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(2) Cost
Extra staff and travelling may increase the costs but some balance may be effected by the
use of auxiliaries on a more static basis. The trend towards more hospital confinements will
eventually have a reducing effect upon the local health authority costs as also will be tendency
of some general practitioners to restrict their practices to smaller areas.
(3) Organisation
(a) Complete re-arrangement of areas will be involved in full attachment schemes.
(b) The work load of the nursing staff will be greater and at the same time more selective.
By wider use of the skills of qualified local authority nursing staff, doctors will be relieved of
tasks inappropriate to their role.
(4) Patients
A recent survey showed that patients' reactions were generally favourable.
(5) General Practitioners
There is evidence that growth in partnerships may be paralleled by growth in attachments.
Conversely it is possible that the provision of attachments might promote group practice or
even the demand for health centres.
SCHEME PREPARATION
After initiat discussion with the Local Medical Committee, the Acting Medical Officer of
Health would communicate with the general practitioners of the area to explain the scheme and to
ascertain the likely degree of response. At first it might be advisable to extend the liaison schemes
as a preliminary to full attachment. Surgery office facilities and receptionist arrangements would
require investigation and detailed discussion on the working of the schemes would have to take
place. Attachment would never be so complete as to preclude central control of the staff by the
local health authority through the Medical Officer of Health who would retain the right for
example, to select staff, make boundaries, prescribe certain duties connected with child health,
health education and student training and determine the feasibility of proposed attachment
schemes. Initial caution is advisable, however, and the possibility of some degree of reorganisation
with a modest increase of staff and costs should be realised.
Approval was given in principle to the attachment of local health authority nursing staff to
general practices in the Borough in those cases where the Acting Medical Officer of Health
considered it appropriate, wherever possible the existing form of liaison to be extended. The
Acting Medical Officer of Health, in conjunction with the Local Medical Committee and the
general practitioners, to ascertain the demand for attachment of nurses to practices in the Borough
and prepare a scheme for consideration by the Committee.
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