Dame Julie Moore told HSJ she wanted to see top providers running chains of hospitals, arguing the district general hospital could be “redefined” as an outpost of a larger trust.

The University Hospitals Birmingham chief executive said she did not foresee the death of the district general hospital, but “the DGH providing all things for all people has probably gone”.

But, she added: “A locally based hospital providing locally based services is right.

“The analogy is we used to have a corner shop that provided a range of things for people. But they went out of business.

“But now we’ve got Sainsbury’s Local, and [smaller local outlets of] Tesco and Waitrose, because they’ve got the weight of the big organisations behind them. They provide same quality goods in a local setting − but in a limited range.”

Dame Julie argued that local specialist units could be linked to larger centres, as they could then access the technology and infrastructure that larger trusts could afford. She added that clinicians at George Eliot Hospital Trust and Burton Hospitals Foundation Trust − both of which her trust is “buddying” following the Keogh review of mortality rates − had benefited by working alongside colleagues at the larger trust in recent months.

“Now the money is getting tighter we need to think about how we configure that and how we can share resources that don’t need to be − or people can’t afford to have − in every single organisation.”

She said the Future Hospitals Forum – which comprises leading trusts including her own, Monitor, the NHS Trust Development Authority and NHS England − was discussing this issue. For the first time, she said, they were openly mooting that “not every organisation is going to be able to stand on its own two feet”.

Leading foundation trusts explore moves into primary care