Like many others, I spent a huge amount of time working on the tenders and contracts for the new walk-in centres (WiCs) under the Department of Health's Equitable Access Programme five years ago. After that, it became clear fairly quickly that in a number of cases the anticipated benefits and levels of activity were not working out as expected. We addressed things where possible through contractual mechanisms but for the most part the reality was that anticipated and actual use were very different.
More recently I have again found myself regularly advising commissioners in relation to these centres as many are undertaking urgent care reviews. Although the so-called 'Darzi centres' are not the only WiCs in existence I have been handling lots of questions around the future of these centres when their current five year terms expire next spring.
The issue of closing WiCs is clearly a complex one with wider issues around ensuring the effective operation of urgent care services across the board. As a result it comes as no surprise that this hot topic has attracted the attention of Monitor in its role as sector regulator. Monitor's review of WiCs is aimed at ensuring that commissioning choice and competition are working in this area.
On Monday Monitor published its preliminary report for the WiC review. This highlights Monitor's initial findings and concerns that WiC closures may lead to problems for some patients in accessing services. It also reminds commissioners to consider patient needs before closing WiCs.
The interim report provides a useful summary of the issues that commissioners have outlined in explaining why they have closed or are considering closing WiCs. It considers in particular the problem of potential double payment for things which could have been dealt with by GPs and raises questions about the possibility of reforming payments for primary medical care. It also highlights issues such as the difficulty of having two commissioners where a centre provides services to both registered and unregistered patients.
At this stage of the process Monitor is using the preliminary report to raise a number of further questions. This is your chance to make sure that your views as commissioners along with the issues you are facing in commissioning these services are taken into account. You have until 3rd December to respond to the questions in the report. Monitor is aiming to make its recommendations in January 2014 and these are likely to affect any urgent care reviews in progress at that time.