The White Paper - An Analysis
1944-03 1944 1940s 12 pages 7 which employ them. Methods of appointment and remuneration are deferred until after the Report of the Goodenough Committee on Medical Schools. PRINCIPLE E. Free choice as between doctor and patient should be preserved as a basic principle of future health services, a...
| 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/10796/341D6F89-C826-49E1-8E99-9E3604923C9B http://hdl.handle.net/10796/1609106C-3400-4F38-A5EC-27AE687E7C77 |
| Summary: | 1944-03
1944
1940s
12 pages
7 which employ them. Methods of appointment and remuneration are deferred until after the Report of the Goodenough Committee on Medical Schools. PRINCIPLE E. Free choice as between doctor and patient should be preserved as a basic principle of future health services, and no administrative structure should be approved which does not both permit and encourage such free choice. WHITE PAPER. 19. The Government accepts the principle of free choice as between doctor and patient in separate practice, and free choice of doctor in grouped or health centre practice, apart from the general desirability of limitation of lists. But in so far as the proposals for grouped or health centre practice stress the salary method and omit specific reference to a capitation element in the remuneration, these proposals cannot be regarded as both permitting and encouraging free choice. The Government states :— "Each Centre will need to be so planned as to be regarded by patients not as a complete break with present habit but as a new place at which they can, if they wish, continue to see their own doctor when he has joined the Centre, or, can choose the doctor in the Centre whom they want to attend them. Alternatively, they must be able, if they prefer it, simply to select a health centre as such, rather than choose a particular doctor at the Centre ; and then arrangements will be made by the Centre to ensure that they obtain all the proper advice and treatment which they need." The considerations set out under principles C and D are relevant here. PRINCIPLE F. It is not in the public interest that the state should invade the doctor-patient relationship. The loyalty and obligation of a doctor rendering personal health service to an individual patient should be to that patient and to none other. WHITE PAPER. 20. The principles of the Paper include :— "The personal doctor-patient relationship to be preserved, and the whole service founded on the "family doctor" idea. Freedom for the doctor to pursue his professional methods in his own individual way, and not to be subject to outside clinical interference. 21. These principles to be combined with the degree and kind of public organisation needed to see that the service is properly provided — e.g., to ensure better distribution of resources and to give scope to new methods, such as group practice in Health Centres." The considerations set out under principles C and D are relevant here. PRINCIPLE G. Free choice of doctor should be reinforced by a method of remuneration which relates remuneration to the amount of work done or the number of persons for whom responsibility is accepted. WHITE PAPER. 22. In regard to general practice, the Government accepts this principle in so far as it relates to separate practice. It does not appear to accept it in relation to grouped or health centre practice. At least it is clear that it prefers the method of remuneration by salary in health centres. 23. In regard to consulting practice, it is not possible to say whether the principle of relating remuneration to the amount of work done is accepted in relation to the proposed salaries until more details are available. 24. It is possible that the Government may agree to the creation in each health centre of a "pool" consisting of aggregate capitation fees and its distribution amongst the participant practitioners on the basis of a scheme approved by them. If this is done or if a salary cum capitation element is the basis generally laid down there will be conformity with this principle. But the terms used by the Government appear to stress the salary method. 25. It is proposed to create a system of limitation of lists where a doctor undertakes private in addition to public practice, but there is no reference in the White Paper to the method by which a practitioner will be able to undertake private practice side by side with public practice. "A doctor entirely free from outside activity and able to give his whole time to general practitioner work in the new service will need to be able to work to a higher permitted limit of public patients. A doctor with an unusually large amount of private work, or with appointments in other branches of the public service, will be expected to work to a lower permitted limit. The effective way to provide reasonable flexibility is to entrust the decision in such cases to a suitable professional organisation — which will naturally be the Central Medical Board working through its local committees. The details of this are for discussion with the profession's representatives at a later stage, but the object must be to see that the care of patients under public arrangements does not suffer in quality or quantity by reason either of private commitments or other public engagements. Nor must anyone have reason to believe that he can obtain more skilled treatment by obtaining it privately than by seeking it within the new service." It would seem to be impracticable to limit lists in the way suggested. 26. In Appendix D to the White Paper, the Government suggests a new approach to the problem of assessing an appropriate remuneration :— "It must be expected that in future the bulk of general practitioners will look to the new service
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