PROPOSALS FOR GENERAL PRACTICE

PROPOSALS FOR GENERAL PRACTICE

94 ready within minutes of a reader’s uncertain. request. The library is also to supply teaching aids on Although this disease almost always progress...

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ready within minutes of a reader’s uncertain. request. The library is also to supply teaching aids on Although this disease almost always progresses steadily, film and tape; and those who have difficulty in visiting the tempo is slow. The importance of the condition is the library may take advantage of a rapid messenger serthat it should be identified as a benign one without sinister vice, closed-circuit television, and facsimile transmitters. implications. In the future, the library may have to take on other duties besides. The plans, therefore, allow for flexibility: NEW LIBRARIES FOR OLD small rooms can be enlarged or book-stacks replaced by computers. A building that is to cost$61/2 million cannot A LIBRARY that cannot meet its readers’ everyday be allowed to become obsolete quickly. The money for its demands is a source of irritation and a waste of time. another$6 million endowment, is With the advance of knowledge and the multiplication of construction, plus raised by public subscription. being specialist journals, however, these demands have reached unmanageable proportions. This is especially true of medical libraries. Among current periodicals there are PROPOSALS FOR GENERAL PRACTICE upwards of 5000 strictly medical journals, besides another CLOSE on the heels of the Gillie comes a brochure 20,000 devoted to related sciences. The housing of even from the Medical Practitioners report Union entitled " Our a small sample of this material presents a problem which for the Future ", which sets out the union’s does nothing but grow. Greater expenditure by the Blueprint for general practice. Justifiably, it is able to claim libraries serves to maintain the status quo; but they must policy of the Gillie recommendations have for that

significance

of this

finding

and of the

anomaly itself

is

hard to stay still. In the face of this dilemma a new trend is apparent: libraries are pooling their resources to serve a wider public without duplication of effort. In this country, for instance, new postgraduate centres at Portsmouth, Kingston-on-Thames, and Stoke share libraries with the local medical societies. And, in the United States, the same considerations are prompting the merger of giants: the Harvard Medical School Library and the Boston Medical Library are to combine and, as the Francis A. Countway Library, to serve both the medical school and the region’s medical community.

run

The

Countway library is

to

start

by providing 450,000

volumes; by 1966, when the collection should have grown

to

750,000 (besides 3000 periodicals), it should be the secondlargest medical library in the United States. For its accommodation, a new building is planned next to the Harvard Medical School. This has been designed as a place where books are not only stored but read; and the architects, Hugh Stubbins and Associates, have devised a structure which should be both functional and agreeable. Five storeys above ground are to contain books and two below are to contain periodicals. Easy access to the stacks has been the guiding principle of the design. Readers’ comings and goings are to be concentrated on the central core of the building; reading areas are to be at the periphery shielded from the noise and bustle by an intervening circle of book-stacks. The card catalogue is to be at ground level, books most often in use on the first floor, and older and less popular books on the second and third floors. Conversely, the younger issues of journals are to be kept the first of the lower levels and those over ten years old on the second. On the top floor there is to be a rare-book readingroom and offices for a professor of the history of medicine, besides an auditorium and rooms for seminars and club meetings. Throughout the building small, sound-proofed reading-rooms are to be provided where readers may dictate or type, and where small groups may meet for teaching or discussion. Special provision is to be made for medical students who may do their required reading in a room of specially reserved books; a second room is to contain a selection of books to encourage extracurricular inquiry. A physicians’ reading-room, containing material of clinical rather than academic interest, is to be provided for local practitioners. The library is to allow all its readers to sit in comfort and in pleasant surroundings: there are to be no large central reading-rooms with regiments of tables and unsympathetic seats.

on

provide their readers with books is as much as most can do. The Countway, however, is to do more. to run a photocopying service to save readers’ note-taking: full-sized copies of texts, tables, or biblioTo

libraries It plans

graphies

are to

be

many

years

been M.P.U. policy. It reiterates and develops its view that the general practitioner should be able to earn a reasonable living from a moderate size of list (not more than 2500), and that he must have proper training for general practice, enough ancillary help, and easily available continuing education. It would like the capitation system of payment to be modernised, and, while it is willing to see the everyday running expenses of the practice (the car, the rent, the telephone, lighting, heating, and cleaning) continue to be paid as at present, direct reimbursement should be the rule in dealing with the cost of employment of secretaries, receptionists, and nurses.

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So far, all these suggestions represent policy which is familiar and largely acceptable. In its next proposition the M.P.U. breaks new ground. It suggests setting up a practice premises fund administered by trustees, at least half of whom would be practising doctors. This trust fund would have power to acquire (from, or for, doctors) practice premises, to maintain these premises, and to rent them to the doctors. The cost would be considerable: the M.P.U. thinks the fund would need to be built up at the rate of E10 million a year until it reached at least a total of El 00 million, if it were to do its work properly. Beyond saying that " in return for the great financial advantages offered, the doctors who benefited would have to agree to maintain certain standards of practice organisation ", the M.P.U. does not see such a scheme as changing in any way our present concept of the relation between the doctor and the State. But, if the cost of providing these services were to be met wholly from Governmentprovided funds, it might not be easy to maintain the principle that the general practitioner is an independent contractor providing services to a community of his own choice. The union is in favour of the attachment to general practice of health visitors, district nurses, and midwives; it would like to see more general-practitioner beds-particularly maternity beds-in hospitals; and it believes in part-time sessional employment of general practitioners in hospital, but considers that payments accruing for this work should not be deducted from the pool. It would favour the establishment of a national locum service, which would employ doctors on a retaining salary, would check on their clinical ability, and would make fuller use of the available medical manpower.