This site is intended for health professionals only

At the heart of general practice since 1960

A step too far?

If community hospitals are the way forward, why not downsize the district generals and make room for them under the same roof?

If community hospitals are the way forward, why not downsize the district generals and make room for them under the same roof?

The story so far

Dr Peter Weaving is a GP in north Cumbria whose PBC experience has ranged from chairing a large consortium to his current role as a locality lead for Cumbria PCT, where he finds himself sandwiched between clinicians and managers as they attempt to implement service reforms...

Save our hospitals! Remember the battle cry of the public marching on the streets and forcing regime change within the PCT?

Cumbria has nine community hospitals that are rightly prized by their communities.

The previous administration lost its head in the political furore that erupted when it decided their closure was the route to financial balance for the health economy. (Remember Kidderminster, where a planned hospital closure led to the incumbent MP losing his seat to a crusading hospital consultant?)

The new administration here has wisely concluded these hospitals are a solution, rather than part of the problem.

Community hospitals cost less per bed day than a district general hospital, and from a Payment by Results point of view the tariff clock stops ticking the moment a patient is transferred from a DGH bed to a community one.

This saving is reflected in the PBC balance sheets of those practices that use them. Community hospitals offer services for their local populations, covering everything from consultant outpatient clinics to minor injuries and physiotherapy.

Where they really come into their own is when used for step-up as well as step-down care from the local DGH. The bulk of the bill to hit your inpatient budget is from the main diagnosis – for example, chest infection – plus additional costs for other carefully sought and coded pathologies. (Would you like diabetes with that, sir? Kerr-ching!)

If you are only stepping down you save on excess bed days, but if you can safely manage a patient presenting at home, in A&E or at your out-of-hours service by stepping up their care in your community facility then you save the lot.

These savings become the funding to enhance and develop your community services.

The next time you are phoning your DGH to admit a patient with a UTI, think carefully about what high-tech secondary care your patient really needs – perhaps they just need 24-hour good-quality nursing and some medical supervision until they're back on their feet?

The way the PbR tariff is set up you will pay (at this year's prices) £2,638 – whether your poor patient stays in for three days or thirty-six.

The real twist comes when you look at your areas of health need and find it is not in the leafy villages but inner cities – that is where you need your community hospitals. But do you need an actual hospital?

How about a separate unit within your existing DGH? Commission that! Downsize your DGH, cut your costs and provide more appropriate community care under the same roof – using the now empty wards.

Is this all just a pipedream? Not at all – and you can read about the next stage, too, in the latest DH PbR guidance for 2008/9, which describes the ‘de-hosting' of services such as A&E.

Why not de-host A&E, combine it with out-of-hours and a clinical decision unit, and route people according to the maxim ‘the right patient in the right place at the right time?'

Or is that a step too far?

A step too far

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say