The future of community hospitals has always been uncertain within the National Health Service despite widespread support for them, particularly from general practitioners.1 Government policies have successively threatened, promoted, and ignored community hospitals, but the number of hospitals has grown over the past two decades. What role do they have now that hospital care is being redefined, and how might they fare in the NHS internal market?

In the 1960s the development of district general hospitals threatened the existence of many of these small hospitals, but in 1974 the Department of Health issued a paper setting out its vision for community hospitals2 - and that view has not yet been formally superseded. This document suggested that community hospitals were needed to provide medical and nursing care, including outpatient, day patient, and inpatient care, for people who do not need the specialised facilities of district general hospitals and cannot be properly cared for at home or in residential accommodation. General practitioners were expected to provide the day to day care of patients. As a result of this guidance several …