Abstract
Recognition of the problemSir Bernard Tomlinson's Report of the Enquiry into London's Health Service, Medical Education and Research (1992) starts with an excellent analysis of the particular problems associated with providing health care in the capital with its high density and turnover of population and disproportionate burden of severe deprivation. He emphasises the particular problems that arise because of the flow into London of vulnerable people with mental illness, drug addiction problems and alcoholism, many of whom are homeless. The consequent difficulties are compounded by the fact that primary health care and community services are poorly developed in comparison with elsewhere in the country and may not be easily accessible to those who need them most. Inadequacies in comprehensive service provision contribute to the high usage of accident and emergency departments as providers of primary health care, where community nursing services are expensive because of higher staff costs and where the characteristics of the patient population referred to above, make maintaining effective contact very difficult.
Highlights
Sir Bernard Tomlinson's Report of the Enquiry into London's Health Service, Medical Education and Research (1992) starts with an excellent analysis of the particular problems associated with providing health care in the capital with its high density and turnover of population and disproportionate burden of severe deprivation
The first recommendation is for a gradual and sys tematic transfer of resources from the acute sector to community health service and family health service budgets. This carries the risk that in the absence of extra, bridging finance, some acute hospitals could close before community provision is properly developed. Hospital closures, such as those rec ommended in the Report, would mean that accident and emergency services would be concentrated on fewer sites
Substance misusers may not be regis tered with a general practitioner and any reduction in the number of accident and emergency departments will reduce the availability of an essential primary health care service, on which this group place great reliance
Summary
ETnhseurreeisasmiutcdhoetos btheawt e"ltcraoimniendgi"n tmhiesarnespoprrte,csiseeelkyinthgatto, while upholding the standards of practice of those deemed eligible for a consultant post. In psychiatry we must protect our achievements far and demon strate that we provide most of what is required already, and are prepared to comply where we do not. 'TrIatinisinagpitfyorthSapt ewcieaalirset mPrisarcetpicree's.enTthedereonispnaogein3t3enof tion to reduce training in psychiatry to five to six years here. This comment is thought to be based on a misinterpretation of discussion about a possible target time. In most countries in Europe, there is a wish to lengthen the existing duration of training, and EC countries each determine the period of training in psychiatry required for their specialist certificate
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