Hospitals must downsize or close, doctors warn Pressed on whether that would mean hospitals had to slim down, close or both, Dixon replied: "Both. [The aim should be to] hopefully bring down [their number] rationally by some of the commissioning groups coming together and deciding how that is best orchestrated. He argued that a rise in demand for treatment caused by an ageing population meant that GPs were responsible for overseeing a healthcare overhaul to stop the NHS coming under "unsustainable" pressure. The British Medical Association, which represents most of Britain's doctors, warned that the proposed measures may threaten specialist services provided by the NHS. A spokesman said: "Patients' needs, and the ability of the NHS to meet them, change all the time. It is right that we regularly review services and where they are provided. However, taking an arbitrarily defined chunk of services away from hospitals would threaten their financial stability, and therefore the ability of the NHS to provide comprehensive specialist care. They added: "The answer is not revolution but a rational, long-term approach to the planning of services. Any changes should be based on clinical evidence, not cost-cutting grounds. Mike Farrar, chief executive of the NHS Confederation, which represents hospitals, supported Dr Dixon's cost-cutting measures. He said: "As a vision for what the future in healthcare could be like, it's right. The public's attitude to hospitals needs to change. We need to explain to people that there are better ways in which we can care for people and that the aim should be to keep people living independently out of hospitals for longer. But to do that we need to take some of the money that goes into hospitals and put it into primary care and community care services instead. A spokesman for NHS England said: "There is no doubt that delivering the best possible care for patients at a time of economic austerity is going to be very challenging and that we need to adapt the way that services are delivered in order to provide the best possible to today's patients. It is really important that there is a full debate about these issues. It is also really important that our new GP commissioners are ready to lead this debate with us. We need them to help the NHS face its strategic challenges and the difficult decisions that will in some cases be involved. We therefore welcome Dr Michael Dixon's contribution to the debate.