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programming may render them invaluable.
The child is father to the man and therefore a
good paediatric, student health, occupational
health and family health service should ensure
at a later stage a healthier mind and body in
retirement and in old age. Nevertheless the care
of the old needs much further thought. With the
compilation of age/sex registers, greater
administrative support and the aid of health
visitors and social workers the general
practitioners will know the vulnerable groups
such as the elderly on their lists and be in an
improved position to prevent or ameliorate many
of their difficulties and ailments. There is still,
however, much to be said for the consultative
clinic especially orientated for the elderly where
their particular problems can be discussed in a
leisurely fashion befitting the dignity of their age.
In Hounslow the health committee and the
council have agreed in principle to the proposed
setting up of such clinics in close consultation and
liaison with the local practitioners, local medical
committee, local consultant geriatricians and the
Regional Hospital Board. Later in the main
report Mr D M Fleet, the borough's chief
welfare officer, gives an account of the rapidly
extending services his department is now able to
provide for the elderly and the adult handicapped.
A comprehensive report on the borough service
for the mentally ill is to be found in my 1965
annual report.
It is my feeling, therefore, that ultimately
specialisation within group practices in health
centres will be as inevitable as specialisation has
become within hospital practice. The previous
discussion has shown that it may well be
preferable for some doctors within the group such
as those dealing with handicapped school children,
in general, students, epidemiology and possibly
Field staff
geriatrics to remain on a salaried basis as is at
present the case for local health authority and
hospital doctors; but it would appear to many
that it remains essential for family doctors as a
whole to retain their present basis of payment as
independent contractors both to ensure their
choice of patient and the patient's choice of
doctor.
Health Centre Practice
Over 50% of the family doctors in the borough
have indicated their wish to practise in health
centres and the health committee with the full
support of the Council have responded by giving
considerable priority to the building of these
centres as indicated in the Department of Health's
ten year programme.
So in Hounslow one may now envisage the
setting up of multi-disciplinary teams in health
centres in much the same way as such teams have
already become an accepted feature of hospital
and local health authority work. During this
transitional phase we feel sure that the remaining
doctors who wish to continue to work in their
existing well established practices will ensure
continuity and balance in the provision of
medical care in concert with their colleagues in
health centres. These doctors may be assured that
the local health authority for its part will continue
to give equal support and help to all doctors
regardless of whether they work in health centres
or not.
In relation to doctors with average lists of 2,500
the suggested relative sizes of the practices of the
appropriate local authority paramedical and
ancillary staff are given below. From these figures
the total establishment in present circumstances
may be formulated for such field staff in a local
authority of 250,000 people. Such an ideal
establishment is not however easily attainable.
Establishment
Ratio of staff to population
Health visitors 1: 5,000 (500 children under 5) 50
Home nurses 1: 6,000 (district and surgery) 40
Midwives 1:14,000 (55 cases per year) 18
Social workers 1:20,000 (Medico-social and mental health) 12
Home helps 1:1,000 250
The above field staff would work in and from health centres in close and harmonious
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