Britain's health services: The family doctor (1962)

[Music] 1948 saw the start in Britain of a great social experiment, the National Health Service, a state medical service which everyone in Britain is entitled to use. its costs met mainly from taxation and direct contributions so that the expense of necessary treatment is no longer an obstacle to any who may need it. While it comprises many services, its backbone is the 23,000 doctors who practice medicine throughout the country. Their practices vary widely from scattered rural communities to big concentrations of town dwellers. Patients register with the doctor of their choice, but the National Health Service limits the number of patients a doctor may look after to 3,600. In practice, they average 2,200. For those who can, and these are the majority, patients come to consult the doctor at his place of work, his surgery. And the daily routine of every general practitioner starts here. [Music] In a typical rural practice like this, the problems confronting a doctor are varied. For example, there's Mrs. Fox, a farmer's wife. She suffers from high blood pressure and a strained heart. With careful treatment, she's improved. But the doctor knows that rest is what's really required, and there's far too much work to do on the farm for her to relax. So, he can only watch her condition carefully, warn her that she must take things quietly, and treat her with medicine, which will help her condition. so that you can obtain this medicine. The doctor writes out a prescription. A simple operation, but one which sets up a whole chain of reactions. After she leaves the doctors, Mrs. Fox takes the prescription along to the chemist where it will be made up. She'll pay a small charge for her medicine. This doesn't cover the cost, but it does help to relieve the huge drug bill of the National Health Service. If a patient cannot afford even this small basic charge, application can be made for state assistance to meet it. The medicine is made up by a qualified pharmacist, a man who has studied almost as long and diligently as a doctor to qualify for his work. Every month, the chemist sends off the prescriptions he has fulfilled for pricing and payment. This is expert work, for a doctor's writing is well known for being almost undecipherable. At the same time, each doctor's prescriptions are analyzed. If it appears that he has been overprescribing or supplying to his patients things not covered by the National Health Service, he may be called before a panel of doctors to explain his actions. After morning surgery, there are numerous calls on patients to be made. [Music] In country districts, the patients are spread over a wide area, and traveling from one to another takes up a lot of the doctor's time. [Music] One of his calls this morning is on an old patient. She suffers from arthritis, one of the diseases that attacks the old particularly and for which no cure has yet been found. A chat with the doctor will relieve her loneliness and probably do her as much good as any medicine he can prescribe. in his work among the homes of his patients. The doctor has an ally and assistant in the district [Music] nurse. Loneliness among old people is a problem in Britain today. Family life has broken down to the extent that many of the old have to live by themselves where previously they would have made their homes with their children. The problem is accentuated by the fact that people are living a lot longer. [Music] The district nurse can report on the state of health of those she attends and continue routine treatment that has already been started. [Music] Mrs. Jones called it her arm. It is now well on the mend, but the dressing has to be changed frequently. The district nurse can do this applying the principles of asepsis she learned in hospital in the rough and ready surroundings of the kitchen. work like this relieves the doctor whose time is precious for more important cases. The nurse keeps an eye on other members of the family during her visits. The doctor's next case on his rounds is a serious one. Mary Elliot should have been treated in hospital, but she's already so ill before the doctor was called in that he hesitated to move her. A factor in this decision was that a district nurse was available to help with the nursing and to report immediately to the doctor any change in Mary's condition. [Music] With a continuous round of patients to be visited, the doctor leaves at home a note of the order of his calls so that his wife, who acts also as his secretary, can contact him when necessary as fresh calls come in. [Music] The doctor's own children have grown up, but he still has a way with his young [Music] patients. This isn't surprising as he's known most of them from birth. In fact, gynecology is the branch of medicine which interests him most. [Music] Dr. Bennett has a few patients in the nearby market [Music] town. This one is a young, worried mother. The doctor knows that she frets unnecessarily over the health of this her first baby, but he pays the same meticulous attention to his examination which tells him that the child is only teething. The mother is reassured. And after all, it might have been [Music] serious. While he is in town, the doctor calls at the hospital to see one of his patients there. For behind the doctor stands the services of the hospital and indeed the whole national health service. Here he can call in the help of the consultant specialist to confirm a diagnosis or to recommend and undertake a treatment. The consultants have all the modern aids to diagnosis. X-ray [Music] [Applause] The backing of fully equipped operating theaters for emergency or routine operations. [Music] And a staff of specially trained physiootherapists to restore patients for a return to normal life. [Music] After the morning and afternoon rounds of patients comes the evening surgery with its fresh quot of problems. Even then, the doctor's work is not yet done. There is his paperwork to finish, records to keep up to date. When the health service was devised, it was recognized that a very special relationship existed between doctor and patient and that this must be preserved. Two fundamentals were therefore laid down. That each patient could choose his own doctor and that each doctor should be paid a flat sum for every patient registered with him. So each month a check is sent off to the doctor calculated on the number of cards registered with him irrespective of whether the patient has consulted the doctor within that time or not. The special relationship between doctor and patient is very valuable. For the doctor can never regard his time as his own, which is just as well. For in the evening, for example, when most people relax after work, or at night when the rest of the world sleeps, the call may come from the sick or those in trouble. A call that cannot be disregarded. [Music]