中国社区卫生服务理论探讨与案例研究 第15页
Environmental hazards are now recognized to be increasingly important in the health of populations. The DHA and matching local authorities will require advice from community physicians on chemical, physical, bacterial and radiation hazards within their territories, in terms of prevention, containment and, in collaboration with other statutory and voluntary organizations, plans for dealing with related emergencies and/or disasters.
Some DHAs will also inherit from existing ALIASstatutory responsibilities for the provision of medical advice to air and sea port authorities which lie within the DHA boundary.
A community physician will be required to provide this advice; to ensure the application of relevant regulations relating to control of infection and to the health of immigrants; and to make arrangement for medical support to the port medical officer.
Planning for care groups
One of the principal tasks of a DHA will be the planning of health services to meet the needs of the population that it serves. The Authority will need to develop health related objectives and a strategy for their achievement, supported by a coherent set of policies which, in turn, will be accorded priorities within short and medium term plans for the deployment of resources. The community physician has a key role in these processes as specialist,manager and adviser.
Experience since 1974 has shown how effective the integrated planning and organization of hospital, community and other services by appropriate teams of professionals can be for many care groups. The acutely ill, the mentally ill, the mentally handicapped, children and the elderly are examples of such care groups. A community physician will therefore need to initiate or, where they already exist, continue these activities in line with current DHSS guidance on the NHS planning system.
Policy formulation
The role of the community physician in policy formulation is based on an appraisal of the health situation in the community and its projected evolution as well as on predictable developments in medical practice. It requires the maintenance of a comprehensive epidemiologicalinformation service.
Policy formulation and planning includes:
a, the planning and organization of integrated health services in the light of local circumstances; the development of operational plans by means of which planning targets are achieved; service, manpower and capital planning, and their careful coordination;
b, the establishment of priorities and the allocation of resources with regard to national, regional and other guidelines, and within economic and other constraints;
c, the promotion of health throughout the population of the District;
d, the provision of health care for special groups, e.g. expectant mothers, children, the elderly, mentally ill, mentally handicapped and physically handicapped people;
e, joint planning with the Local Authority, wherever appropriate.
Success in formulating policies and bringing about change, will be to a great extent
dependent upon the availabilityof:
a, adequate health care information systems upon which to base the assessment of need including the maintenance of a suitable district profile relating to health care;
b, facilities to undertake research into methods for assessing need utilizing expert advice from social and other scientists, where appropriate;
c, resources to carry out epidemiological investigations into the causation of ill health, in association with epidemiologists, university departments, etc.
Operational activities
Community physicianshave responsibilities for the maintenance and evaluation of established health services, implementing change where necessary and developing new services as indicated. They also have direct management responsibilities with particular services.
District health services
Community physicians have a prime responsibility to make provision for and manage the following services:
Health education.
Community child health services including developmental screening and the School
Health Service (see below).
Vaccination and immunization.
Family planning, pre-symptomatic screening for adults.
In some Districts, community physicians will have a management responsibility for
services involving disciplines such as the professions supplementary to medicine, speech therapists, clinical psychologists, etc.
Community physicians may act in an advisory capacity to occupational health services within the District.
Local authority services
Community physicians, in their specialist capacity, are responsible for advising Local Authorities, or ensuring that general medical advice is made available to them. They may also be involved in case.related management.
The fields of activity include:
1. Proper Officer duties: for the control of infectious disease and other environmental hazards; sea and airport duties; implementation of Section 47 of the National Assistance Act of 1948: (n.b. A rota of community physicians is kept to cover these duties at all times.)
2. Support to the Education Department:
medical examination and treatment of school children; executive responsibilities for handicapped pupils under Sections 33 and 34 of the Education Act of 1944
medical examination of candidates for admission to teacher training colleges and new
entrants to the teaching profession.
3. Support to the Social Services Department:
in the care of vulnerable groups in the community. Children, particularly where child
abuse is suspected or proven, the elderly, mentally ill, mentally handicapped and physically handicapped people come into these groups.
4. Support to the Housing Department:
on the medical aspects of general and special housing needs including advising technical departments thereon.
5. Occupational Health Services: for local authority employees in some areas.
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