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78
communities in small urban districts, attachment offers great scope.
In thickly populated, highly urbanized centres of population where
the pattern of life is more impersonal, the difficulties are many,
and these are the conditions found in Inner London. From careful
investigations we have from time to time conducted in Wandsworth,
the conclusion has been reached that with the present predominant
pattern of general practice, it is not practicable to arrange for
secondment of staff, except on a minimal scale. This is because of
the very " patchwork " structure of general practice. Thus, there
is in Wandsworth a large number of single-handed practitioners
and comparatively few large groups of practitioners working in
group practice. The result is that one finds that in any one of
the densely populated, thouch territorially small, areas of the
Borough, many general practitioners may have patients. In other
words, it is unusual for there to be any heavy concentration of
patients attached to any one doctor in any one locality. Indeed,
this pattern is found in some of the large blocks of flats which
have gone up and it is not uncommon to find quite a large number
of doctors from different practices with patients on their lists from
one single block of flats. Under these conditions, it has been concluded
that it would not be feasible to attach health visitors, midwives or
home nurses to any one practice, still less to any one doctor. To
do so would be impracticable from the work organization point
of view, apart from its being extremely uneconomic in terms of
staff time. Reluctantly, therefore, we have decided that while these
ideas are forward-looking and may be the norm in the future,
there are no opportunities in Wandsworth to put them into practice.
We must await more group practices, more partnerships and possibly
a more circumscribed area of practice, although this latter
is probably the most difficult to achieve.
Nevertheless, all health visitors work in close co-operation with
the general practitioners in their areas and most health visitors
find that they make fairly frequent contact with from 10-14
doctors. While attachment of health visitors to a particular group
practice has not as indicated above been possible, one health
visitor does most of the work arising from one group practice.
This practice mainly covers a very limited geographical area and
has been found suitable for this type of liaison for it is not practical
to have health visitors travelling over large areas to visit
the families on the list of one particular practice. The health
visitor is responsible for visiting the children of all the mothers
on the lists of these three doctors and these families comprise about
one half of her cases. Any families which live right outside this
area are passed over to the health visitor for that area. In fact,
this group of doctors keep in touch with the whole group of health
visitors in that area and realise that they benefit by being able to
call on the services of several health visitors from time to time.
In another area one health visitor regularly visits a group practice
each week.