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Appendix IX.
APPENDIX IX.
General Terms oF Agreement with Hospitals, Committees op Medical Practitioners, and
Nursing Associations for the Treatment of the Several Ailments included in the
Council's Scheme:—
The following are the conditions and terms of the agreements between the Council and hospitals
for the treatment of eye, ear, nose and throat defects and of ringworm in the administrative county of
London—
(i.) No cases shall be received for treatment by the hospitals except such as are found on inquiry to be from
their circumstances and the nature of their disease suitable for special hospital treatment.
(ii.) The hours of attendance shall be made to suit the convenience of the hospital, but special arrangements
shall be made within the hospital for passing the children through the routine of the hospital apart from the arrangements
made for dealing with other out-patients.
(iii.) Any assistants appointed for the work shall be fully qualified, and shall be appointed by and be under the
sole control of the governing body of the hospital. They shall devote the whole of the time for which their services
are paid for by the Council to the work of dealing with children referred to the hospital by the Council.
(iv.) Each clinical assistant shall be required to deal with twelve new eye cases or twelve new ear, nose and
throat cases (viz., a total of approximately 500 children a year), or two new ringworm cases (viz., a total of 88 children
a year), a half-day of not more than three hours in addition to such old cases as he may have instructed to attend for
further treatment. An anesthetist shall be allowed in ear, nose and throat cases on one half-day a week for each
1,000, or part thereof, children agreed to be treated at the hospital.
(v.) A payment by the Council of £50 a year for each clinical assistant or anaesthetist working one half-day
a week, and a capitation fee of 2s. for eye, ear, nose and throat cases, and 7s. for the treatment of ringworm
cases by means of X-rays shall be accepted by the hospital in full discharge of any extra expense incurred by them.
The capitation payment for the treatment of ringworm by means of ointment or lotion shall be 2s. Any payment
made by the Council for the services of medical staff shall be paid proportionately to the doctors doing the work.
(vi.) No payment given shall entitle the Council to representation on the governing body of the hospital nor
to interference in any way with the work of the departments concerned, but the hospital shall allow the attendance
of an officer of the Council at the hospital for the purpose of regulating the attendance of the children and of supplying
to the Council such particulars as will enable the Council to ensure that every child referred to the hospital shall
continue in attendance at the hospital until discharged, and that any home treatment or spectacles ordered by
the hospital doctors are satisfactorily provided.
(vii.) Each child patient shall be taken to the hospital by the parent or guardian or other responsible person
and the prescription in each case shall be given to the child or its parent. Medicines or drugs required for the treatment
of the special defect for whch children are referred to the hospital shall be supplied by the hospital to the
patient free of charge. In oases in which spectacles are prescribed and children are referred to a particular optician,
the prescription card shall contain a staetment of the prices charged for the spectacles.
(viii.) Each child patient referred to the hospital by the Council shall present at the hospital a card issued
by the Council, directing the child named thereon to attend the hospital on a specified date, which shall be handed
to the hospital authorities by the person presenting the child. The card shall be the voucher for the capitation
payment.
(ix.) The hospital shall, if required by the Council, certify whether a child patient is fit to attend school during
the treatment.
(x.) Agreements shall be for one year, and shall be subject to annual revision and to termination at the end
of each year by three months' notice on either side.
The following are the conditions and terms of the agreements between the Council and the committees
of local medical practitioners formed for the establishment of medical treatment centres in the
administrative county of London—
(i.) The committee of medical practitioners shall provide a medical treatment centre in a central position in
premises to be approved by the Council, for the maintenance of which the committee of medical practitioners shall be
responsible. Administrative control of the arrangements for supplying the centre with patients, " following up "
and generally the supervision of the work of the centre shall be vested in the Council. The centre shall be available
without extra payment by the Council for use in connection with the Council's system of medical inspection of
school children and for the further examination of children.
(ii.) The classes of cases to be dealt w th at the centre shall, unless otherwise arranged, include eye cases for
errors of refraction, ear, nose and throat cases requiring operation, ringworm oases for X-rays treatment, and minor
ailments, including discharging ears, external eye diseases, such as blepharitis and conjunctivitis, skin disease
such as impetigo and sores, and such other conditions as require the daily services of a nurse, and arrangements shall
also be made for home visits by district nurses after operations for adenoids, tonsils, etc.
(iii.) No cases shall be received for treatment by the committee of medical practitioners except such as are
found on inquiry to be from their circumstances and the nature of their disease suitable for treatment at the centre.
The committee of the centre reserve to themselves the right to refuse treatment in any particular case.
(iv.) The hours of attendance shall be made to suit the convenience of the children and of the committee,
(v.) The medical staff appointed for this work shall be selected by the Council from nominations received from
the local medical practitioners. The dootors shall devote the whole of the time for which their services are paid for
by the Council to the work of dealing with children referred to the centre by the Council. Each doctor shall be required
to deal with an average of ten new eye (refraction) cases or ten new ear, nose and throat cases each half-day of
two and a-half hours (viz., a total of 440 oases a year), in addition to suoh old cases as he may have instructed
to attend for further treatment. An anaesthetist shall be allowed in the ear, nose and throat department on one halfday
a week for each 880, or part thereof, children agreed to be treated at the centre. Doctors appointed to deal with
ringworm cases shall treat two new oases a half-day (viz., 88 cases a year), except where any inclusive capitation
payment is made. Doctors appointed to deal with minor ailments shall see 15 new cases a session (660 a year).
(vi.) A payment by the Council of £50 a year for each medical practitioner or ansesthetis working one half-day
a week, and a capitation payment of 2s. for eye (refraction), ear, nose and throat cases, of 7s. for X-rays treatment
of ringworm cases, shall be accepted by the committee in full discharge of any expense incurred by them. For the
treatment of minor ailments, the capitation payment shall be 4d., which shall be accepted by the committee of
medical practitioners as covering the full cost of dealing with these cases, including the provision of the medicine and
drugs necessary for the treatment at the centre. The capitation payment [with the exception of that for minor
ailments] shall be made upon the number of cases arranged to be treated, whether or not that number actually attends
the centre. This payment shall be made quarterly in advance about the middle of the quarter. In the first year a
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