Medical generalism in smaller hospitals

The revival of general physicians, whose breadth of expertise enables them to manage both acute and chronic health problems, has been proposed as a way of better caring for the increasing numbers of older and more complex patients requiring emergency medical admission.


Published: 07/02/2017

Project status: Current

Models of generalist and specialist care in smaller acute hospitals: an exploratory study

This 30-month project will provide high quality evidence about the models of medical generalism currently in use in smaller acute hospitals in England and explore their strengths and weaknesses from patient, professional and service perspectives.

The Nuffield Trust leads a team of researchers from external organisations, including:

Through five work packages we will explore processes and models of care, their alignment with patient case mix, their impact on staff, patients, costs, and patient and staff preferences. More specifically, we will seek to:

  1. Create a typology of the different models of generalist and specialist care used in smaller hospitals, considering workforce deployment, skills mix and service configuration;
  2. Create a case mix classification that identifies patients which may benefit from generalist care and use this to describe and compare workload, resource utilisation and outcomes between hospitals and models of care; 
  3. Assess the degree of alignment between patient case mix and medical generalist/skills mix in smaller hospitals; 
  4. Identify the strengths and weaknesses of the different models from patient, professional and service perspectives;
  5. Investigate the economic costs attached to different models; 
  6. Assess the types, utility and relevance of potential variables and measures of outcome for a more detailed evaluation of the different models of medical generalism; 
  7. Explore the different definitions and boundaries of medical generalism in the context of smaller hospitals.

Smaller hospitals are an ideal microcosm in which to investigate these questions, since their patient population is older and has more complex needs, and thus could be considered to be more ‘general medical’ than that attending larger hospitals. A recent study by Monitor further suggests that the tensions in the wider health service around generalist and specialist care are concentrated in smaller hospitals.

We expect this study to have a major impact and that its results will inform and influence decision making around ways of working in hospitals; issues around workforce education, continuing professional development and contractual arrangements; and the future of smaller hospitals and their role in the wider healthcare system.

Outputs of this work will reflect the exploration of medical generalism in smaller hospitals and will include: a descriptive analysis of current medical staffing in these hospitals; a model of the patient case mix and workloads of smaller hospitals; a typology of the models of medical generalism in smaller hospitals; a classification tool to assess patient need for general medical care based on case mix data; an economic analysis of the different models of medical generalism; potential outcome indicators to test models of care. 

The study will also prepare three short report papers outlining the service delivery implications for the medical workforce, the future of smaller hospital and medical generalism.