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3. Hospital and Consultant Services.
(a) It will be the duty of the joint authorities themselves to secure a complete hospital and consultant service
for their area—including sanatoria, isolation, mental health services, and ambulance and ancillary services
in accordance with the approved area plan.
(b) The joint authorities will do this both by direct provision and by contractual arrangements with voluntary
hospitals (or with,other joint authorities) as the approved area plan may indicate.
(c) The powers of present local authorities in respect of these services and the ownership of their hospitals
will pass to the joint authority.
(d) Voluntary hospitals will participate, if willing to do so, as autonomous and contracting agencies ; if so,
they will observe the approved area plan, and certain national conditions applying to all hospitals in the
new service alike ; they will perform the services for which they contract under the plan, and receive
various service payments from both central and local funds.
(e) Special provision will be made for inspection of the hospital service through centrally selected expert
personnel.
(/) Consultant services will be made available to all, at the hospitals, local centres, or clinics, or in the home,
as required ; they will be based on the hospital service, and arranged by the joint authority, either
directly or by contract with voluntary hospitals under the approved area plan.
(g) Measures for improving the distribution of consultants, dealing with methods of appointment and
remuneration, and relating the consultant service to other branches of the new service generally, will
be considered after the report of the Goodenough Committee.
4. General Medical Practice.
(a) Everyone will be free, under the new Health Service, to choose a doctor—the freedom of choice being
limited, as now, only by the number of doctors available and the amount of work which each doctor
can properly undertake.
(b) Medical practice in the new service will be a combination of grouped and separate practice.
Grouped practice means practice by a group of doctors working in co-operation.
Separate practice means practice by a doctor working on his own account—broadly similar to practice
under the present National Health Insurance scheme, but with important changes.
(c) Grouped practice will be conducted normally, though not exclusively, in specially equipped and
publicly provided Health Centres. In England and Wales the Centres will be provided and maintained
by county and county borough councils.
(id) General practice in the National Health Service will be in the main organized centrally under the responsible
Health Minister. All the main terms and conditions of the doctor's participation will be centrally
settled, and much of the day-to-day administration will be the function of a Central Medical Board—
largely professional in composition, and acting under the general direction of the Health Minister.
(e) The main duties of the Board will be :
(1) To act as the "employer" of the doctors engaged in the public service. Thus, the Board will
be the body with whom every doctor will enter into contract. In the case of practice in Health
Centres in England and Wales, however, there will be a three-party contract between the Board,
the local authority and the doctor.
(2) To ensure a proper distribution of doctors throughout the country. For this purpose the Board
will have power to prevent the taking over of an existing public practice or the setting up of a
new public practice in an area which is already " over-doctored."
(/) It is not proposed that there should be a universal salaried system for doctors in the new service. Doctors
engaged in Health Centres will be remunerated by salary or the equivalent ; doctors in separate practice
normally by capitation fee. In some cases, e.g., grouped practice not based on a Health Centre,
remuneration by salary or the equivalent could be arranged if the doctors concerned so desired. Rates
of remuneration will be discussed with the medical profession.
(g) It is not proposed to prohibit doctors in public practice from engaging also in private practice for any
patients who still want this. Where a doctor undertakes private in addition to public practice, the number
of patients he is permitted to take under the National Service, and consequently his remuneration,
will be adjusted.
(h) Young doctors entering individual practice in the public service for the first time will normally be required
to serve for a period as assistants to more experienced practitioners, and the Board will be able to require
them to give full time to the service if necessary.
(j) Compensation will be paid to any doctor who loses the value of his practice, e.g., by entering a Health
Centre or because he is prohibited from transferring the practice to another doctor on the ground that
there are too many doctors in the area.
Superannuation schemes will be provided for doctors in Health Centres and the possibility of providing
them in other forms of practice will be discussed with the profession, and the practicability of abolishing
the sale and purchase of public practices will be similarly discussed.
(k) Arrangements for the supply of drugs and medical appliances will be considered and discussed with the
appropriate bodies.
5. Clinics and Other Services.
(a) It will be the duty of the joint authority to include in its area plan provision for all necessary clinics and
other local services (e.g., child welfare, home nursing, health visiting, midwifery and others), and to
provide for the co-ordination of these services with the other services in the plan.