STRUCTURE: The accident and emergency department at either the Royal Bournemouth Hospital or Poole Hospital could be downgraded to an urgent care centre under proposals for changes to acute services in Dorset.

A major emergency hospital with 24 hour access to consultants will be developed at either the Royal Bournemouth Hospital or Poole Hospital.

The second A&E will be downgraded to a 24 hour urgent care centre and will become an elective hospital.

Dorset County Hospital will keep its 24 hour A&E and consultants will be on-site 14 hours a day. Specialist cases would be taken to either Bournemouth or Poole outside of these hours, according to the plans.

Dorset County Hospital

Dorset County Hospital will keep its 24 hour A&E but consultants will only be available 14 hours a day

The development of a major emergency hospital with consultant access 24 hours a day would be a first for the county.

Commissioners decided the changes were necessary because of “variable quality” in both hospital and out of hospital care, and a gap between funding and costs that could reach up to £200m a year by 2020-21 if no changes are made, according to the CCG’s proposal document.

The Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole Hospital FT had plans to merge in 2013. However, this was blocked by the Competition Commission. The two trusts had hoped a merger would allow them to increase consultant cover.

In October Dorset CCG named McKinsey its preferred bidder to deliver the £2.75m, six month review to examine the challenges of the county’s ageing population, clinical standards and financial pressures.

The CCG said over 300 clinicians had been looking at ways to improve the health system.

The proposals will go to the group’s board meeting tomorrow and, if approved, the plans will be reviewed independently and then go to public consultation later this summer. The final decision will be made in March next year.

One idea is to organise GP surgeries around health “hubs” where patients can see health visitors, pharmacists, dentists and receive care that sometimes require a visit to hospital, such as minor operations.

Forbes Watson, chair of Dorset CCG, said: “Our local services must work better together to meet our patients’ needs and quality standards within available funds.

“Doing nothing is not an option because the way we currently deliver care in Dorset isn’t as good as it should be and isn’t sustainable in light of changing and increasing needs from our growing and ageing population, and we have a shortage of specialist staff available for some services.”

Debbie Fleming, chief executive of Poole Hospital, said the options present “exciting opportunities” to increase consultant presence and “shape care more effectively around patients in the county”.

She added: “Dorset has never before provided the range of services that make up a major emergency hospital site within one location, and the development of this type of hospital will mean significant benefits for the local population.”

Tony Spotswood, chief executive of Royal Bournemouth and Christchurch, said the model of care proposed by the CCG “enjoys substantial clinical support and has been co-designed by clinicians from the three hospitals, community service colleagues and those working in primary care”.

This story was updated 4.38pm to reflect that one accident and emergency department will be downgraded to an urgent care centre. HSJ tried to clarify this before original publication but was told by a Dorset CCG spokesman that all three hospitals would keep 24/7 A&Es.