Proposed Public Medical Service of England
Authors: R. R. Rentoul
Journal: BMJ (1889)

THE providing of"medical treatment for those wage earners who are making from 20s. to 45s. per week for the entire family, on their making small immediate payments, of 2s. for the first visit and Is. for subsequent visits during the same illness, or 4s. per week, paid in advance, for five visits.[Such a scheme would in- clude those in domestic service, shop and factory hands, some clerks, mechanics, and small shopkeepers, these being the classes who generally frequent and overcrowd the out-patient depart- ments of the medical charities.It will not arrange for the pro- viding of medical treatment at the homes of wage earners.]PROPOSED RULES. 1.That each town or city be divided into as many districts as necessary, a branch being established in each.The rent of the branch to vary from £25 to £45 per annum, and the branch to be situated in the locality in which the patients live.2. That each branch staff consist of three to six medical practitioners and a dental surgeon.Medical and dental staff to be registered.No unqualified men to be engaged to assist or to act as locum tenens.Each practitioner to prac- tise, in so far as he wishes, that branch of his profession which he may select, and to arrange the days and hours on which he will treat patients at the branch.Each practitioner to take the fees paid to him by the patient, but in cases of operations the doctors to arrange beforehand to assist each other, and at a cer- tain division of the fees paid in this case.No practitioner who keeps an open or branch dispensary, or an unqualified assistant, to be eligible to serve on the staff.Practitioners who have resided in the locality for two years to be eligible to serve.3. The rates and taxes and other expenses of the branch to be defrayed by an equal levy on the medical staff, but no expenditure to be Incurred without the consent of two-thirds of the staff.4. That the registered chemists in the vicinity of each branch supply medi- cine to the patients at the rate of 4d. for each prescription, this sum to be paid to the chemist by the patient when the prescription is left to be dispensed.No prescription to be dispensed a second time by the chemist unless the patient has been advised again by his doctor.Prescriptions to be retained and stamped and dated by the chemist.Standard mixtures, their formule to be arranged by the medical staff along with the chemists, to be prescribed, as far as is consistent with the right treatment of the patient.No prescriptions to be copied by the chemist into his books.No drugs to be dispensed by the medical staff either at the branch or at their homes to the branch patients.The niedical staff not to use any influence with patients so as to induce them to go to any particular chemist, but each patient to select whom he wishes, or that one who has recommended him to seek ad- vice.Chemists to have the right to refuse to dispense a prescription on more than one occasion, if they believe that the patient so prescribed for is above the 45s." wage limit," and until they discuss the matter with the doctor who has prescribed, and to arrange accordingly.[Such a plan is now carried out by