Community Medicine in the Restructured NHS
作者：John Smith
国籍：English
出处：Community Medicine
原文正文：
In many areas the establishment of the new District Health Authorities entails a rearrangement of the ways in which some community physicians will function. The British Medical Association's Central Committee for Community Medicine (CCCM) has already circulated a document outlining the tasks of community physicians employed by Dstrict Health Authorities. This has concentrated on the managerial responsibilities, the operational activities and the size and nature of the workforce needed to discharge them. The Faculty has supported the CCCM document. At the same time it has prepared a complementary paper,based upon views received from community physicians in the regions, in which the emphasis is placed more upon the role of community medicine in the restructured service. We reproduce it here in the belief that it will be of particular help to any of the specialty's practitioners who continue to have to expound its raison d'etre in a professionally competitive environment.
This document outlines the role and function of community medicine and makes recommendations so that the discipline may continue to make a maximum contribution during and after the impending restructuring of the Health Service in England.These recommendations take account of the importance of the task of community medicine, the larger number of district authorities to be serviced, the shortage of community physicians,the differingboundaries of health and local authorities with shared responsibilities to be discharged by community physicians, and the continuing need for special skills in discharge of the separate identified responsibilities of community medicine despite the removal after restructuring of special labelled posts.
WHAT IS COMMUNITY MEDICINE?
Community medicine is that branch of medical practice that is concerned to promote, maintain and, where necessary, restore the health of human communities. The practice of community medicine resembles that of clinical medicine in that it consists of the formulation and communication of advice on how health problems may be solved. It differs from clinical medicine in that clinicians usually offer their advice to individuals on request whereas community physicians offer their advice to communities and most often take the initiative in deciding both when to advise and to which agency of the community advice should be directed.
Community physicians consult with their communities through the medium of the
management, planning and decision-making agencies of the community's health and related services and most frequently through the management structure of the National Health Service. It is the NHS that employs community physicians as members of the management teams but they must also have responsibilities towards clinical and other colleagues and to other agencies involved in matters related to health and to the communities directly.
The NHS is the main agency for the treatment of illness and the care of the sick and it has an important rote in the prevention of disease although many other agencies make important contributions to prevention. It is important that the job specification and the staffing levels in community medicine take full account of the range of functions and responsibilities involved. Of all branches of the practice of medicine, community medicine has the most impressive record in terms of the health improvements that have taken place since the specialty emerged under its old name of public health in the middle of the last century. The problems that face us now are different in kind but equally formidable if health improvement is to be maintained and equitably distributed in the years ahead.
Before reorganization of the NHS in 1974 community physicians were mainly employed by the Regional Hospital Boards and Local Health Authorities. In both situations, the work of these doctors was supported by a
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