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77
the clinic doctors become known to the general practitioners. We
are very insistent that there should be this close contact on a
clinical basis.
Co-ordination of effort also shows itself in the sphere of the care
of the aged. From time to time, a senior medical officer of the
Health Department is called upon to visit the homes of old persons,
at the request of general practitioners, to advise on suitability
for care in a hospital geriatric unit and this also calls for consultations
with the hospital geriatricians.
The nursing of patients in their own homes is carried out by
home nurses under the direction of the family doctor. The initial
request for nursing care may come from the family doctor or it
may be arranged by a hospital prior to the patient being discharged
home. In the latter case the family doctor is informed.
Home nurses are encouraged to discuss their cases with the family
doctor whenever necessary.
All midwives work closely with the general practitioner obstetrician
booked for each case. It is not possible to attach midwives
to the practice of a particular general practitioner obstetrician, but
a eroup of midwives tend to work mainly with a limited number
of general practitioner obstetricians and they get to know each
other well. With a decreasing number of home confinements the
midwives are now working over larger areas and may have to
work with an increasing number of doctors. Two midwives regularly
attend ante-natal clinics in doctors' surgeries and one general
practitioner obstetrician attends his own ante-natal cases in one of
our centres. All midwives use the ante-natal co-operation cards on
which both doctor and midwife keep their records.
The health visitors in Wandsworth work in decentralized groups
with headquarters at clinics in various parts of the Borough. The
general practitioners are aware of this and every insistence is
placed on health visitors in the group getting to know and work
closely with the family doctors practising in the particular area
of their group. This applies to work in the infant welfare clinics
as well as in the schools. In this way, continuity of contact is
maintained since although the individual health visitors may
change, the group remains a fairly static unit. From time to time
also, apart from the purely professional contacts, health visitors
in a group organize an "at home" at the clinic with modest
refreshments, to which other health workers, including general
practitioners, are invited and this again helps to foster good
relationships.
Very considerable thought has been directed to those more
formal attachments, to which a great deal of publicity has been
given. In theory, this is an excellent innovation and in some parts
of the country has apparently proved successful and where general
practice is conducted on a group basis, undoubtedly to be actively
encouraged. Thus, in predominantly rural areas or self-contained