Community hospitals

Shaista Sultan

doi:10.3399/bjgp08X342435

As a GP trainee, I have worked in district, general, and teaching hospitals alone. However, I recently received the opportunity to do an 8-month rotation in elderly stroke care and orthopaedic rehabilitation at Woking Community Hospital.

Woking Community Hospital provides NHS Walk-in centre and emergency dental access clinics. It has 48 beds for older people; 12 beds for younger physically-disabled people, and 20 beds for older patients with dementia. Outpatient services including physiotherapy, podiatry, X-ray, community dentistry, family planning, paediatric, and geriatric clinics are available.

Geriatric in-patients generally include individuals from local acute hospitals requiring continued medical care and physiotherapy. However, we also manage complex community-based patients referred by local GPs, most of whom need further investigation and treatment. The type of GP referral, highlighted to me some of obstacles a GP may encounter in the community, such as a lack of immediate investigative facilities and specialist review. It encouraged me to re-evaluate the potential role of the proposed ‘polyclinic’ within primary care.

Lord Darzi has envisaged the replacement of single-manned GP surgeries with ‘polyclinics’ by 2009. ‘Polyclinics’ are planned to provide specialist services run by several health professionals based in a single location. However, the Sheffield Faculty of the RCGP recently debated Lord Darzi's review of the NHS. They concluded that general practice should continue to be locally accessible, personal, and the source of a wide range of services to provide effective continuity of care.1

It appears that perhaps the government should invest more into existing community hospitals, which to some extent already provide specialist inpatient and outpatient services. These hospitals could work alongside GPs without disrupting their existing setup, thus allowing GPs to nurture personal and trusting relationships with their patients', which to me, is a fundamental aspect of being a GP!