The smaller general hospital: Delivering joined up cross-specialty working for the benefit of our patients.

Smaller acute general hospitals, especially those in remote and rural locations, provide vital services to their populations who might otherwise struggle to access safe and effective healthcare. By the nature of their location and, often also reputation, these hospitals are challenging to resource in terms of staffing which makes traditional models of care very difficult to sustain. This article proposes adjustments to the conventional model of acute care that is designed to ensure that patients presenting acutely receive a rapid assessment, according to their medical needs. This is delivered by a multiprofessional team of clinicians delivering care focused on the patient. Hand-offs between clinical teams and duplication of clinical assessment is kept to a minimum. The goal is to deliver care from the most appropriate professional or team as rapidly as possible post presentation, with alternatives to hospital admission being prioritised where appropriate. Early evidence is that this model of care is safe and effective, if delivered within a suitable physical environment for its provision. It is designed to deliver a sustainable model of working for the smaller, remote, rural or challenged healthcare system and is likely to be applicable to such systems elsewhere. © Royal College of Physicians 2020. All rights reserved.