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PART II
PERSONAL HEALTH SERVICES AND INFECTIOUS DISEASE CONTROL
Co-ordination and co-operation with Hospital and Family Doctor Services
The Department of Health has asked for information about co-ordination and co-operation in the tripartite
service.
Hospital Services
The Medical Officer of Health is represented on the Medical Executive Committee of the Tottenham Group
Hospital Management Committee and he serves on the Investigational Department Committee and the Medical
Library Sub-Committee and the Deputy Medical Officer of Health serves on the Group Control of Infection
Committee and the Geriatric Liaison Committee. Medical Officers employed by the Council have an effective
liaison with this hospital and with the North Middlesex and Bearsted Hospitals, especially with the paediatric,
obstetric and audiology departments. In addition, there are special links between the Consultant Dermatologists
and the "Warts Clinic"; with the Consultant Haematologist for the detection of genetic blood dyscrasias in the
interests of safer anaesthesia by the Dental Officers; and links between the Consultant Bacteriologist and the Chief
Public Health Inspector in the best interest of hospital kitchen hygiene. The Chest Physicians are ready to advise
us when tuberculosis is diagnosed in schools; and the V.D. Contact Tracer is in daily contact with the Consultant
Venereologist. Dr. Seidel, the Principal Medical Officer Mental Health, spends more of his time in hospital
since the passing of the Seebohm Legislation. Arrangements have been made for the Council's Midwives to
conduct deliveries of their patients in several Maternity Hospitals which serve the Borough.
General Practitioners' Service
The programme described in the Annual Report in previous years for the attachment of midwives and home
nurses to General Practitioners has been maintained.
A Weekly Bulletin is distributed to all General Practitioners and it carries basic information about infectious
disease notifications and about lectures at Hospital Academic Centres and changes in services, and it is also a
useful medium for the communication of a wide variety of ideas between different agencies of the Health Service
and doctors in general practice.
The improvements most likely to follow the abolition of the tripartite service and the unification of the Health
Service will include better communication between the different branches. Although a Bulletin is not the only
solution, it has an important part to play.
The community physician of the future will have to learn as much as he can about the problems of other doctors
and their patients and improved contact between the different groups of clinicians must take place.
The problems of general practice are not static in time and as I wished to revitalise my personal experience of
general practice I was most grateful to the Chairmen of the Health and Personnel & Management Committees,
Councillor Mrs. Levinson and Councillor Douglas Smith, who agreed that I should take some study leave for this
purpose.
Report on a Period of Leave to Study the likely Relationship between General Medical Practice and the Future
Health Authorities.
I was fortunate in making arrangements with a firm of general practitioners who allowed me to study their
practice and then employed me as a part-time assistant for two days a week in February and March of 1971, and
I was also very glad to spend some time with the duty doctor of the G.P. Relief Service.
There have been considerable changes in general practice since I worked as an assistant in Lancashire about thirty
years ago. In general, diagnosis remains much the same, drug therapy is completely different, the liaison with the
local authority staff is developing slowly and the attitudes and expectations of the public have changed beyond
belief.
General medical practice can be considered from the viewpoint of the patient whose needs may be divided into
three main groups.
1. The doctor as an apothecary
Since the development of the National Health Service the patient has learned to make extensive demands on his
doctor for diagnosis, reassurance and advice, and although diagnosis is often elementary it cannot readily be
delegated. In treating a variety of minor conditions the doctor works in conjunction with the pharmacist and must
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