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ATTACHMENT AND LIAISON SCHEMES
The gradual abandonment of geographical areas of work in favour of attachment to family
doctors is a declared objective of the Department during the next five years. During the year the
Social Services Committee authorised the crossing of administrative boundaries between Local
Authorities where this would assist the care of individual patients.
There is one full attachment scheme in the Borough; two health visitors, a home nurse and
a midwife work with a group practice of four doctors. Another practice of two doctors has an
excellent liaison with the community services; a health visitor visits the surgery once a week for
discussions and instructions, and a midwife attends the practice ante-natal clinics. At one other
surgery the midwife attends the ante-natal clinics and in five other practices a home nurse attends
the surgery daily, but visits patients on a geographical basis.
The process of attachment of community nurses to family doctors' practices continues but
depends upon the availability of nursing staff. It is easier in the case of midwives and home nurses
to carry out treatment as opposed to the provision of an advisory service. It is necessary for the
functions and potentialities of a health visitor to be fully understood before her services can be
used most effectively in group practice. It must also be remembered that she may appear to increase
the doctor's work instead of reducing it by uncovering the previously submerged portion of a
family's problem.
LIAISON BETWEEN HOSPITAL
AND LOCAL AUTHORITY NURSING SERVICES
There is considerable co-operation between the hospital and community services especially
in nursing education. During their basic general training student nurses from the Hillingdon, and
Harefield and Mount Vernon Schools of Nursing receive lectures from the Health Department
medical and nursing staff; they also pay visits to various Local Authority establishments, and
accompany community nurses on their visits. In addition students taking domiciliary midwifery
training and integrated health visiting or district nursing training undertake practical work in the
Borough under the supervision of qualified staff within the Health Department.
The General Nursing Council has revised the syllabus for nurse education and its recommendations
in 1969 included an increased proportion of training in community nursing. Discussions
continued between the Hospital teaching staff and the Health Department staff concerning the
best methods of implementing the new syllabus. The final results will be to the benefit of the
student nurse but will increase the teaching responsibilities of qualified nursing staff working in
the Department.
DOMICILIARY MIDWIFERY SERVICE
The number of domiciliary deliveries has remained steady and has allowed pupil midwives
on the district to carry out the full number of deliveries under supervision required by the Central
Midwives Board.
The scheme described in the 1969 report (page 33) whereby selected patients are delivered
by domiciliary midwives in the Duchess of Kent Maternity Wing has continued. 68 women were
delivered under this scheme during the year.
Midwives have been able to perform episiotomy on patients if necessary, but only this year
have they been permitted to use a local anaesthetic for this purpose. This is a considerable addition
to the comfort of the patient in labour and its introduction in this area has been widely welcomed.
The midwifery establishment consists of the Non-Medical Supervisor of Midwives, her
Deputy and 22 full-time midwives.
DOMICILIARY NURSING SERVICE
It has become obvious during the year that the work load is now too heavy to be carried by
the present level of staffing. The natural desire to stay in familiar surroundings wherever possible,
especially during illness or incapacity coupled with the policy of early discharge from hospital in
order to use expensive resources most economically is resulting in a rapid increase in domiciliary
case loads.
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