The White Paper - An Analysis
1944-03 1944 1940s 12 pages 6 11. The Government does not adopt, at least directly, the plan of a whole-time salaried medical service under central or local government for the whole profession. 12. It will be convenient to consider here the Government's conception of general and consultin...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
| Published: |
March 1944
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/FAC0F8C7-C7D2-4EA3-9692-2C412C03F207 http://hdl.handle.net/10796/0CD08723-B28C-4643-A4D4-CE235B55CBFF |
| Summary: | 1944-03
1944
1940s
12 pages
6 11. The Government does not adopt, at least directly, the plan of a whole-time salaried medical service under central or local government for the whole profession. 12. It will be convenient to consider here the Government's conception of general and consulting practice. General Practice. 13. Under the Government's plan general practitioners will work either in separate practice, as at present, or in grouped practice, probably in health centres. They will enter into contract with the Central Medical Board, or, in the case of health centre practice, with the Central Medical Board and the county or county borough council. The Central Medical Board will be, in effect, the employing body or one of two joint employing bodies. In future, it will be necessary to obtain its permission before setting up in public practice in any area or transferring from one area to another. Further, it is proposed to give the Central Medical Board power "to require the young doctor during the early years of his career to give his full time to public service where the needs of the service require this." 14. In separate practice the remuneration will be by capitation fee. In health centre practice, remuneration "will be by salary or similar alternative." In arguing for a salaried or some similar alternative remuneration within health centres the Government condemns competition for patients within health centres. It is fair to infer that while not dismissing a method of payment which includes a capitation element the Government prefers the salaried method of remuneration in health centre practice. 15. Do these proposals interfere unnecessarily with the personal freedom of the doctor or point to the conversion of the medical profession, now or later, into a salaried branch of central or local government? The Government argues that it is reasonable to prevent new practitioners entering an area already with enough doctors in it, but then proceeds from this premise to recommend that all doctors proposing to enter public practice or to change their area of practice should seek the approval of the Central Medical Board. The suggested power of civil direction of newly qualified practitioners to engage wholetime in the public service — for that would be the effect in practice — might be used to direct them to health centre and so to salaried practice. All newly qualified practitioners will be liable to direction to the public service. There are three additional factors which are relevant:— (1) The Government proposes to compensate existing practitioners who join health centre practice in future. Unless the compensation arrangements are universal the incoming young practitioner will choose between the form of practice for which he pays and one for which he does not pay. Not unnaturally, he will tend to the health centre form and so the salaried form of practice. And, as a result of compensation in certain cases, the capital value of all practices will fall automatically. The Government appears to recognize this by offering to discuss the whole question with the profession. (2) The development of health centres will not under the existing proposals proceed on a trial or experimental basis. Subject to the Minister's approval, the decision to establish them will rest on the Joint Board and the county or county borough council. They, subject to the approval of the Minister, will determine not only the type but the pace of health centre development and so of salaried service development. In the absence of a proper adjustment of remuneration as between practitioners employed at health centres and those employed in separate practice, the salaried form of service may be weighted to the disadvantage of practitioners not working in health centres. Further, as the proposals stand, unless a practitioner accepts the salaried form of service he will be precluded from the benefits of working in a health centre. (3) The third relevant factor is the constitution of the Central Medical Board. It is to be mainly medical in character under a regular chairman, a few of its members being full-time and the rest part-time. It is conceived as a civil service structure analogous to the Board of Control. To this quasi-corporate body of civil service structure, not responsible to Parliament on matters of detail, are to be allocated important functions which in their operation may limit the right of practitioners to practise in the public service where they like and may involve a measure of civil direction of some practitioners in peace-time. 16. Taken together, and in the absence of fuller information, these considerations make it doubtful whether the White Paper as a whole conforms to the freedoms set out in its principles and suggest that its adoption in toto may lead to a whole-time state salaried service. Consultant Services. 17. The consultant services, as is stated in the administrative paragraphs of this document, will be organised on quite different lines. Consultants will be appointed by individual hospital authorities, voluntary and local authority, although there is a slight reference to the observance by hospital authorities of certain general conditions. "These conditions will be settled centrally for the country as a whole, and they will then become the conditions on which exchequer grant will be payable. In framing the conditions the Minister will seek the advice of the Central Health Services Council, but the more important conditions will relate to subjects such as the following :— (a) each hospital will be required to maintain the services under the approved hospital plan it undertakes to maintain, and generally to comply with the plan ; (c) in appointing senior medical and surgical staff each hospital will conform with any national arrangements adopted for regulating appointments and remuneration ; it will be necessary to consider a system under which an expert advisory body recommends a number of suitable candidates from which the hospital authority makes the final choice ..." 18. Consultants will be remunerated on a part-time or whole-time basis by the hospital or hospital
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