Undated. probably 1955

General Observations

‘There are now 12 Health Centres in Great Britain. These all provide general practice service in addition to the usual variety of local authority facilities which vary from centre to centre. The smallest number of GPs engaged in any centre is at Darbishire House in Manchester (4 GPS). The largest is at Hestersway at Cheltenham where 23 GPs are employed. There are 6 health centres provided under section 21 of the National Health Service Act 1946, 2 Scottish health centres under the Department of Health for Scotland, and 3 under the Nuffield Provincial Hospitals Trust.

On the GP side all the suites with one exception provide waiting, consulting and examination rooms. The extent to which this accommodation is shared varies considerably in the different centres. Woodberry Down has a separate suite for each of its 6 GPs. Most of the others have accommodation which is shared by firms of GPs.

In most cases GPs pay a rental, for the use of these premises and ancillary staff ranging, from the maximum of £350 pa for each suite down to £82.10 pa. Conditions in the Nuffield centres are different. In Darbishire House the premises are rent free for the first two years and then £200 pa. At the Corby centre Northamptonshire GPs pay 10/~ per session, no details are available for Harlow New Town. The Ancillary services provided for this charge include nursing, secretarial, reception, telephone, domestic, laundry, car-park or garage and the sterilising services. Not all the centres provide all these services. Most however provide the first 4 and Harlow only provides domestic services free, the doctors there are responsible for their own ancillary services.

It is exceptional that GPs in these centres perform the work of the local authority clinic doctor. It is argued that this would in general put the doctor at an advantage over his colleagues out­side the centre in the sense that he would have contact with patients not his own, and reference is made to the tradition of not employing GPs in the local authorities services in their own area.

In 6 of the health centres some of the GPs have hospital appointments. This is usually confined to one or two GPs in each centre.  In only 2 centres is any medical research pursued at the present times

In 5 centres there is full or part time laboratory technical assistants provided in most cases by the R.H.B. In 4 health centres there is a dental X-ray service and only in the case of Darbishire House does the X-ray service extend beyond this, but even here, there is no provision for Barium Meals, IVP or spine X—rays. In the case of The William Budd centre at Bristol medical students sit in with GPs in their surgeries. At Sighthill one GP has had one student.

In only one centre – Darbishire House – do all the GPs work exclusively in the centre and in the remainder some do.

In two cases only is there a resident caretaker who is responsible for transferring calls at night. In the remainder the doctors make their own arrangements as in general practice outside these centres. In most cases there are adequate arrange­ments between the GPs for holiday work and general rota duties.

Impressions

As a result of a comprehensive correspondence with all of the MOHs of the 12 areas in which these centres are situated it is clear with the notable exception of Darbishire House and Harlow that the centres are not used in any decisive fashion in a way which makes them superior to branch surgeries. There has even crept in the tendency in many cases for doctors to be as busy or busier in their home surgeries as they are at the health centre.

The extent of the collaboration between the GP side and the excellent local authorities’ side in most cases is very limited.

The striking exception of Darbishire House illustrates in the words of the GPs working there what enormous advantages exist when proper arrangements are made in advance of the health centre beginning to function. In this instance the GPs negotiated a contract which provides them with a salary, and with the perspective of reducing their list to 2,500 each. Three of the four doctors here have sold their houses and surgeries and moved into newly built houses without surgery accommodation. I quote some of the many observations made by those GPs after one year’s work in this centre.

“We had no idea of the incidence of anaemia in our practices.  Haemoglobins of less than 60% are common and the patients have been anaemic for so long that they have come to accept their poor state of health as normal. 50% of our blood tests showed Haemoglobins under 85.”

“After one year of general practice with X-ray help the doctors wondered how they managed without it, for all the years they have been in practice. Some criticism has been on the grounds of cost, but it is felt that the help given to the patients and the high percentage of abnormals (26%) fully justified capital, outlay and the expense of. running an X-ray plant. What a great boom.it is to the patients to get their X-rays done on the premises and not to have to go through the out-patients departments of the hospital and what a saving of time to both patients and doctors alike.”

“Three nurses of the staff are entirely seconded to the work of the centre. This arrangement has worked well but we are only starting to learn its full possibilities. The benefits both to doctors and patients of having nurses in attendance are obviously great. Patients get to know the nurse in the same way as they know the doctor. Nurses are available to do the time consuming tasks like giving injections, applying dressings, obtaining Catheter Specimens, supervising minor infra-red and Ultra Violet treatment besides acting as chaperones.”

“The four medical officers who previously worked as single handed GPs have had to introduce themselves to each other as members of a group practice. The secretarial, X-ray, laboratory and nursing teams have undergone a similar experience, and most important of all, patients have had to be introduced to the idea of a health centre. On the whole the experiment has succeeded so far. The team spirit has developed satisfactorily and the patients have attended in great strength, (too great at times}.”

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