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the development of close working relationships. The Local Medical Committee is always
consulted before new arrangements are made with general practitioners and, in particular,
all proposals for use of Council premises by general practitioners (and general practitioners'
surgeries by the Council) or of allocation of local authority staff (health visitors, midwives,
district nurses, social workers) to general practitioners.
General practitioners are employed in the Council's health services on a sessional basis
for many types of work, e.g., ante and post-natal, child welfare, vaccination, immunisation
and in the school health service. At the request of the Local Medical Committee, they are
not employed within their area of practice.
Free facilities are provided in the Council's ante-natal clinics for general practitioner
obstetricians to see their own booked maternity patients and others with the consent of
the booked doctor concerned. The Local Medical Committee preferred this arrangement
to the allocation of domiciliary midwives to surgeries of general practitioner obstetricians.
The health visitor and general practitioners—Meetings with general practitioners have
been arranged locally at which the part of the health visitor was given prominence and the
wide range of her duties stressed. The fact that there are only some 400 health visitors in
London and over 2,200 general practitioners on the Local Medical Committee's list limits
the amount of effective help which the health visitor can give. Co-operation is very fruitful
in dealing with the medico-social problems of families where difficulties do not come
singly: the family doctor plays his part by giving treatment and influencing the family to
accept specialised local authority services and to follow the skilled guidance of the health
visitor. In some instances, especially where a group practice is concerned, it has been
possible to set aside a regular time each week when a health visitor would call at the surgery
to talk over such cases with the practitioner.
Where attendances justify it, a health visitor is allotted to attend child welfare sessions
provided by practitioners in their own surgeries. A condition is that the practitioners are
willing to complete all appropriate maternity and child-welfare records and make them
available as required. In addition, general practitioners doing child-welfare work should
be willing to co-operate in the application of new trends in child-welfare introduced into
the Council's own clinics, e.g., developmental diagnosis and routine screening tests of
children 'at risk' of congenital handicaps; preventive mental health in the child welfare
service. It is thought possible in these circumstances that the health visitor may gradually
come to be based on the list of families registered with the practice, such families being
withdrawn from the care of the district health visitors. The attendance of a minimum of
ten children per session is thought to justify the allocation of a health visitor to an infant
welfare session at a general practitioner's surgery.
Social work with families
Special mention must be made of the tremendous changes that have taken place in
social work with families. Up to the end of the War the social services had been deployed
mainly to serve the needs of the individual, with an emphasis on physical needs and the
improvement of environmental conditions. The measures of social legislation passed after
the War—the Family Allowances. Act, 1945, the National Health Service Act, 1946, the
National Insurance and the National Insurance (Industrial Injuries) Acts, 1946, the
Children Act, 1948 and the National Assistance Act, 1948—changed the pattern of social
and welfare services and made available to all without distinction the benefits of these
new services. The new services, coupled with general advances in living standards and
education, brought into sharp relief the problems of a minority of families who appeared
not to be benefiting from the new legislation and showed that now the need was for family
casework and not casework with the individual in isolation from his family. Increasingly
it became clear that such families' problems needed to be considered as a whole and services
deployed in an integrated way if proper use was to be made of them.
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