South West London Collaborative Commissioning

Why do you want to move services out of hospitals and into the community?


  • This has been the direction of national policy for the NHS for several years, because of the changing needs of our population. It is less expensive for the NHS as well as being a more effective way of providing care for patients, for whom it is usually more convenient.
  • GPs, practice nurses, district nurses and health visitors will in future play a much bigger part in coordinating the healthcare of people in their area. We are talking about a complete transformation of the way in which health services are delivered, with a much broader range of services provided outside hospital. Hospitals will focus on providing specialist care for those who really need to be in a hospital. These are very significant changes which have been carefully thought through to address the changing health needs of our population.
  • We have an ageing population in which many more people are living with long term conditions such as diabetes, asthma or heart disease. Older people are often better treated at home or in a local health centre than in hospital. The same is true of people who have long term conditions. These patients can be better managed by GPs or community-based specialists than in hospital and it means hospitals are freed up to care for those patients who really need to be in hospital.
  • For example, does an older person with diabetes need to go to hospital unless in an emergency? If we can support them to manage their condition locally, through their GP and a multi-disciplinary team based in their community, we could keep them healthier and reduce the need for them to go to a hospital.
  • Because of the higher overhead costs of running a hospital, hospital visits are more expensive as well as being less convenient for most patients. So not only do patients get a better service – sometimes delivered by the same clinicians, but outside hospital – it also costs less for the NHS.
  • We need to invest more in preventing people becoming ill in the first place. This means investing money in services that work with patients to help them to manage their own health, reduce the chances of them becoming unwell and encourage them to live healthier lifestyles.
  • Better integrated community services, with GPs and other primary care professionals coordinating patient care, will enable us to work with patients and carers to manage long term conditions, improve lifestyles and reduce the chances of them becoming unwell enough to need treatment.
  • Health services need to work much more closely with the social care services provided by local authorities. Our vision is for all of these services to be ‘wrapped around’ the needs of the patient, rather than working in isolation from one another.