The coalition intends to make GPs responsible for all commissioning other than that of specialist services.
The trust provides healthcare to the London boroughs of Lambeth, Southwark and Lewisham, and a range of specialist services for patients across south east England and beyond.
Tariff changes will accelerate the concentration of specialist services in fewer hospitals, while the year-round pressures on A&E will see increasing numbers of trusts providing some form of on-site primary care.
To begin to address and reverse these problems will need not only the intervention of specialist services, but the engagement of the media, politics and the public at large.
Pragna Patel of Southall Black Sisters, which took Ealing council to a judicial review to establish the importance of specialist services such as theirs, believes that "this is a serious, serious problem.
This includes moving care closer to people's homes and re-thinking the role of hospitals which must change to improve the quality of specialist services and better meet the needs of older patients.
Firms cluster together for a variety of reasons: the skills that are available in a particular area, the concentration of specialist services and the venture capital from investors with a close understanding of their market.
The British Association of Dermatologists (BAD) said it was "very worried" about the decision to end acute services at Nottingham and warned that the privatisation and "fragmentation" of specialist services was "decimating" some areas of the NHS.
"We're working with nearly 3,400 children in need of specialist services.
Seven hospitals between Swansea and Newport provide a range of specialist services for the most sick patients.
However, the system has some disadvantages, including short consultation time, poor gate-keeping of specialist services, and lack of an effective referral system.
