Does the district general hospital have a future?

December 01, 2005

Government reforms are threatening the future of district general hospitals, says an expert in this week's BMJ. Given the iconic status of hospitals in the eyes of the public, government risks huge unpopularity in dealing with the consequences.

District general hospitals have formed the backbone of NHS hospital care since the 1960s, but government reforms to increase patient choice will see these hospitals competing with other NHS hospitals, NHS treatment centres, and independent sector providers, writes Professor Chris Ham.

District general hospitals may also find themselves under pressure from the devolution of budgets to general practices and payment by results.

Taken together, these policies mean that many district general hospitals may find it difficult to sustain a full range of services and could be left providing expensive complex care.

In these circumstances, one strategy is for hospitals to compete aggressively to maintain, and if possible, increase market share. An alternative and more plausible strategy is for hospitals to reduce or cease some activities and to focus on improving productivity in areas where they have competitive advantage.

A third strategy is for hospitals to diversify into other services - for example, sub-acute and primary care.

In the NHS of the future, it is possible to envisage enhanced primary care facilities and independent sector providers acting as a one stop shop for most forms of care apart from hospital inpatient services, says the author. On a more pessimistic note, the changes could result in reduced access to services and ultimately hospital closures.

However, one thing is certain. Managing the effects of choice and competition represents a huge political challenge, he concludes.
-end-


BMJ

Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.