Evidence to the Royal Commission on the NHS

Abstract

1. It is the right of everyone in the UK to have access to personal and continuing primary health care of a high standard (para. 4.1).

2. The primary health care service should be built on general practice (paras 2.3 to 2.10, 4.1 to 4.3).

3. The nature of the most important health problems today means inevitably that the main burden of care will fall on the primary health service (paras 3.2 to 3.7).

4. It follows that the NHS must be reorientated around primary health care; the functions and size of the hospital service will then depend on the responsibilities of the primary health care sector (para. 4.2).

5. It also follows that primary health care must attract a higher priority in the allocation of resources (paras 4.4, 5.2 to 5.8).

6. Setting standards of performance is a high priority for all the health professions and the NHS itself (paras 3.6, 3.7).

7. In medicine, professional standards will not improve unless medical education is radically reshaped by the implementation of the recommendations of the Committee of Enquiry into the Regulation of the Medical Profession (para. 5.4).

8. Inadequate care by some general practitioners today is acknowledged (paras 2.12, 2.13); the main causes are examined (para. 2.15) and remedies are suggested (paras 4.4, 5.4 to 5.6).

9. The special problems of primary care in parts of conurbations are described (paras 2.14 to 2.17); a proposal to deal with this exceptional situation is made (para. 5.7).

10. Primary health care should be provided normally by functionally integrated teams of general practitioners, nurses, health visitors and, where appropriate, social workers, supported by receptionists and secretarial staff (paras 2.4, 2.10).

11. Within the primary health care team ultimate responsibility must rest with general practitioners (para. 4.1).

12. To provide good primary health care we need:

i) Appropriate manpower (para. 5.2).

ii) Adequate premises (para. 5.3).

iii) Effective education (paras 5.4, 5.5).

iv) A modern record/information system (para. 5.6).

13. General practitioners should remain independent contractors so that patients have an independent medical adviser in a State dominated health service (para. 4.7).

14. The administration of the NHS should work on the principle that bureaucratic interventions between patients and the health professions should be kept to an absolute minimum (para. 4.4).