Royal Society of Health Journal

APRIL 1979


payments become for general practice the

ACCESS TO PRIMARY CARE E REALLY must try harder to get things right. Royal Commission at present deliberating ~ ’ on the National Health Service (NHS) should have preceded the costly, crude and cumbersome reorganization of the NHS in 1974. The administration of the health care system for the nation’s sick deserves more sensitive and intelligent

The treatment.

Some indication of the commendable working method the Royal Commission have adopted can be gained from the publication of studies undertaken on their behalf into various aspects of the service. The sixth and latest in the series of research papers is Access to Primary Care prepared by Robin Simpson of the National Consumer Council. This consumer-orientated study was based on interviews with old people (over 70) and parents of children under 11 randomly selected from two small contrasting 205 were from Stoke Newington in communities inner London, an area of urban stress (71 per cent response), and 256 from a mixed rural urban area, the Cockermouth Maryport district of West Cumbria (85 per cent response). Thus the study provides a snapshot of primary care in two small communities. A broader national picture will be available later from a survey currently being carried out by the Office of Population Censuses and Surveys. The population interviewed showed general approval of the service provided by GPs, pharmacists, dentists, opticians and chiropodists. Most of the observations and problems reported are already well known. This is in no sense a criticism, since the area is one which requires regular monitoring. Where problems have been found, recommendations are made to attempt to solve them and it is here that detailed scrutiny and wide debate are required. Many of the recommendations appear to accept the soft option of asking for further resources. In a time of financial stringency it is hard to see this being a winner in the face of competitors with more glamorous vote-catching demands. To be fair, however, the making of such recommendations is difficult because the object of the survey was to see how easy it was to get to primary care, not to measure its quality, much less to look at secondary care in hospital. Solutions therefore must be considered in the context of wider issues. Although consumers were generally pleased with the service provided by their family doctors there were complaints about the care provided for children and the slow response of the deputizing services. The report recommends that the deputizing service should become part of the National Health Service. This recommendation certainly deserves careful study with a close look at the alternatives. The more complex the provision and -

more attrac-

tive a full time salaried service appears to the bureaucratic mind. Pharmacists came out of the survey with a warm glow. It is not always widely appreciated how much of a burden is carried by the friendly dispensing chemist giving advice and treatment over the counter. They probably do act as the primary point of contact for the public with the NHS. Full support should be given to the report’s recommendation for more help to avoid further closures of chemists’ shops. Charges for service are identified as barriers to the services provided by dentists and opticians and it is recommended that treatment for these services should be made free to old people initially with the ultimate aim of making the service free to all. Of the services studied chiropody was the one found to be in shortest supply and the report recommends that this undermanning should be overcome by increasing the number of chiropodists while at the same time

proposing that only qualified chiropodists be allowed to treat feet in return for payment. There is something of a

contradiction here because like many other situations there is a need for support with less highly trained assistants to meet the unmet need. This report is about access to care and it must be of concern to us that a constant theme was that many people did not know about facilities available whether it was chemists’ rotas or dental charges. Surely here we could improve our communications with clients by a little extra effort and by adopting known good practice. This report can be commended as good reading for those concerned with the delivery of care in whatever section of the service although it should be regarded as commentative and sociological rather than statistically representative of the national situation. It is well scattered with illustrative quotes. From 1949 to 1973 the hospital service increased its proportion of health service expenditure from 55 to 66 per cent whilst at the same time the primary care services saw their share of the total budget being reduced from 35 to 23 per cent. The voracious appetite of the hospital service for resources must be curbed to allow investment in primary care where most of the sick are treated. It is hoped that the Royal Commission will propose measures to redress the balance.



of the booklet entitled


Safety Packages and

Labelling of Dangerous Substances, should be carefully studied by all members of the Royal Society of Health


because of their interest and involvement in to Health and Safety for the

everything pertaining

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Access to primary care.

45 Royal Society of Health Journal APRIL 1979 VOLUME 99 NO 2 payments become for general practice the ACCESS TO PRIMARY CARE E REALLY must try ha...
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