British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 255 are, nevertheless, counter considerations: (1) it is of the utmost importance that in any general medical service for the nation the general practitioner service s...
| 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/FEFE8351-E1F5-4EDE-9575-0508A9F71DA8 http://hdl.handle.net/10796/0FECC0EA-09A0-4084-A273-EDD7BD664C18 |
| Summary: | 1938-04-30
1938
1930s
14 pages
APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 255 are, nevertheless, counter considerations: (1) it is of the utmost importance that in any general medical service for the nation the general practitioner service should be brought into the most intimate relationship with all the other health services; (2) even in the present insurance service and the constitution of its committees it is recognized that the local health authorities have important interests, and these would be largely increased in the extended service proposed, especially by reason of the fact that, as public assistance authorities, they would be making a substantial contribution from the rates in paying the whole of the premiums of those in need of public assistance. We regard the suggested administrative liaison between the insurance service and the local authority services as certainly no less important than the clinical liaison previously mentioned. 17. There should be a purely medical liaison also between all the services. It is proposed that this should be effected in two ways. The medical officer of health appointed by the council of each health area would be charged with the general supervision of all the health services, and would have appropriate duties. Further, in each area would be established a Medical Advisory Committee representative of the whole profession in the area. Such committee would be available for securing such co-operation of the medical practitioners of the area with the local health authority and its officers as was desired or as was necessary. It would be consulted on behalf of the local authority on all purely professional matters and on those in which the interests of the medical profession were concerned. 18. Central medical committees, whether representative of insurance practitioners in particular or of the profession generally, should be maintained and recognized as at present for the purpose of consultation or negotiation with the central health government departments. 19. Proposals on these lines have been submitted by the British Medical Association for some years now for public discussion. As a result of such discussion they have been revised and amended, and in this form the Association invites further discussion, with a view, however, to some such proposals being practically implemented at no distant date. I. THE PROBLEM 20. The past thirty years have been characterized by a widening and a deepening of the public interest in the problems of personal and public health. The establishment of the systematic medical examination of school children, the creation of the national health insurance service, the organization of tuberculosis, venereal disease, maternity and child welfare, mental and mental deficiency services, and the transfer from Poor Law to public health administration of a large number of hospitals and institutions, all illustrate the greatly increased interest which the community, through the State, has manifested in health and sickness provision as a form of social service. The reports of the Consultative Medical Councils, the Royal Commission on National Health Insurance, the Departmental Committee on Scottish Health Services, the Voluntary Hospitals Commission, and the British Medical Association; the various inquiries, official and unofficial, into the problem of maternal mortality; and the recently issued report on British Health Services by Political and Economic Planning, have all in their turn focused public attention on one or other aspect of the health services. The Press, the radio, and the public platform have combined to keep continually before the public as a live and personal issue "The Health of the People." 21. The existing health agencies are different in their origin and inspiration, diverse in their form, and bewildering in their complexity. The State, which forty years ago confined its interest in national health exclusively to the protection of the community from the ravages of infectious disease and the abatement of the grosser dangers to communal health, began in the early years of this century to interest itself in personal health services. In particular it has made forms of provision for the mother and the infant, the school child, and the wage-earner, and for those of all ages who are suffering from certain diseases or defects or who need institutional treatment. The voluntary hospitals, born of religious and humanitarian motives and intended mainly to serve the poor, now minister, with or without State aid, to a section of the community which is, in the great majority of cases, neither destitute nor poor. The services of the general practitioner, formerly available on an individual fee-paying or charitable basis, are now available to nineteen million wage-earners through a State service, and by voluntary co-operative arrangements to another large section of the community. Different services have been estabtished at different times by different agencies with different motives. 22. The State continues steadily to increase and extend its health and sickness activities. But it cannot be said that each new development is an expression of a unified health policy of ordered development. Still less can it be said that the State, in creating new facilities or services, invariably takes steps to ensure a close correlation with parallel non-State or voluntary provision. The result has been piecemeal and fragmentary growth rather than consistent and systematic development. The public is often served by unrelated and competitive agencies. The individual passes from local authority to voluntary body, from consulting room to clinic or hospital, from private to official doctor and often back again, to obtain from many unrelated agencies a service which could be more efficiently provided as one co-ordinated whole. Some services are available to one citizen but not to another in similar circumstances; some serve the citizen at home, while others are prohibited from so doing; some services he obtains at public expense, others he must pay for privately. 23. What is urgently needed to secure co-ordination and co-operation is an integrated national policy on health. The British Medical Association, representing the great majority of doctors in this country, has constantly studied in principle and in detail many aspects of this subject. The Association's Proposals for a General Medical Service for the Nation, first published in 1929, have been widely examined and discussed. As an outcome the Association now submits for the consideration of the public a coherent and inclusive scheme of medical service based on a few simple basic principles. The plan of medical provision which the Association advocates is one that would ensure for all who need it every kind of treatment available for the cure of the sick and prevention of disease and would utilize for this purpose every class of medical practitioner. It is in accordance with the belief and traditions of the medical profession and would have its whole-hearted support. II. GENERAL PRINCIPLES 24. The main basic principles of the scheme are four in number: (1) That the system of medical service should be directed to the achievement of positive health and the prevention of disease no less than to the relief of sickness. (2) That there should he provided for every individual the services of a general practitioner or a family doctor of his own choice. (3) That consultants and specialists, laboratory services, and all necessary auxiliary services, together with institutional provision when required, should be available for the individual patient, normally through the agency of the family doctor.
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