HC Deb 14 July 1950 vol 477 cc1773-6

1.45 p.m.

Mr. Hastings

I beg to move, in page 3. line 14, to leave out paragraph (b).

I hope that I may be permitted very briefly to put my case before the Minister, and that he will unequivocally accept my Amendment, as I have no doubt he will, when he has heard the arguments. I agree entirely that there can be no better training for a general practitioner than to take part in the general work of a health centre, to undertake substitution duty for all those working there, and to be specially attached to perhaps one or two of the senior members. In my view no better training can be imagined for general practice.

But when we come to the special departments which, we hope, will be working in the health centres, and where on one or two days a week, the skin man, or the nose and throat man, or the eye man from the hospital comes to the health centre to see, not just ordinary cases but cases sent on by the general staff of the health centre, about which their combined wisdom cannot find an efficient answer, and the needs of the services of a specialist are required—in such cases, I regard the work in the specialised departments as first-class training for young specialists but not for the provisionally registered doctor who is wanting to obtain a complete registration. Therefore, I hope that the Minister will agree with me in proposing the deletion of paragraph (b).

Mr. Bevan

It will be within the knowledge, I am sure, of hon. Members that the provision relating to health centres was put into the Bill in another place. I accepted it, but I am bound to say I did so with considerable misgivings. I thought that it would have the consequence of detracting from the value of the Bill itself unless it was handled with extreme care.

First of all, it is the hope—although I think that we must keep some sense of proportion about it—that subsequently most general practitioners will be engaged in group practice, and will be operating from a building which might be described as a health centre; but everyone knows that health centres can be variously defined. We can have a very big polyclinic centre, in which there is a considerable variety of diagnostic facilities alongside maternity and child welfare centres, local authority dental and ophthalmic services, and the whole range of personal medical services outside the hospitals. It might be possible to find a health centre of that sort as a place where the year intern service could be served, but we have none of them at the moment, as far as I know, and it will be a very long time indeed before the country is going to have them, if ever it does have them.

These are institutions which ought to be examined further before we embark upon them, because unless we are careful they will be merely reproductions of the hospital itself, apart from the fact that they will not have patients staying in them. I am extremely doubtful about this proposal, and I hope that when these institutions come to he approved it will be done with extreme frugality. I should have thought that one of the main purposes was to bring the would-be general practitioner into daily contact with the specialist services. The effect of the Amendment will be to deny to the intern physical access to the work of the specialists if he happens to be in an outpatients department of a health centre. That would surely be a distortion of the whole thing, and would merely mean prescribing an assistantship only for the internee year.

Mr. Hastings

May I point out that the Clause does not say "employment in the general service and employment in such out-patient services," but either employment in the general service or in such out-patient services? I take it, therefore, that the meaning of paragraph (b) is that employment in the special out-patient services takes place only in a health centre, and will qualify as an intern period.

Mr. Bevan

If we had to choose between the two, I would select paragraph (b) as against paragraph (a), because in the case of paragraph (b) the intern would be in daily association with the specialists, whereas in the case of paragraph (a) he would be in daily association with general practitioners. If it be the fact that ultimately we want all doctors to work in group practices from health centres, we shall be prescribing that the intern year shall normally be service with general practitioners. We do not want the interns to serve in health centres, but to have a full variety of experience of all the services.

Dr. Hill

I think that the Minister's arguments are unanswerable. It is desirable, most of all, that this intern period shall be spent in a hospital, and that it shall not be merely a year attached to the end of a man's training. I agree that if there is to be a second-best and a third-best, this opportunity for specialist work in the out-patient department, particularly in the field the hon. Member for Barking (Mr. Hastings) suggests, is the second-best. I wish to underline what the Minister has said—that these alternatives are less desirable than the hospital. I hope that we shall not get into the habit of regarding this as a year added to the ordinary medical education, but rather as a phase of responsible work. I suggest that paragraph (b) is important, but that both are less important than the main theme.

Dr. Morgan

I so seldom agree with the Minister on this Bill, that I should like to say that on this occasion, like the hon. Member for Luton (Dr. Hill), I think his answer is unanswerable. In an institution an intern may get every practical phase of medical diagnostic skill portrayed to him. He may even get mental cases, but at a health centre he is very unlikely to have any experience of such cases, even if a psychiatrist were at the health centre. I hope that when a man wants to specialise he will go into a mental institution after his period of service is over, and that he will not spend this extra year in a mental institution. If he wants to specialise, he should go to an institution after his training.

Mr. Hastings

In view of the fact that the danger which I so seriously apprehend is not likely to come about until there are more health centres, I beg to ask leave to withdraw the Amendment.

Amendment, by leave, withdrawn.

Clause ordered to stand part of the Bill.

Clause 4 ordered to stand part of the Bill.