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Interchange of information between general practitioners and the home nursing service—
There are two entirely distinct but equally important aspects of the interchange of information
between these two services. One relates to the availability of local health authority
services and how they can be obtained. This is covered by the issue from time to time of an
information booklet to, among others, all general practitioners in the county, with a local
appendix which gives details about the services in each division. In the same way and in
the same format the Welfare department issues information on the welfare services for the
handicapped.
The other aspect covers the means of direct communication between the family doctor
and the nurse on individual cases. Here the traditional pattern persists. The doctor
establishes communication by telephone with the nurse at the district home or office and
leaves written instructions on the case at the patient's house. The nurse enters her report
on the same sheet. The old method of leaving notes in local shops has, however, completely
disappeared.
In all associations every case must be nursed under the care of a general practitioner
and not more than two visits of observation may be paid before a doctor is called in.
Each nurse is now responsible for her own case records on standard cards, which were
designed in 1957 by the Public Health department in consultation with the Central Council
for District Nursing.
The changing pattern of home nursing—What are the salient changes in the work of the
home nurse during the last thirty years? In the first place she now serves all sections of
the community, in contrast to her predecessor in 1931 who provided nursing mainly for the
sick poor—'and only in exceptional circumstances, as when a doctor made a very special
request for the services of a certain district nurse, did a district nurse attend a patient able
to pay the usual five shillings a visit for a private nurse'. Another important change
brought about by the National Health Service Act, 1946 has been the gradual breaking
down of the isolation of the home nurse and the recognition of her place with the health
visitor, the midwife and the home help in the local authority team. This integration has
been helped by the fact that the divisional medical officer is a member of the committees of
the district nursing associations in his area and by the setting up of divisional home nursing
committees. In 1955 the Council also appointed a supervisor of midwives with special
liaison duties in connection with the home nursing service. A principal medical officer and
the Chief Nursing Officer sit as observers on the executive committee of the Central
Council for District Nursing in London.
In a service so largely financed from public funds the home nurse has been able to draw
readily on up-to-date equipment, unlike her predecessor in 1931 who often spent hours
on the improvisation of containers, making of bags, etc. In the past, too, the home nurse
had to depend solely on voluntary resources for many essential needs of her patients. In
an era of full employment, patients are better housed and in the main are able to provide
for themselves the linen, blankets and even food which once the home nurse had to try to
bring to them. However, the demand for specialised nursing equipment to be used in the
patient's own home has, if anything, increased with the growing complexity of medical and
nursing procedures. The Council makes grants for this purpose to the British Red Cross
Society, which maintains medical loan depots in certain parts of London. At the request of
the family doctor, the Council also supplies hoists and other lifting aids, wheel-chairs,
cardiac beds, walking aids, etc., free of charge. A nominal deposit (returnable) is required
for each article borrowed.
A permanent exhibition of gadgets and other aids for the handicapped is maintained
by the Welfare department of the Council and is open to all general practitioners, Council's
staff or relatives of handicapped persons for advice and guidance on the supply or making
of these aids. In addition, adaptations and special fittings have been installed in patients'
homes by the Welfare department.
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