Health Service in Great BritainA de

Health Service in Great Britain

A delegation of Russian doctors went to Great Britain on a return visit. They were met by the British doctors who had been the guests of

the Russian Medical Workers' Union last year. The Russian doctors visited the Health Centre in Hampshire and some hospitals in London, Liverpool and Aberdeen. Now they are having a talk with their British colleagues on the health care system in Great Britain.

Dr. Sharova, head of the Russian delegation: Dear colleagues. During our stay in Great Britain we visited many medical institutions. The doctors kindly acquainted us with their work. We were told that the National Health Service Act was passed through Parliament in 1946 and in 1948 this Act received the Royal Assent and was brought into operation. And what about Scotland and Ireland?

Dr. McDonald: Similar services operate in England, Wales, Scotland and Northern Ireland. Further administrative changes were introduced by a number of other Health Service Acts.

Dr. Kelly: I'd like to say that most medical treatment in our country is free, but charges are made for drugs, spectacles and dental care. Free emergency medical treatment is given to any visitor from abroad who becomes ill while staying in our country. But those who come to England specifically for treatment must pay for it.

Dr. Nikitina: The National Health Service provides free medical care both in hospital and in the out-patient clinic. So you have no private patients in Great Britain, have you?

Dr. Sharland: Not quite so. People may use the NHS or they may go to doctors as private patients. In big cities there are some private hospitals which people may use. Many people who have enough money still prefer to be private patients because they think that they can in that way establish a closer relationship with the doctor or because they do not want to be put in a large room with other patients.

Dr. McDonald: I'd like to add that a patient in our country can choose between NHS or private treatment at any time. Moreover he can take some of his medical care through the NHS, and some privately. If a patient is dissatisfied with his NHS family doctor or dentist, he may change to another one. In fact, 97 per cent of the population use the NHS.

Dr. Kruglov: What is the role of the family doctor in the Health Service system?

Dr. Kelly: The role of the family doctor (General Practitioner) is very important. Not all patients need highly specialized attention and the GP does invaluable work by filtering off 90 per cent or so of the total medical work.

Dr. Sharova: You told us that if a patient is dissatisfied with his family doctor he may change to another one. And what about the doctors? Does this freedom of choice apply to them?

Dr. McDonald: Yes. This freedom of choice applies to doctors and dentists too. They can choose whether they want to join the NHS or not, and whether they will have NHS patients or private ones. In fact, the majority work in the NHS.

Dr. Kruglov: We visited the St. Thomas' and St. Bartholomew's Hospitals in London and noticed that they are small hospitals with about 200 beds. They are housed in inconvenient buildings. Can such small hospitals provide a full range of medical service?

Dr. McDonald: You see, we do have modern hospitals but half of the buildings are over 100 years old. 70 per cent of our hospitals are small, with only about 200 beds. Such hospitals are not economical and cannot provide a full range of service, which requires a district hospital of 800 beds or more. Now we have more than 150 health centres in the U.K. The first Scottish health centre was opened in Edinburgh in 1953. These health centres are an integral part of a unified comprehensive health service. Health centres provide all the special diagnostic and therapeutic services which family doctors may need, such as electrocardiography, X-ray, physiotherapy and good administrative and medical records systems. Family doctors work in close cooperation with the hospital doctors. Health centres are the basis of primary care.

Dr. Nikitina: Are there consultant services in such health centres?

Dr. Sharland: There are centres which provide consultant services in general medicine and surgery, ear-nose-throat diseases, obstetrics and gynaecology, ophthalmology, psychiatry and orthopaedics. All consultations in the centre are by appointment only. The patient is given a definite time at which to attend. This is recorded on a card for him. Each doctor decides for himself how many patients he can examine in one hour. We believe that the patient is the most important person in the health centre and that we should direct all our energy towards helping him as much as possible.

Dr. Sharova: Dear colleagues, thank you ever so much for the warm reception, for this interesting discussion and for the opportunity to get acquainted with the health service system in your country.