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25
SECTION 21
HEALTH CENTRES
(by A. Shaw, M.B., B.S., D.P.H.,
Deputy Medical Officer of Health)
Development of
the Health
Centre Concept
The Act lays upon local health authorities the duty to
provide, equip and maintain health centres for all or any of the
following services: general medical services, general dental
services, pharmaceutical services, any of the services which
the local health authority is required or empowered to provide,
and specialist services. The idea of Health Centres was
hinted at by Beatrice Webb in 1918, but it was not until 1920
that definite proposals were put forward by a British Medical
Association Committee headed by Lord Dawson of Penn. Lord
Dawson's Committee, which reported on the future provision of
medical and allied services, recommended that personal health
services should be provided by primary and secondary health
centres. The primary health centres were to be staffed by
general practitioners and were to offer preventive and curative
services; the secondary health centres were to be hospitals
with consultant staff.
These proposals were shelved for 22 years and then revived
in a modified form by the Medical Planning Commission of the
British Medical Association in 1942. The changes proposed
involved grouping of doctors in practice, a strong link with a
local hospital, facilities for X-rays and pathological examinations
in the Centres and apparently a take over of the local
authority medical services.
The Government White Paper in 1944 which followed the
Beveridge Report accepted the health centre as necessary and
the concept was included in the 1946 National Health Service
Act. Enthusiasm ran high for a time and then died altogether.
The reasons for this are easy to see.
Woodberry
Down Health
Centre
One of the first health centres to be built was by the L.C.C.
at Woodberry Down. Many reasons were put forward for its apparent
lack of success including fears for the doctor-patient
relationship, lack of security of tenure, progression to an
aventual salaried service, but it is generally agreed now that
the basic reason was that it was too expensive. In the early
1950's rent for an individual doctor's suite was £450 and by
1959 this had risen to £550. This was more than most general
practitioners could afford or were willing to pay. A few other
authorities tried brave experiments without conspicuous suc-