• Elimination of a projected 2020/21 deficit of £226 million;
• Development of urgent care hubs to act as a single point of access to health and social care;
• Redesign of primary and community services;
• Increased focus on prevention and self-care.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that financial pressure will mean that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

A public consultation has taken place on the closure of Lydney & District Hospital and Dilke Hospital. The results were reported in January 2018, with a majority (46%) of respondents to the consultation in favour of not closing the community hospitals.

The STP includes plans for reviews of several care pathways and services in the hospital sector. Reviews generally seek ways to cut costs and/or move the service into the community. Plans include the following:

• Implementation of a new MSK model with clear pathways across primary and secondary care;
• Changes to cancer pathways with a new community based survivorship model;
• Implementation of an eye health clinical programme including delivery of new community eye health services;
• Development and implementation of new pathways for respiratory and dementia care;
• Development of an integrated specialist perinatal health service.

In March 2018, the board of the Gloucestershire NHS trust has approved controversial proposals to set up a subsidiary company (SubCo) to employ almost 700 of its staff. Gloucestershire Hospitals NHS Foundation Trust chiefs say the move will help them deliver necessary savings. The SubCo, as it is known, will come into force on 1 April and include staff from the trust’s estates, sterile services and materials management departments.

In urgent care, the STP contains a major redevelopment including  the development of urgent care hubs around the area, providing a focus for urgent care within geographical localities to include GP, community hospital and other community services.

The STP discusses the design of new models of care that will increase integration between primary and community care but with few precise details. The STP does note, however:

• The increased collaboration of GP practices to cover 30,000 plus population areas;
• An increase in patients able to access primary care online or via apps, with a target of 10% by the end of 2017 and 95% by 2021;
• That by 2021 the STP's aims is to have 35 additional pharmacists qualified as prescribers working in practices, 65 additional GPs and 45 whole time equivalent advanced/specialist nurses.

The STP does not include details of how the deficit is going to be eliminated and services maintained. Campaigners have been highly critical about the lack of figures in the STP document.

Stroud Against the Cuts has written to all councillors, arguing the plan’s budgets are “riven with holes” and provide no information on projected changes to staffing levels, number of beds, asset sell-offs, or deficits of the NHS Trusts."

They fear that behind closed doors the full plans hold details on “further cuts and sell-offs” to the county’s “much loved and vital hospitals”.

Liberal Democrat councillors have expressed concerns about cuts to beds in hospitals around the county: Councillor Iain Dobie, the Lib Dems' spokesman for public health and communities, said “From what we have heard there will probably be cuts in the number of hospital beds around the county. This is deeply alarming in light of increasing demand."

In May 2017 the councillor reiterated his concerns about the effect of the STP: “I predict the upcoming rollout of the government’s Sustainability and Transformation Plans (STP) may well lead to the complete closure of at least one local hospital service in the county.”