NHS walk-in centre closures: is everyone losing services as a result?

"a quarter of walk-in centres have been closed since 2010"

Ed Miliband speech on the NHS, 12 May 2014

As part of the Labour party's critique of the Coalition's NHS record, Ed Miliband hit out this week at the Prime Minister's "broken promises" to protect services on the frontline. In doing so, he referenced figures on walk-in centre closures in England from health service regulator Monitor.

The latest estimates suggest 21% - closer to one in five - centres have closed since 2010, but even then these figures don't necessarily reflect reduced services on the same scale. As Monitor notes, around one third of these closures actually involve moving some services elsewhere, rather than withdrawing them completely.

Walk-in centres are different across the country

Even if you have some idea what NHS walk-in centres do, there's no actual standard definition for one. Monitor goes with sites that provide routine and urgent care for minor cases where there's no need to book an appointment beforehand.

Even then, different local areas in England will offer different services. Most walk-in centres (if they're even called that locally) will treat basic ailments from coughs and colds to back pain, but not all offer things like x-rays, blood tests or care for wounds.

Much of this depends on whether they're GP-led or nurse-led. In practice, people tend to see a nurse at either.

Because of these difficulties and how the NHS is structured, the government doesn't collect any estimates of its own on how many have been opening or closed. That's why we're left with the best estimates of organisations like Monitor.

Buildings closing, not necessarily services

Monitor estimates that 238 walk-in centres originally opened in England, most of those in 2009. Between 2010 and 2013, 51 of those were closed: about 21% of the estimated total. Monitor itself describes this as "almost one in four", but in reality it's about one in five.

These closures, "in some cases" adversely affect patient access to primary care, according to the regulator. People often turn to walk-in services where it is difficult in some way for them to get an appointment with their local GP.

But Monitor reported that in about one third of cases, the closures in part reflected services being moved around: walk-in centres' services moving to 'urgent care centres' located alongside existing A&E departments.

Whether or not the quality or range of services being provided suffers depends on what the 'replacement' services offer in each area.

Monitor notes what while these kinds of centre "often provide services that are very similar to those offered at walk-in centres", there's a "wide variation" in the nature of these services. Some, for instance, will only accept patients who've come from A&E: hardly the same provision as what is thought of as a 'walk-in' centre.

Update (19 May 2014)

Monitor has provided a detailed list of 17 walk-in centres which have closed but had some of their services transferred. These comprise one third of the closures to date.

Again, we can't tell whether or not the services are equivalent or to what extent they have been reduced, but it still indicates that closures of buildings don't necessarily mean a like-for-like reduction of services.