中国社区卫生服务理论探讨与案例研究 第12页英文文献
substantial staff comprising both clerical and secretarial workers and often research and other staffneededfor collecting and analysing epidemiological data related to the health problems experienced in the community or its health institutions.
Since 1974, community physicians working in Areas and Districts have often been seriously short of such supporting staff since the new administrative bodies often lacked the necessary resources or were insufficientlyaware of their importance.
The new restructuring, involving the creation of Health Districts, is being carried out
against a background of even more severe economic constraints and it seems especially necessary to state the importance of providing appropriate resources so that the practice of community medicine may make the important contribution that it has traditionally made to the health of the community.
Since 1974, there has been a manpower shortage within the specialty of community
medicine. However, recruitment has improved and every region now has a functioning training programme.
THE ROLE OF THE SPECIALTY AND THE COMMUNITY PHYSICIAN
The emergence of community medicine as a specialty in 1974, coinciding with the reorganization of the NHS, has led to its being associated with the less successful structural and management changes brought about at that time. However, the specialty was not created out of NHS reorganization but from the integration of three well-established streams of medical practice: first, public health with its roots in the practice of preventive medicine, health education, epidemiology and the control of disease among whole populations; second, medical administration which had developed rapidly from the beginning of the NHS as the discipline responsible for the planning, delivery and monitoring of hospital and specialist services to the whole country; and third, university departments of public health and social medicine whose teaching and research in epidemiology and the delivery of health care provided the theoretical basis for advances in much medical practice. These three streams were evolving and changing. Each could claim triumphs of its own, but all foresaw the
future need to work together. The specialty, therefore, not only created itself with new
challenges in mind, but it also inherited the responsibilities of guarding the public against health hazards, of preventing disease and of teaching both the public and the profession the meaning of health and the means for its pursuit.
Community physicians can be said to have three complementary medical roles; specialist, manager and adviser.
As specialists, community physicians are able to offer a combination of medical background with a knowledge of epidemiology, behavioural science and management techniques to provide an important contribution to health care planning. Their medical background helps them to maintain close working relationships with clinical colleagues in health service development and so ensures that their advice is based on current medical practice. Their epidemiological training equips them for a specialist role in the promotion of health and the prevention and control of disease in the community and in the evaluation of health services.
As managers, their combination of medical knowledge and management skills enables them to develop with others in management, policies and plans for improving the health of the population. In addition, they have to promote the development of joint planning and management between health and local authorities. They have a particular managerial responsibility for activities concerned with the promotion of health and the prevention of disease and disability. The community physicians' role as managers involves them in the administration of the health service, whether or not as a chief officer member of a management team, since all community physicians are as much concerned with implementing as with making policy.
As advisers community physicians have a number of responsibilities. They have to provide specialist medical advice to the health authority which employs them and to departments of education, social services, environmental health and housing of the related local authorities.
They are also responsible for advising the community served by their employing health authority about all matters affecting health.
The full development of the specialty since 1974 has been handicapped by the complexity of the present structure of the National Health Service in England. Scarce manpower and skills have been diluted by the need to staff three tiers--district, area and region.
One consequence has been that, in the main, each district has had only one specialist—the District Community Physician. Single individuals, with little in the way of supporting staff, have had an almost impossible task in trying to discharge the duties and responsibilities laid upon them. The new simplified structure will provide a better opportunity to practice community medicine and the chance to deploy the limited manpower of the specialty in a way which will allow its skills to be fully applied.
The role, functions and relationships of District Health Authorities (DHAs) will be
similar to those of the present single-district Area Health Authorities (AHAs). They will be responsible for the planning and management of health services for the population of the district; decide on district policies and priorities within the context of national and regional policy; and assess the adequacy of services provided. Each DHA will appoint a District Management Team (DMT) of chief officers of whom the District Medical Officer (DMO) will be one.
The principal external relationships of DHAs will be with their matching Community Health Council (CHC), with district councils (or London borough councils) whose territory lies wholly or partly within the health district boundary and, outside metropolitan areas, with one or more county councils. In addition, relationships within the National Health Service (NHS) will be with other DHAs, with the Regional Health Authority (RHA) within which the district lies and with the Department of Health and Social Security (DHSS).
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中国社区卫生服务理论探讨与案例研究 第12页下载如图片无法显示或论文不完整，请联系qq752018766
