Innovative models of community hospitals in Scotland: a multiple case study
Community hospitals, primarily staffed by nurses and general practitioners (GPs), sit between primary and secondary care, providing a range of local services. Their role in facilitating service integration is becoming increasingly relevant as policymakers struggle to meet the health and social care needs of ageing populations. Currently, however, knowledge regarding the organisation and functioning of the UK’s diverse community hospital models is limited. This study aims to address this gap, seeking to provide an in-depth understanding of the role, development and functioning of two innovative community hospitals in Scotland.
We used a multiple case study design, selecting case studies based on their variation with respect to key factors and their perceived innovative service models. The methods used comprised document review, stakeholder interviews and non-participant observation. Thematic analysis of data from each setting was followed by cross-case analysis to compare and contrast themes.
The community hospitals studied offered primary, intermediate and post-acute care in addition to allied health, social care and more specialist services. They served as hubs for service integration, providing holistic, accessible care in a friendly setting, particularly to elderly patients. More widely, they served to alleviate the burden on acute provision and regional inequities in care access. The role of GPs in the leadership and delivery of hospital services was central, with prior patient knowledge and relationships considered beneficial to patient experience as well as the community-oriented character of the hospitals. Factors related to the nature of the GP role, clinical skills to support diverse services, interdisciplinary collaboration and community engagement affected the degree to which community hospitals were seen to fulfil their intended role. Reliance on community hospitals to plug shortfalls in acute provision constrained their ability to fulfil their preventative and step-up functions.
The findings of this study should inform the place of community hospitals in current plans to enhance service integration locally and to effectively organise care for the elderly and chronically ill. In designing future care models, it will be important to recognise that continued use of community hospitals to alleviate pressure on acute services may prevent them from realising their full potential. Enabling GP ownership and continuity of care, maintaining clinical skills and confidence to support the range of services offered, overcoming the challenges of co-location and service integration, and ensuring adequate mechanisms and space for community engagement will also be important considerations.