Polyclinics: a Soviet triumph

There can't be many New Labour policies that have Soviet origins. But the large scale health centres or polyclinics currently under discussion as part of Lord Darzi's proposals for the NHS in England do have very surprising historical roots. Polyclinics, which house GPs under the same roof as other medical professionals, have been discussed in British health care circles ever since 1920 when Lord Dawson wrote a report recommending a comprehensive health system. He suggested Britain might look more closely at how the new Soviet Union was organising its medical facilities.

Dawson, "the Darzi of his day", according to the leading medical historian Virginia Berridge, was taken seriously. Looking back now in the post-Soviet age, well aware of the gulag and the economic misery of Soviet life, it is hard to remember how fascinating this new society once seemed to many in the West. In the interwar years some British polyclinics were created, especially in London, grouping together doctors' practices and other health care facilities.

But when many more were proposed as the NHS was founded in 1948, they fell foul of some doctors' fear that a national health service meant some kind of totalitarian takeover. Nazi rather than Soviet analogies were more popular with senior figures in the British Medical Association who opposed the creation of the NHS - one compared the minister of health to a 'medical Fuhrer'. But as opposition to Lord Darzi's latest version of the polyclinic idea has gathered steam, opposing doctors, keen to mobilise opposition from their patients, have been quick to remind their listeners of the original Soviet link.

The irony is that the Darzi version of polyclinics would probably have Soviet health kommissars spinning in their graves, as it offers a new route for private health care into NHS provision. The government, aware of the sensitivities, has dropped the term polyclinics and calls them 'GP-led health centres' instead. But private companies are to be allowed to compete with groups of GPs for the contracts to run the 150 centres proposed around England. Virgin Health Care is hoping to run 20 of them, beginning with one in Swindon, making the once Soviet idea more Richard Branson than retro-Bolshevik.

All this marks the latest in a tortured Labour relationship with the private sector in the NHS. Its creation is still celebrated as one of the British Left's great triumphs, and there is no doubting what a difference free care made for the poor in particular. However the NHS has always had to compromise with the private sector.

When in the 1970s health minister Barbara Castle tried to abolish 'pay beds' allowing private practice in NHS hospitals, she had to compromise with consultants' power. "We have to fight like hell to prevent the build-up of a vast empire of private medicine," she had said. But the pay beds dispute ironically led to a huge expansion in private health care provision. And while the service is still provided free at the point of care, it is Labour governments since 1997 that have rapidly increased private sector involvement in NHS work.

So polyclinics provide a fascinating symbol of the historical echoes in today's health care debate, with constantly competing and shifting visions of public and private provision, and an independent medical profession always wary of outsiders deciding how care should actually be run.
The NHS at 60 - National Doctors, presented by Chris Bowlby, begins on BBC Radio 4 on June 26 at 8pm. ·