Community hospitals

What do community hospitals in the UK do? Are they sort of a bridge between acute care and nursing homes and are they primarily meant for the elderly?

I don't think they're meant for the elderly, but elderly people will invariably comprise the majority of the inpatients. There may also be a minor injuries unit or other nurse or GP led services.

From what I've seen the inpatients are those who no longer need an acute hospital bed but for whatever reason cannot go back to their own residence e.g. they need daily long term IV antibiotic therapy, long term physio/OT, social issues which need sorting out, etc.

Ah ok thank you! Do you think having more of these would help solve the bed crunches in the NHS?

If it allows for smoother discharges and easier patient flow then yes, it would be one way of stopping "bed blocking". It's not just a case of having the facilities though - you would need to ensure there are enough nurses, GPs, physios etc to provide safe care. What are your thoughts?

If it allows for smoother discharges and easier patient flow then yes, it would be one way of stopping "bed blocking". It's not just a case of having the facilities though - you would need to ensure there are enough nurses, GPs, physios etc to provide safe care. What are your thoughts?

What do community hospitals in the UK do? Are they sort of a bridge between acute care and nursing homes and are they primarily meant for the elderly?

Yes, I agree with you, the quality of support at these facilities has to equal that available at normal hospitals in order for it to be successful. I do believe though that other countries with aging populations (eg. Singapore) have made very good use of community hospitals to treat patients with chronic issues, and such a model might really help the NHS treat more elderly patients effectively. I still lack an in depth understanding of the issues in the NHS, since I am just a school student, but from my knowledge of it this is what I feel.

That's fine, I assume you're asking as part of interview prep. The interviewers will not expect you to be an expert on NHS politics, they just want to see that you can give a sensible answer which considers the question from multiple angles. Keep reading BBC Health, The Guardian etc and consider getting an interview book which explores some of the common NHS politics topics.

Ah ok, thank you so much! Do you have any book recommendations?

I used this one: https://www.amazon.co.uk/Medical-Interviews-Questions-Analysed-Multiple-Mini-Interviews/dp/1905812051

I have worked in 2 and we took calls from GPs who wanted to avoid acute hospital admission but needed a bit more investigation and medical/nursing care than can be put in at home. As stated, mainly this was for older patients, but we had on the spot testing for DVTs (blood clots in the leg), inflammatory markers (potential signs of infection), Xrays, etc so operated a Clinical Decision Unit - patients would come here, get some testing and may be sent home, admitted to the Community Hospital or transferred to the main hospital. we were, however, fairly rural, so for bigger cities, this function is likely to be performed by a normal hospital. We stopped frail elderly patients filling up beds/chairs/waiting areas whilst awaiting results and transfer home or to the ward. There were also dedicated OTs and Physios and regular visits from SaLT.

Can't Decide Unit

Community Hospitals usually do both step up and step down care. The medical care is usually given by a particular Practice or by the hospital's own dedicated team of GPs employed by the CCG.

I have worked in 2 and we took calls from GPs who wanted to avoid acute hospital admission but needed a bit more investigation and medical/nursing care than can be put in at home. As stated, mainly this was for older patients, but we had on the spot testing for DVTs (blood clots in the leg), inflammatory markers (potential signs of infection), Xrays, etc so operated a Clinical Decision Unit - patients would come here, get some testing and may be sent home, admitted to the Community Hospital or transferred to the main hospital. we were, however, fairly rural, so for bigger cities, this function is likely to be performed by a normal hospital. We stopped frail elderly patients filling up beds/chairs/waiting areas whilst awaiting results and transfer home or to the ward. There were also dedicated OTs and Physios and regular visits from SaLT.

As said, though, inevitably beds were full of step down patients, usually elderly, often post fracture/surgery who needed a bit of convalesence with nurses available 24hrs. We did a medical ward round on most of them daily (maybe not those just waiting for a Care Home placement) and a Consultant came out once every 2 weeks to advise about difficult cases, etc. As the beds were nearly always full, a lot of the step up care is now dealt with by Community Multidisciplinary Teams who are (supposed to be) able to be mobilised at short notice to care for people in their own homes. We have a Community Rehab Team who consist of Nurses, OTs, Physios and HCAs/carers who can visit a patient up to 4 times a day in their own homes to try and avoid hospital admission. Clinical care remains with their own GP in this scenario and we would meet with members of this team a minimum of weekly to reassess needs (though is often daily if things are changing rapidly). The advantage to this is the GP often knows the patient and their family/community very well, so is more likely to recognise changes and instigate a patient-centred care plan as they have prior knowledge of a patient's views.

I would disagree that the support at Community Hospitals needs to be the same as at a standard hospital, otherwise there is no point having both! Patients are carefully selected as fit for transfer to a Community Hospital or not needing secondary care if step up - remember, it is frequently the GP who decides to admit a patient, so makes that call every day. They need good medical care, nursing support, mainly Physio and OT input and this happens daily in the community anyway, just these patients need it 24/7 rather than intermittently, but they need it at a level consistent with Primary Care doctors and nurses, not those from a hospital. We have had acute medics really struggle in a Community setting as they have tried to "cure" everybody there, when that is rarely the demographic of patient we are talking about! Secondary care input, if provided, is best done by somebody with community older adults experience.

As also stated, one of those hospitals had a nurse-led MIU (with GP input if needed). The other did too, but it shut down due to changes in funding several years ago. They also both provide out patient services for clinics by Consultants (and at 1, we run combined clincis with Paeds consultants and the pt's GP so knowledge and learning can be shared) and they have out patient Physio services on site as well as other visiting clinics (podiatry, retinal screening, audiology, dietitian, etc).

Community Hospitals' existence has been under threat for years now, as they are considered unnecessary by those that know nothing about how the NHS works, but patients generally love them and prefer the local and often more personalised approach they get at them. Most of my patients plead to be admitted to our local Community Hospital if they have to go in and explaining they cannot do their appendicectomy or repair a fractured hip is a common discussion!