Much debate has centred around the future of acute services in the NHS in the UK with particular reference to the role and function of the District General Hospital. This paper explores a new model of hospital development--the 'Local General Hospital' which lies somewhere between the DGH and the cottage or community hospital. The paper uses the case study of Neath General Hospital in South Wales which moved to a LGH model. The paper explores the functional content of the LGH balancing accessibility with cost and clinical effectiveness. The paper makes particular reference to the development of clinical networks which cross organisational boundaries and the support of GPs and consultant medical staff as key success factors in the transition from DGH to LGH.