District general hospitals have a future in truly rural areas

doi:10.1136/bmj.331.7530.1473-a

BMJ 2005;331:1473 (17 December), doi:10.1136/bmj.331.7530.1473-a

Letter

District general hospitals have a future in truly rural areas

The first 150 words of the full text of this article appear below.

EDITOR—Ham clearly has the governments of both Englandand Wales in tow with his ideas on market reform in the NHS.¹To rationalise services that may be duplicated in several hospitalswithin a radius of 10-15 miles, as may be found in many citiesor other densely populated areas, is certainly sensible. However,none of Ham's ideas answers the question, "How do you maintainthe skill mix to deal with acute life threatening conditionsin a hospital that is 30 miles from the next district generalhospital up the road?'

The answer, of course, is that you have to maintain it as adistrict general hospital in its own right. To do that you cannotchip away at some services and hope that the others will bemaintained. For example, if you acknowledge that you need somebodyaround with the skills to deal with a ruptured spleen or . . . [Full text of this article]

Peter J Milewski, consultant in general surgery

Withybush Hospital, Haverfordwest, Pembrokeshire SA61 2PZ peter.milewski@gmail.com