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We must reconfigure healthcare providers

BMJ 2011; 343 doi: (Published 14 December 2011) Cite this as: BMJ 2011;343:d6997
  1. James A Smallwood, surgical oncologist, Department of Surgery, University Hospital, Southampton SO16 6UY
  1. jamesasmallwood{at}

The time has come to tackle the configuration of healthcare providers in the NHS. Do we need the current number and disposition of hospitals to meet the population’s health needs, evidence based practice and quality targets? Can we afford to sustain so many small independent general practices from the public purse? Are providers fit for purpose, and are they working well together in the interests of patients? Has the piecemeal introduction of competition produced high quality, cost effective care?

In my health economy, serving a population of about two million people, there are seven acute hospitals and two large community hospitals within a fifty mile radius, with two acute hospitals only twelve miles apart. In two modest sized local rural towns, there are three independent general practices with extensive premises within a five minute walk of each other. Current provider configurations, it seems, have often grown randomly, without long term vision. Yet explicit proposals for modification are frequently halted by the mistrustful responses …

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