185 are still open. However, Monitor stressed that in light of some evidence that GP-led Darzi centres had at times forced local GP practices to “raise their game” and that paying GPs when they actually treat patients, rather than allotting funds based on the size of their practice register as at current, could help spur more such competition.

Monitor also noted a potential conflict of interest with GP-led CCGs commissioning services that were in competition with GP practices, and appeared to suggest handing commissioning responsibility for walk-in centres to NHS England (it already handles primary care commissioning for the same reason). However, this would signal another centralisation of power to NHS England, already dubbed “the daddy of all quangos”, and could compromise local autonomy – BMA GP Committee chair Dr Chaand Nagpaul has defended the need for local discretion over the cost-effectiveness of walk-in centres. This is another instance in which a balance between local decision-making and the benefits competition can yield for patients must be very carefully struck – Anton Howes’ recent proposal for Patient-led Commissioning, which would remove the GP conflict of interest, is a potential solution, perhaps.

Monitor’s intervention is overall valuable, not only shining a light on the extent and risks of closures, but also proposing positive measures to improve primary care for patients. However, it remains important to allow local discretion, especially in any cases when walk-in centres are genuinely underused.

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