Community nursing – a forgotten element in systems reform: the London polyclinic experience

Internationally, the polyclinic has been a feature of many health systems. The recent UK policy shift towards enhanced coordination of care closer to home resulted in the development of polyclinics most notably in London. This paper explores the background to the development of polyclinics and draws on the early experience of developments in London to explore what their impact has been, and is likely to be, on community nursing. Emerging findings from an evaluation of 4 pilot polyclinics suggests that rather than one model, polyclinics evolved in distinctively different ways more appropriately labelled as polysystems. Although policy makers clearly identified community nursing as being one of the key components of integrated, community based care, the evaluation suggests that a focus on high level organisational restructuring and system change can in fact shift attention from what many would consider core activities such as community health services.