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Doubtless, if and when a new charter for general practice gives financial
encouragement to family doctors to undertake such tests, the pattern of
relationship will be altered. Exploratory work on the possibility of district
nurses also undertaking the work on a domiciliary basis is being pursued. It
may well be that, as elsewhere, those women greatest "at risk" will not attend
either their own doctor, or clinics, for these pre-sijmptomatic diagnostic
procedures, but, domiciliary visiting by accepted trained staff will cover
these groups, once more, in this sphere the limiting factor is the availability
of trained technicians to read the slides.
By arrangement, the local family planning clinics have been brought into
the scheme, so that continuity of re-testing every three years is maintained .
Future Plans
The ten-year development programme for the health services is outlined
on page 68 . This is subject to annual review, and, as has been made clear
this year,to financial sanction if the state of the economy requires restraint
on public sector expenditure. Envisaged is a programme of construction of
purpose-built training centres, and clinics, to replace some older premises.
With the building of one such clinic in a large redevelopment area it is hoped
to include premises for a group general practice. Much discussion and planning
will precede any realisation but auguries for the future appear good .
Combinations of general practices having closer links with local authority
services must be the pattern for the future in this area. Recently there has
been evidence of an encouraging change in the attitude of some practitionersmany
younger doctors perhaps see less to fear in such a setting?.
The need for new Centres in the mental health field is accentuated by the
growing emphasis on increased community care, both for the mentally ill and
the subnormal patient. With fairly long waiting lists for long-term hospital
care for the severely subnormal, special care units have been set up attached
to day nurseries for the under five's,and in training centres for the over
five's. To relieve the burden on parents, particularly of children with
multiple handicaps, these provisions are to be expanded. Special transport
facilities are required for this category. There will remain some severely
subnormal patients, with other handicaps, for whom community care centres
(as we know them) will not offer a reasonable alternative to hospital care,
If a local hospital could provide" day hospital" facilities, as given for the
mentally ill; these children could be cared for adequately at home by night,
and during the weekend. Whatever the solution, such special units will be
expensive to run partly due to the large staff-to-patient ratio. It is heartwarming
to see what is being achieved to aid these children by a limited staff
working under adverse conditions and with a paucity of facilities,thus helping
the parents carry an otherwise intolerable burden on their family whilst often
also coping with normal children.
8.