A National Health Service : Report of the Council of the B.M.A. to the Representative Body
1944 1944 1940s 11 pages 8 regard to auxiliary services which will help to ease the demands on a doctor's time. The total number of doctors in this country has been for some time increasing at the rate of about 1,000 a year, and if the resources of the medical schools are enabled to be used...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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1944
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| Online Access: | http://hdl.handle.net/10796/0593864E-F560-4616-A5B1-695A72DC4005 http://hdl.handle.net/10796/69C0F4B8-0665-4232-83C3-D42CE55ED24E |
| Summary: | 1944
1944
1940s
11 pages
8 regard to auxiliary services which will help to ease the demands on a doctor's time. The total number of doctors in this country has been for some time increasing at the rate of about 1,000 a year, and if the resources of the medical schools are enabled to be used to fullest capacity this rate of increase can be accelerated in the future. The Minister will want to discuss the question generally with the profession's representatives in due course. The recommendations of the Goodenough Committee will, no doubt, be relevant. Equality of Sexes Question 7. — Will the Minister give an assurance that in the operation of the service there will be no discrimination between male and female practitioners? Answer. — There is certainly no intention of discriminating between men and women doctors in the new service, apart from obvious kinds of special appointments which may require a woman rather than a man, or vice versa. Central Administration Question 8. — What are the reasons why the service should not be administered as a "Corporation" (e.g., B.B.C. or P.L.A.), or as a council of the Privy Council (e.g., General Medical Council or Medical Research Council), or a body similar to the Board of Admiralty, responsibility still lying through a Minister to Parliament. Answer. — The reasons for vesting the ultimate central responsibility for the service in a Minister of the Crown, with the normal departmental machinery of central government, have been explained on pages 12 and 13 of the White Paper. It is not felt that there is any true analogy between the proposed new service and any of the services or activities with which the bodies mentioned in this question are concerned. Question 9. — What are the Minister's objections to making the Central Health Services Council a body composed mainly of elected representatives — i.e., its medical membership being in the main, elected by the medical profession through its organizations? Question 10. — What are the Minister's objections to the publication of reports by the medical group of the Council for the information of Parliament, the public, and the medical profession? Question 11. — Is there any objection to the Council being given a secretariat independent of the Ministry? Answer. — The Minister is anxious to consider in much more detail with the profession's representatives the whole question of consultative machinery, which is only roughly outlined in the White Paper, and to the success of which he attaches the utmost importance. All the matters raised in these three questions will then need to be examined at some length, and it is impossible to cover the ground adequately in a short answer at this stage. Question 12. — Will the Minister give some further reassurance and explanation with regard to the powers of the Central Medical Board, as the statements made by the Government spokesmen in Parliament have not removed the profession's apprehensions of its powers of compulsion? The following are examples of the type of question being asked: (a) If there were a shortage of public service practitioners in a particular area could not the deficiency be remedied by two or more part-time practitioners rather than by persuading or directing one practitioner to practise there whole-time in the public service? (b) Is it not likely that the Central Medical Board will direct the flow of assistants to practitioners in full-time public service, and that practitioners doing some private practice will have difficulty in obtaining assistants? (c) Is it the Government's intention that under certain circumstances a practitioner engaged in private practice shall not be able to accept and give treatment under public service conditions to any patient who wishes to receive it from him and to whom he is willing to give it? Answer.— The proposal for a Central Medical Board is intended as a means whereby professional men and women, engaging themselves with the central government in future to take part in a service of general medical practice for the whole population, may be able to have direct contractual relations with a body which is itself predominantly professional. One reason for the proposal was that it was believed that many professional men and women would prefer such an arrangement to a contract either direct with a Government Department or with any local government organization. If this is not so, there are other possible alternatives which could be considered. It is probable, however, that it is not so much on the establishment of such a body, but more on the powers to be vested in it, that reassurance is sought in this question. In this connexion it is to be emphasized that there has never been any suggestion that the Board should have power to direct doctors to any particular area or to any particular engagements. Two powers are proposed in the White Paper in regard to the distribution of public medical practice: (i) A power to refuse to admit additional doctors into the public service in a particular area if that area clearly does not need them. The machinery proposed for this is a requirement of the Board's consent when a doctor proposes to enter into a new public practice in which he has not been previously engaged. (ii) A power in regard to new doctors starting in general practice for the first time ; a power to say to such a new doctor that, if he wants to engage in the public service in a particular area which is in serious need of a doctor who will give all his time to public practice, then he can only engage himself there on that basis — for his first few years — although he can go elsewhere, of course, without giving all his time to public practice, or he can practise in the area privately. On the particular aspects of the Board's powers which the question raises: (a) If two or more part-time doctors were available and could remedy the deficiency equally well, then there would be no need to ask for the whole of the time of the young doctor who wanted to go there. That would be a question of fact in each case. (b) It is difficult to see why a mainly professional Board should want to do this. But it is in any case a matter which could be corrected by general directions from the Minister, in consultation with the profession. (c) It is intended that any practitioner shall have the normal right to participate in the service for all or part of his time, subject only to points (i) and (ii) mentioned above. Generally, in regard to the proposed Central Medical Board and particularly in regard to the question of "over-doctored" and "under-doctored" areas, the Minister will welcome the profession's own ideas and suggestions and the opportunity of more detailed discussion. Question 13. — What is the objection to securing a proper distribution of doctors by the attraction of elastic conditions of service and remuneration adaptable to different types of areas — e.g., Highlands and Islands Service ? Answer. — It is recognized that there may be advantages in this for certain types of area if practicable methods can be devised. Any proposals from the profession will be carefully considered. Question 14. — Is it in the interests of the service that the general practitioner should be under central (or central and
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