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GP commissioners could make small local hospitals a reality

In recent years we have seen increased pressures on our National Health System and these challenges require a genuine change in expectations, but foremost a sustainable healthcare strategy plan.   With an increasing and ageing population, growing healthcare costs and the constraints of technical advancements in medical care, the reality is that healthcare delivery challenges will be unavoidable.


The trend in future healthcare provision will require two key things for acute and chronic disease care: consolidation of acute and emergency services in fewer locations, and an increase in the provision of chronic care in the community through locally-based clinics.

This is not a political choice, but rather a clinically-driven reality and would lead to better healthcare for all regions in the UK.

In order to secure and further develop current services, hospital sites and services need to be run in a cost effective way. Figures based on an analysis lead by the Department of Health revealed that under an assessment of the productivity challenge the NHS in England will need to release between £15 billion and £20 billion of unprecedented levels of efficiency savings between 2011 and 2014 across all service over the three years.

The numbers are set against spending that would be required to meet demographic changes, upward trends in historic demand for care, additional costs of guidance from the National Institute for Health and Clinical Excellence (NICE), changes in workforce and pay, and the costs of implementing government policy. Hence, in my opinion, the resulting ‘gap' between actual and required funding of between £15 billion and £20 billion by 2013/14 is very likely to be an underestimate.

Additionally, in my experience of general practice, changes in patient's health-seeking behaviour demonstrate that real demand for healthcare cannot be accurately measured. The elderly have a different perception of pain and suffering compared to their children and grandchildren.

This trend is not good news for the long-term future of the currently constituted NHS and with the ‘Baby-Boomer' generation now approaching an age when their healthcare demands will increase significantly, coupled with changes in patient's behaviour and such profoundly different expectations to adverse symptoms, a significant impact on the NHS is unavoidable. No amount of tweaking of the system will address the pressures of rising demand in the coming decades. If we don't take this issue seriously, the system will collapse under the weight of demand and it is the truly vulnerable who will suffer.

The centralisation of key specialist hospital services has been a key theme in health policy for a number of years. In Lord Darzi's review of the NHS in 2008, the rationale has demonstrated that increasing the volume and variety of cases in larger centres with expanded catchment areas would lead to greater specialist expertise in surgery. In addition, future technological advances would result in an expanding number of diagnostic tests and therapies that would be more cost-effective to provide in a smaller number of regional specialist centres, rather than a large number of low volume district general hospitals. The case for centralising specialist services in larger centres has focussed on areas such as major trauma, coronary angioplasty, neuro-surgery and vascular surgery. The centralisation of "hyper-acute" Stroke surgery in London is often cited as a successful example of improved outcomes through the centralisation of services.

These are only few reasons why I have recently published a ‘Future Sustainable Healthcare Plan' for the Thames Valley region to provoke some discussion on improving patient care for my constituency of Bracknell and the wider region.

I strongly believe that my plan and the consolidation of acute services across the country would not only secure our NHS in the future but more importantly would improve clinical outcomes. I would encourage health officials to get involved with a proposal for each of their regions.  Major service change is about modernising treatment and improving facilities to improve patient outcomes, developing accessible services closer to home and saving lives. I am not arguing that this is a new idea, the Department's National Clinical Directors have previously found that specialist care needs to be centralised where necessary and localised where possible, so that clinicians with the right expertise, experience and equipment can treat the sickest patients safely and conveniently.

Although bringing about change in healthcare in England is a tough task, evidence suggests that a future with fewer, better located acute hospital sites and more community-based clinics would lead to better health outcomes for all. We must get real about this issue and act now to protect our future generations' healthcare provision.

Dr Lee's report is available for download here.

Dr Phillip Lee is a GP in Bracknell and MP for the town.