A challenge for the future — A positive approach to community medicine

Abstract

Prior to the inception of the Na:tiooal Health Service and since it has become operational, there has been a continuous stream of articles questioning the nature of community medicine and o£ the ~community physician, ~- 4 This has had a deleterious effect both on the morale of those practising community medicine, and on the quality of the reladonsh!p between community physicians and their colleagues in the clinical specialities. 5. 6 However, this phenomenon may be attributable to an instinctive defence response consequent upon the fundamental change in the structure of the organization and the.resultant responsibititie,~ inherent in .the role of the community physician, r- ~0 The insecurity, anxiety and uncertainty exhibited by many .practitioners previously experienced in public health and preventive medicine.'are natural sequelae to a transition requiring a drastic modification in attitudes and behaviours acquired over a long period, but which have been exacerbated by a failure to recognize one basic fact. Despi~te views to the contrary, -~, n community medicine is a new speciality ~ and until this is accepted, articles of pessimism and nostalgia will appear in the ~journals and many community physicians will continue to experience dissatisfaction, talking of early :retirement. as though it were a higher degree. For the first time since :the days of John Simon, a medical speciality has been given the opportunity to influence significantly ~the development of health care services. Those of us who are optimistic about the.future of Community Medicine see the community physician as the core of health ,service evolution. With the protean skills that he/she possesses, the communityphysician has the potential to meet adequatdy ,the demands of this central a~d powerful role. The basic requisite is t~he self-confidence to apply the appropriate skills. However, there are three underlying factors militating against the achievement of maximum potential by community physicians Which are: (a) A conflict of values of the organization vis-6-vis the values of the individual working within it. (b) Underutilization of available skills. (c) .Indeterminate goals and objectives. The ethos of the reorganized 'National Healtt, qervice is epitomized by .the sentence 'The objective in reorganizing the National Health Service is to enable health care to be improved'! This ,is to be found in the first paragraph of the Grey-Booky which proposed mffltidisci:plinary management by means of consensus through the creation of district and area management teams. It gave the provider the right to ,determine service provision. Opportunity for the consumer to exert some influence was provided by the establishment of community health councils. The integration of hospital and non-hospital services acknowledges the importance .of a unified approach to health. The structure of .the