Comparative study of district and community hospitals

The role of the general practitioner hospital in inpatient care

The rationale of the general practitioner hospital continues to be questioned. A study of the services and case-mix of two of the four remaining general practitioner hospitals in Northern Ireland was undertaken to determine whether the nature and cost of inpatient care in these hospitals was comparable to the available alternatives. The case-notes of all non-maternity admissions (n = 509) were reviewed. The two hospitals provide acute medical care for a wide range of patients. The majority of patients appeared to require hospitalisation. It is likely that the beds at the two hospitals were mainly a substitute for district general hospital care. The general practitioner hospitals were estimated to be less costly than alternative forms of care, although it was doubtful whether they fulfilled all the structural criteria of quality generally regarded as important for hospitals of this type.

Contribution of a general practitioner hospital: a further study

OBJECTIVE

To audit the workload of a general practitioner hospital and to compare the results with an earlier study.

DESIGN

Prospective recording of discharges from the general practitioner hospital plus outpatient and casualty attendances and of all outpatient referrals and discharges from other hospitals of patients from Brecon Medical Group Practice during one year (1 June 1986-31 May 1987).

SETTING

A large rural general group practice which staffs a general practitioner hospital in Brecon, mid-Wales.

PATIENTS

20,000 Patients living in the Brecon area.

RESULTS

1540 Patients were discharged from the general practitioner hospital during the study period. The hospital accounted for 78% (1242 out of 1594) of all hospital admissions of patients of the practice. There were 5835 new attendances at the casualty department and 1896 new outpatient attendances at consultant clinics at the hospital. Of all new outpatient attendances by patients of the practice, 71% (1358 out of 1896) were at clinics held at the general practitioner hospital. Since the previous study in 1971 discharges from the hospital have increased 37% (from 1125 to 1540) and new attendances at consultant clinics 30% (from 1450 to 1896). The average cost per inpatient day is lower at this hospital than at the local district general hospital (pounds 71.07 v pounds 88.06 respectively).

CONCLUSIONS

The general practitioner hospital deals with a considerably larger proportion of admissions and outpatient attendances of patients in the practice than in 1971 and eases the burden on the local district general hospital at a reasonable cost.

IMPLICATIONS

General practitioner hospitals should have a future role in the NHS.

End of an experiment: report from an inner city community hospital

Community hospitals are associated with the provision of health care in rural rather than urban areas. However, the urban community hospital can reduce the pressure on acute hospitals and decrease the isolation of community health workers. In 1982 a community hospital was established in an inner London health district. This paper examines the role and function of this hospital over a oneyear period in 1986-87 and makes comparisons with the hospital's first two years of operation. The problems identified in the initial evaluation, such as low bed occupancy and the limited participation by general practitioners in the area, were still present. It was found that there had been a decrease in the number of patients treated for musculoskeletal, nervous system and respiratory problems but an increase in circulatory disorders and injuries or poisoning. There was also a marked decrease in the percentage of acute admissions but an increase in admissions for convalescence, rehabilitation and carer relief. Following a severe financial crisis in the health district the hospital was closed temporarily in November 1987.

First year of an inner city general practitioner community hospital

The first inner city general practitioner community hospital opened on 4 January 1982. This paper describes the operation of the hospital over the first 12 months. There were 316 admissions, with an average length of stay of 13 days. The average age of the patients was 73 and the most common reason for admission was disease of the respiratory system. Thirty five per cent of patients were admitted because of an acute illness and 37% were admitted on the same day as the request for admission. The policies of intermittent or phased care allowed for the admission of patients at regular intervals to relieve carers, and the assessment of the home circumstances of all patients allowed for planning the patient's return home.

The vital role of the cottage-community hospital

The history of general-practitioner hospitals is reviewed and a case made for their retention and extension. Among the advantages they provide are: a local service for patients, less expensive hospital care than is possible in a district general hospital, less travelling expenses for patients, valuable postgraduate education for doctors, and improvement of general-practitioner morale.