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HEALTH DEPARTMENT,
ELMFIELD HOUSE,
HIGH STREET,
TEDDINGTON,
MIDDLESEX.
June, 1967.
To the Mayor, Aldermen and Councillors of the
London Borough of Richmond upon Thames.
LADIES AND GENTLEMEN,
I have the honour to submit my Annual Report for 1966.
The evolution of the health department is now such that the end of the beginning
is in sight. The process of blending and crystallization has continued. In fact the first
tentative steps in controlled expansion are taking place.
There are two complementary trends in the field of community medicine. On the
one hand the working relationships between the family doctor and local authority health
staff are becoming closer. On the other the further development of screening techniques
in the early detection of disorder and the presymptomatic diagnosis of disease is
apparent.
If the premise is established that the family doctor is the personal medical attendant
to a family, then the practitioners and personnel of community medicine must be closely
associated. In passing, the practical definition of a family should be one individual
sitting at a table, thus the elderly and the lonely are not excluded. This liaison and
creation of the family health team can be brought about in a number of ways, depending
on history, ecology, personalities and attitudes.
The prime point of contact is in the patient's own home, and your nursing staff
and family doctors have been working in this locus for many decades. The next logical
step is that health visitors, district nurses and midwives collaborate on socio-medical
matters in the family doctor's surgery. Every request from medical colleagues for such
association has been met, but to my mind there are two limiting factors : the availability
of staff; and the personalities of individuals concerned. The team must co-operate
harmoniously to be effective. Eleven such liaison arrangements have been made.
The family doctor can work in local authority premises for specific services, e.g.
ante-natal care, child welfare and possibly the elderly. Two groups of doctors attend
Essex House Clinic, Barnes, for ante-natal care in collaboration with the district midwife
and health visitor. Negotiations were initiated during the year for possible general
medical services from a clinic, e.g. Ham Centre. Further discussions were taking place
for the ultimate in this field of co-operation — the Health Centre. You have two
schemes in mind, the adaptation of Essex House, Barnes, and the Twickenham Health
Centre, possibly in the grounds of St. John's Hospital, Twickenham. The latter project
is exciting in that all three branches of the National Health Service would be on the
one campus. By the same token it is to be hoped that the proposed Teddington clinic
will be within the curtilage of Teddington Hospital.
Screening techniques for the early detection of disorder and the presymptomatic
diagnosis of disease have been steadily built-in to local authority services over a number
of years. The very essence of the School Health Service depends on this concept, and
the expansion of sweep testing for vision and hearing defects is the latest example.
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