A merger or a partnership are two possible options for Weston General Hospital.
All hospitals need to have foundation status by March 2014 but Weston does not have the "critical mass of clinically and financially sustainable services" to become a standalone NHS foundation trust. In other words, it's too small.
Weston Area Health NHS Trust is now in talks with NHS South of England and the new NHS Trust Development Authority to work out what it will become.
Weston trust chairman Chris Creswick said: "Weston General Hospital currently provides safe, high quality services but it is increasingly clear that as more healthcare is best delivered very locally – in GP surgeries or at home – or in large, regional specialist hospitals – small district general hospitals find themselves under increasing pressure."
The hospital had hoped to team up with North Somerset Council and North Somerset Community Partnership to become an "Integrated Care Organisation" combining social, community and acute hospital services. But this new organisation would not pass the foundation trust tests and so the trio will work together in some areas, but not as a new, official agency.
Talks are expected to suggest the hospital be acquired by another NHS foundation trust or partner with someone who can run the services that local clinical commissioning groups wish to commission. Such a partner could be a private health organisation, a voluntary organisation or a charity.
Dr Mary Backhouse, chief clinical officer designate of the North Somerset Clinical Commissioning Group said: "There is a future for Weston Hospital to continue to provide services for patients across North Somerset, now and in the future.
"We want local patients to continue to have access to as wide a range of services at Weston as possible, including emergency services, routine surgical operations, diagnostics and outpatient services, with the ability for patients to access more specialist services in Bristol when appropriate."