TY - JOUR T1 - The future of the small(er) district general hospital JF - Future Hospital Journal JO - Future Hosp J SP - 69 LP - 71 DO - 10.7861/futurehosp.14.017 VL - 1 IS - 2 AU - Paul Jenkins Y1 - 2014/10/01 UR - http://www.rcpjournals.org/content/1/2/69.abstract N2 - With the inexorable advance of technology, the UK's larger hospitals, which are frequently tertiary or quaternary centres, appear to grow bigger, consuming increasing proportions of the available national resources and attracting first-rate medical graduates who aspire to develop or contribute to delivering cutting-edge clinical services, education and research. Striving for the new and the excellent, embracing intellectual initiatives and promoting scientific advancement are all essential if we are to enjoy a health system capable of delivering high-quality care that improves continually with advances in knowledge. However, this picture of achievement is counterbalanced by serious and growing threats to equality in the system. First, cutting-edge therapeutic interventions should be accessible to all, regardless of geographical variations in proximity to a centre of excellence. Moreover, what might be termed the ‘bread and butter’ or day-to-day care that serves most of the population deserves to be allocated an appropriate and equitable proportion of the resources available. Second, the public desire and deserve health care delivered as close to their homes as is feasible and safe; familiarity with the environment, not having to travel significant distances to access care and having immediate support from friends and family are hugely important factors in aiding recovery from illness. There is a challenge, however, in achieving the necessary compromise between delivering effectively those services that can (and should) be provided locally (‘core services’) and accessing those that cannot, for reasons of economy of scale and safety of delivery. Indeed, the UK report on emergency services published at the end of last year recognises this.1 Furthermore, smaller district general hospitals (DGHs) and community hospitals are struggling both to achieve financial balance and to attract high quality clinical staff, both nursing and medical, as they find themselves in competition with larger centres. Longer-term and better-informed planning is therefore … ER -