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APPENDIX 'A'
NURSING ATTACHMENTS TO GENERAL PRACTICE
The Acting Medical Officer of Health reported as follows to the Social Services (& Children's)
Committee on 29th June, 1970
Attachment of local health authority nursing staff to general practice is a concept now
applied on a wide scale. The three main types of nurse — health visitor, midwife and district nurseare
involved. Hitherto in Bexley only the co-operative type of attachment has been practised
although in one practice a Type III attachment (see below) has been tried.
The geographical allocation of nursing duties does not usually favour the introduction of
schemes of attachment and indeed this has been one of the difficulties in the Bexley area. The
Council's policy of the development of health centres is not prejudiced in any way; if anything
the scheme of attachment might be expected to aid that development or at least be complementary
to it.
TYPES OF ATTACHMENT
I. Full attachment to specified practices with provision of local health authority services
exclusively to those practices. A qualified full attachment would apply when a health
visitor retains a geographical district for some particular purpose such as school health
work.
II. Partial Attachment
(a) Schemes of full attachment to specified practices but also involving traditional
arrangements with other practices.
(b) As in (a) except that when patients live outside the nurse's area, she is responsible
for liaison between the general practitioner and the appropriate nurse.
III. Association. Geographical areas are maintained but regular contact is made with
specific general practices, e.g. by staffing general practitioner clinics.
IV. Co-operation. Informal meetings or contacts are made when there is a need to exchange
information.
Possible effects on:—
(1) Manpower
In a recent survey (D.H.S.S. 1969) some increase in staff was involved in a proportion of the
schemes due to increased travelling, surgery time, more follow-up work, earlier referral of
more seriously ill patients, and an increased amount of borderline chronic work. On the
other hand recruitment of staff was said to have been improved by virtue of these schemes.
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