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Proposals are being considered for the provision of a General Practitioner Unit at Central Middlesex
Hospital and it is envisaged that the domiciliary midwives will participate in the scheme in the very near
future.
Refresher Courses
Two midwives attended refresher courses during the year to comply with Section G.1 of the Rules
of the Central Midwives' Board which require every practising midwife to attend a residential refresher course
every five years.
Pupil Midwives
A total of 20 pupil midwives were accepted for Part II district training from St. Mary's Hospital,
Harrow Road, W.9, and Central Middlesex Hospital.
As a result of the continuing decline in domiciliary bookings with its adverse effect on the training
of pupils, i.e. insufficient cases to meet the requirements of the Central Midwives' Board, a revised scheme
of training was approved by the Board. As from 1st November 1968, the number of cases delivered by pupils
was reduced from 10 to 6, an additional 4 patients to be delivered within the hospital during the intern part
of the training. In addition to complying with the Rules of the Board, a programme of talks and visits was
arranged extending over the 13 week period of domiciliary training. At the request of the Board the programme
was planned to give pupils a broad outline of community care, with a composite picture of the
work of the Local Authority as it affects community care generally and the maternity services in particular.
48 Hour Discharges
Six hundred and ten patients were discharged from hospital before the tenth day, compared with
469 in 1969. The majority were planned for early discharge, others were accepted on account of emotional
disturbances and domestic difficulties, and a number took their own discharge. One part-time midwife is
employed solely for the nursing of early discharges, assisted by full-time midwives acting in the capacity
of maternity nurses.
HEALTH VISITING
Under the National Health Service Act 1946, the Council makes provision for health visitors to
visit persons in their own homes for the purpose of giving advice on the care of expectant and nursing
mothers; young children; persons suffering from illness; and the aged. The health visitors hold the joint
appointment of school nurse as part of the integration of the School Medical and Health Services. In addition
to attendances at clinic sessions, her other duties include health education to groups in health clinics,
schools and to voluntary organisations. Clinic nurses are valuable aides to the health visitors and relieve in all
routine clinic and school work.

This year saw the attachment of health visitors to four general practices, one outside the Chalkhill
Health Centre and three to practices now operating from within. Liaison schemes are in operation elsewhere.
Attachment to hospital Diabetic and Geriatric Units has proved valuable to both hospital and
Council staffs, and provided a more personal service in patient-care.
Study days are shared with hospitals and health visitors attend paediatric rounds at Kingsbury
Maternity, Edgware General and Central Middlesex Hospitals. Health visitors have been invited to Case
Conferences at Mount Vernon Hospital and Northwick Park Hospital.
Refresher Courses
Three health visitors attended refresher courses and the Superintendent Health Visitor attended the
final weekend follow-up course on Management at Lady Margaret Hall, Oxford.
In-Service Training
The Group Adviser, who also holds a Tutors' Certificate, has been responsible for the instruction
of staff in birth control methods. In this way trained staff have facilitated the rapid expansion of Borough
birth control clinics.
Other training is included on page 9.
DISTRICT NURSING
Under Section 25 of the National Health Service Act 1946, it is the duty of every local health
authority to provide nurses for persons who require nursing in their own homes. The establishment of nurses
is 49 plus 2 State Enrolled Nurses. The nurses work in close liaison with general practitioners and hospital
staff. Facilities have been given for senior student nurses in general training to accompany the Council's
nurses on their rounds.