Evening star., 1949-02-27

LQe service mas plleQ on Top OF
their purely professional duties
is too much for one brain and one
pair of hands. They have almost
given up hoping for the govern
ments promised local health CEN
ters, at which doctors were 10
have found all the sccIG tayial ard
nursing aid they needed There
were to have been hundreds Of
these centers up and down the
country. They would, in part,
have supplemented. in part SUD-
planted, the surgeries of some
$4,000 doctors. mostly in the
towns. AS outlined by Mr.. Bevan.
the health minister, the project
was in many respects alluring.
Upkeep of private surgeries has
always been a heavy item in the
private doctors overheads. Un-
fortunately. the entire scheme had
to be shelved because of the Short
age of building labor and mate
rials. Nobody could have been
more acutely aware of these
shortages than the health min
lister himself, whose department
has charge Of Britains entire
housing program. Plans have only
just been completed for the first
local health center. It is not
expected to be built for three or
four years. Is it surprising that
practitioners should feel a little
cynical when promise and per-
formance are compared?
For the secretarial help which
was to have been provided at the
health centers the average gen.
eral practitioner relies upon his
wife. 1t is she who, unpaid, types
for him. answers the telephone,
opens his door, helps with the
rm-fllling, enters up his home
visit diary; all this on top of
family and household work, which
are a whola-ti Job in them
selves.
Returns Inadequate
! The provisions of the act are
such that it is easy to misjudge
what doctors earn. For example,
! it is pointed out that the individ-
ual doctor may have up to 1000
! patients on his list. In some
urban areas man might be able
to undertake this maximum num-
ber if he happened to be fatigue
proof. 1t is fact that few doc
tors are earning more than they
did before. But more typical
list would be one of about 1000
patients. A list of 1000 patients
would keep most men busy in the
case of rural practitioners, very
busy. The capitation fees for
1000 patients come to about
$4,000 from which at least 80 per
cent must be deducted for ex-
penses. This leaves the doctor
with about $4,000 a year, on which
he has to pay income tax. His net
income is undoubtedly an made
quate return for very hard work,
following a long and expensive
training. He cannot possibly live
or educate his children in a man
ner commensurate with the serv-
ices he gives.
The doctor may, if he wishes,
of course, stay out of the scheme,
and depend for his living on pri-
vate patients. Or he may be half
out and half in, combining private
with State service Such, at least,
is the theory. In many districts.
however, private practice is dying
out. When the National Health
Service was being formulated Mr..
Bevan blandly assured the coun-
try that private practitioners
would be at liberty to carry on as
before if the scheme did not in
terest them. Actually his meas
ures are putting the private men
out of business-and seem de-
liberately designed to do so. The
fellowship is constantly getting
evidence on this point. Of two
letters recently received from doc
tors. one says: My private prac-
tice has completely disappeared"
The other says: Il now have
three private patients left" The
fact is. that while many patients
prefer to avoid N. H. S. queues and
to consult their doctors on a fee-
paying basis as before, few are pre-
pared to pay into the bargain for
drugs which everybody else is get
ting nominally free of charge. The
private patient is as entitled as
the rest to free pills, medicines.
Spectacles, false teeth and what
not. After all, he pays his contri-
button under the scheme like any,
body else. But the law tells the
private patient, mo. you must pay
for these things twice over; firstly
as taxpayers and health service
contributor; secondly over the
druggists counter" Here is an
anomaly that cries out for reform.
Remedy for Disaster
However, the paramount ques-
ton is: How does the general
public fare? They gain in the
matter of free" dentures, spec
tacles and such like; out when
their appetite for such benefits
has been satisfied they will find
at what cost these good things
have been purchased. There will
be service run by overworked
and tired doctors who cannot give
the time or thought necessary
for good work. The public will
find their doctors fast becoming
civil servants who are more re-
Sponsible to Whitehall than 10
heir patients. That treasured,
,hough undefinable thing, DOCTOR
patient relationship, does not per-
nit of third-party interference:
See HALE-WHITE, Page CD