British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL except that there is some representation — in practice almost negligible — of the county and county borough councils upon the Insurance Committees. We regard it as esse...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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[London : British Medical Association]
30 April 1938
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| Online Access: | http://hdl.handle.net/10796/E6365442-AFEA-4E60-AA8F-D262C814C4B3 http://hdl.handle.net/10796/E3B53462-E315-48E2-896F-2329C43080AF |
| Summary: | 1938-04-30
1938
1930s
14 pages
APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL except that there is some representation — in practice almost negligible — of the county and county borough councils upon the Insurance Committees. We regard it as essential that these two systems shall be much more closely connected both administratively and in medical personnel. 6. Broadly the present provision may be set out as follows: (i) Under the auspices of the Insurance Committees a general practitioner service for some nineteen million persons who are under a "contract of service" and, if non-manual workers, have incomes below a certain limit. (ii) Under the auspices of the local authority: (a) An environmental health service. (b) A general practitioner service for persons who are destitute or in need of public assistance (c) A school medical service of limited scope. (d) A maternity service based mainly on attendance of midwives.* (e) The supervision of certain cases of mental deficiency. (f) Clinics for certain purposes — for example, for infant welfare, early mental disorders, venereal disease, and tuberculosis. (g) The services of consultants and specialists for certain purposes. (h) General hospitals and special hospitals, including those for infectious diseases and abnormal mental conditions. 7. In addition there are certain voluntary bodies or agencies which render the most valuable service to the public health. Those concerned with infant welfare and with mental health are particularly noteworthy, and the position of the voluntary hospitals throughout the country is fully recognized. In any national scheme of medical and health provision the work of such bodies and institutions should be continued, extended, and utilized to the full, both as essential auxiliaries to local authorities in the exercise of their statutory duties and powers and as pioneers and experimenters in fields and directions not yet recognized as within those powers. 8. The provision which should be made in any general medical service for the nation includes, in addition to the environmental health and sanitary service: (i) A general practitioner service; (ii) Auxiliary services — for example, nursing, massage, physical medicine; (iii) Dental and ophthalmic services; (iv) A complete maternity service; (v) A consultant, specialist, and laboratory service; (vi) An institutional service. 9. Accepting the form of medical benefit under the existing national health insurance system, while recognizing that it requires to be improved and supplemented, we propose that it shall be extended to include (a) the dependants of the present insured persons, (b) those at present receiving domiciliary medical attendance through public assistance machinery, (c) others of like economic status with the present insured persons though not under a "contract of service" and their dependants. Thus all domiciliary general practitioner attendance for beneficiaries would be in accordance with one system and under the supervision of the same agency. 10. In close association with the general practitioner service would be certain auxiliary services of lay persons, such as pharmacists, nurses, masseuses, and biophysical assistants, necessary for the treatment of the insured clientele under the responsibility of their general practitioners. These services would be statutory and arranged by contract, and would not be dependent upon the affluence of approved societies or the will of their officials. 11. Similarly there would be for insured persons a dental benefit and an ophthalmic benefit — both as statutory benefits for all and not as "additional" benefits for some. It is undoubtedly somewhat illogical to put ophthalmic treatment in the position suggested rather than to include it under like conditions with other consultant or specialist services, but there are considerations which seem to make this more convenient. As an alternative, however, it could be placed in the more general category. 12. The consultant service should be similar to that now available to private patients, and would be rendered, as a rule, in the consulting-room of the consultant or in the home of the patient. Although the approach of the patient to the general practitioner should be direct and free, it is essential, in the interest of the patient, that consultant and specialist services should be available only on the recommendation of the family doctor. The consultant service should be administered by the statutory bodies responsible for the service as a whole, or by combinations of such bodies. 13. The scheme for a complete national maternity service and the hospital policy favoured by the British Medical Association have been set out in full in separate publications of the Association, and have met with wide acceptance. It is not proposed that either of these services should form an integral part of the insurance system, but they must both be included in any general medical service for the nation and associated as closely as may be with the other parts of such a service. We favour the grouping of hospitals of all kinds into somewhat large regions, and the establishment and extension of contributory schemes and provident schemes in accordance with suggested models. 14. Administratively the modifications or changes suggested may be grouped as threefold. They relate to (1) the local health areas, (2) the committee work of the authorities of those areas, (3) medical supervision and relationships within those areas. 15. In lieu of the present multiplicity of local health authorities, most of them with only partial health powers and functions, it is proposed that every area — whether county, county borough, municipal borough, or county district — with a population above a certain minimum, varying in accordance with its predominantly urban or rural character, should be constituted a health area, and that its council should have full powers and a complete service. The powers permitting combination or joint action between such authorities for all, or for certain, health purposes might be extended, and the councils should be induced to use them on all suitable occasions. Particularly should this be the case for the establishment of appropriate wider regions for the purpose of hospital grouping and usage and for the establishment and usage of a consultant and specialist service. By such an arrangement a vast amount of overlapping and confusion would be avoided. 16. A rearrangement of statutory committees and the reconstitution of Insurance Committees in relation to local authority councils would conduce to efficiency and co-ordination of work and unification of control. The position of the transferred insurance services committee should be the subject of special consideration. It is noteworthy that such a transference has been recommended by every royal commission, departmental committee, or authoritative inquiry that has considered the matter. But (1) the general practitioner service is at present financed, and may continue to be financed, mainly by contributions made by beneficiaries or on their behalf; and (2) it must continue to be a nation-wide service directed in its essentials from the centre and conducted in every area on uniform lines. In view of these facts it would be essential to preserve central control of the service much as at present, and to secure substantial representation on the committee of contributing beneficiaries or those charged with their interests. There * In Scotland a more comprehensive maternity service exists, including the services of medica! practitioners and consultants.
292/847/1/60 |
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