The White Paper - An Analysis
1944-03 1944 1940s 12 pages 8 for the whole, or substantially the whole, of their professional earnings. Hence, whatever methods of payment are adopted — whether by capitation fees, by salary, or in some other way, the substantial question at issue must be seen in a new light. It must be...
| 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/10796/9BB32948-58AF-4FE4-A217-78FB410853A2 http://hdl.handle.net/10796/516E620D-FD7F-4AB3-AB54-9FF7FC59159F |
| Summary: | 1944-03
1944
1940s
12 pages
8 for the whole, or substantially the whole, of their professional earnings. Hence, whatever methods of payment are adopted — whether by capitation fees, by salary, or in some other way, the substantial question at issue must be seen in a new light. It must be seen as the question of what is on ordinary professional standards a reasonable and proper remuneration for the whole-time services of a general practitioner working in a public service. Whether this should be worked out in terms of gross or net earnings, whether superannuation rights are to be assumed and taken into account, what adjustments are to be made for part-time work, are matters of comparative detail. When once the main figures have been satisfactorily settled, not only remuneration by capitation fee but remuneration under the salaried or part-salaried systems could be easily determined. As the White Paper makes clear, the Government do not contemplate the introduction of a universal salaried system, but they propose that doctors taking part in the public service should be remunerated on a basis of salaries or the equivalent in any part of the service in which this form of payment is necessary to efficiency. They contemplate also that it may be possible in certain other cases to offer remuneration by salary where the individual doctors concerned would prefer such an arrangement. In any event, whether payment is on a salaried or part-salaried system or on a basis of capitation fees, two principles will have to be observed in the arrangements made. First, the doctors taking part in the scheme must be assured of an adequate and appropriate income. Second, the aim must be to achieve a system flexible enough to allow for proper variations attributable to extra qualifications and extra energy and interest, as well as representing the reasonable and normal expectations of general practice at all its stages. The Government fully recognise the importance, and the urgency from a professional point of view, of reaching an understanding on these crucial matters, and they will be ready to discuss them in detail with the profession's representatives." PRINCIPLE H. Every member of the community should be free to consult the doctor of his choice either officially, as when he consults the doctor he has selected under an official service, or privately, as when he consults some other doctor, whether that doctor is a member of an official service or not. Nothing should be done to encourage the splitting of the medical profession into two groups — the official doctors and the non-official doctors. WHITE PAPER. 27. The White Paper contains the following principle :— "Freedom for people to use or not to use these facilities at their own wish ; no compulsion into the new service, either for patient or for doctor ; no interference with the making of private arrangements at private cost, if anyone still prefers to do so." 28. It is clear that the Government intends that practitioners who are participating in the public service should be free to engage also in private practice, although the application of this principle to the health centre practitioner is less explicit. What is not defined is the machinery or procedure to be adopted to enable the doctor to distinguish between the person taking advantage of the scheme and the person seeking to be treated privately. 29. The prospect of the continuation of private practice depends not only on the enunciation of the principle, but on the machinery adopted to make it really effective. 30. It is clear that the Government accepts the principle of private practice in relation to consultants and specialists employed on a part-time basis. What is not clear is whether the patient who goes into private accommodation in the private wing or block of a hospital will automatically renounce, for the purposes of his current illness, the benefits of the scheme in regard both to professional fees and to accommodation. Unless this position is accepted the principle of not interfering with private arrangements at private cost will mean little. 31. A subsidiary, though not unimportant, question is whether the patient will be free to avail himself of the public service for one item of service but not for another. Without such an arrangement the principle of private practice will suffer greatly. 32. The future of private practice depends on the clarification of government policy on these points, and upon the attitude of the public. PRINCIPLE I. Consultants and specialists should normally be attached to the hospital. For those persons who wish to be treated in private accommodation, whether part of a hospital or not, private consulting practice should continue. WHITE PAPER. 33. The questions of the appointment and distribution of consultants are dealt with in a general way in the White Paper. It is stated that consultant services will be best and most naturally based on the hospital services ; that it must be ensured that an adequate consultant service is available to all G.P.s in the service. 34. Consultant services will be available at the hospitals, centres, clinics, or in the home as required. The consultant will be provided by the Joint Health Authority directly, or by contract with voluntary hospitals. In other words consultants may be appointed either by voluntary hospitals or by the Joint Health Authority. To some extent therefore the Joint Health Authority may be an employing body of consultants. The question of private consulting practice is dealt with under principle H. PRINCIPLE J. The Central Administrative structure should be a corporate body concerned only with
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