Last reviewed 19 November 2013
A review by competition regulator Monitor has found that walk-in centres are frequently being closed down because commissioners believe they are “paying twice” for primary care services when patients are registered with local GPs.
Monitor suggested that greater competition for funding with such centres could force GPs to “raise their game” and respond to patient needs better.
The preliminary report, Review by Monitor of the Provision of Walk-in Centre Services in England, examined the possible impact of closures of walk-in centres on patients, whether commissioning arrangements for walk-in centres are working well for patients, and whether payment mechanisms related to walk-in centres and GP services were generating benefits for patients. It concluded that commissioners might not be looking at “the full range of options” when deciding not to renew their contracts with walk-in centres, as they could use them to encourage both higher quality and value for money.
The initial findings showed that 53 walk-in centres had closed since 2010, 25 of which were GP-led “Darzi” health centres, 22 were nurse-led and six were commuter centres. The review found that 185 walk-in centres were still operating throughout England, with 135 being GP-led and 50 nurse-led.
GP practices currently receive most of their income through payments based on the number of patients registered on their lists. Their income is not directly affected if patients attend a walk-in centre, and therefore have little incentive to improve their services to draw patients to their practice instead.
Monitor executive director of co-operation and competition Catherine Davies explained: “GPs aren’t affected financially if a patient goes to the walk-in centre, so we think that the way the incentives work at the moment, patients aren’t benefiting from the competition between GP practices and walk-in-centres.
“One option might be to have GP services which reflected patients attending, and consultations that occurred. But at this stage we are looking for people to make suggestions about how that could be improved.”
Monitor went further in suggesting that some GPs referred patients to walk-in centres when they were unable to offer a same-day appointment, “using the centres to meet the needs of some patients for whom they are paid to provide primary care, rather than responding to what these patients want, for example, accommodating more same-day or convenient-time appointments”.
The report also said: “Providers consistently raised concerns that some clinical commissioning group (CCG) members have conflicts of interest when taking decisions about walk-in centres.”
British Medical Association General Practitioners Committee (GPC) chair Dr Chaand Nagpaul said that, at a time of severe financial pressure in the NHS, commissioners needed to ensure funding was properly allocated and used responsibly to avoid duplication.
GPC deputy chairman Dr Richard Vautrey said the remaining walk-in centres should be closed and their funding reallocated to England’s 8000 practices, which could receive around £25,000 each from the move. He added: “The best solution is to use the resource in existing practices. There is no reason why it couldn’t happen.”
Monitor is welcoming submissions and any additional information in response to the preliminary findings, with a deadline of 3 December 2013.