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.
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Contact: Emma Dickinson
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BMJ-British Medical Journal
1-Dec-2005