Posted by: Nicholas Swetenham | February 9, 2009

The future of London’s health

Yesterday I sent in my comments to the BMA about the report “Healthcare for London – A local hospital model for London”. You can find the short, summarised leaflet here:

Local Hospitals – Summary

and the full report is linked on this page:

Healthcare for London

The report’s main arguments are:

1. The current District General Hospital model is not adequate for the NHS’ future needs.

2. Some services should be made more conveniently and rapidly available locally

3. Some highly specialised urgent services (e.g. acute stroke and major trauma care) should be concentrated in specialised centres.

4. Hospitals currently do no co-operate and communicate effectively to share the load of care and ensure every patient has access to appropriate services for each patient, and will do so under the new model.

In the summary leaflet, the colourful diagram on pages 5-6 exlpains quite clearly the ideas behind the new model. The full report presents some limited case-study evidence for improved outcomes under the new model. The new multi-GP Polyclinics would become the point of access to primary care, and would provide minor urgent care. More complex secondary and urgent care would be provided in the Local Hospitals, and the most complex would be provide in Major Acute Hospitals. Under these proposals, old District General Hospitals will gradually become financially unviable and be supplanted by the Local Hospitals.

I replied with the following comments:

1. The proposed change in hospital paradigms underline the need for swift action on Workforce Planning; for example, the proposed model includes a need for an increased number of consultant posts. If the hospital landscape is to change dramatically and DGHs are gradually going to be replaced by Local Hospitals, we need to start thinking now about how many doctors from what specialties we need in London 10 years from now.

2. Although the report presents some limited evidence in the form of case studies as examples of the purported benefits of the new model, we will need to build an evidence base going forward as these changes are implemented to prove that they do indeed lead to improved clinical outcomes.

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