The practice of modern medicine

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A general practitioner under the National Health Service remains an independent contractor, paid by a capitation fee; that is, according to the number of people registered with him. He may work entirely from his own office, and he provides and pays his own receptionist, secretary, and other ancillary staff. Most general practitioners have one or more partners and work more and more in premises built for the purpose. Some of these structures are erected by the physicians themselves, but many are provided by the local 'authority, me physicians paying rent for using them. Health centres, in which groups of general practitioners work have become common.

In Britain only a small minority of general practitioners can admit patients to a hospital and look after them personally. Most of this minority are in country districts, where, before the days of the National Health Service, there were cottage hospitals run by general practitioners; many of these hospitals continued to function in a similar manner. All general practitioners use such hospital facilities as X-ray departments and laboratories, and many general practitioners work in hospitals in emergency rooms (casualty departments) or as clinical assistants to consultants, or specialists.

General practitioners are spread more evenly over the country than formerly, when there were many in the richer areas and few in the industrial towns. The maximum allowed list of National Health Service patients per doctor is 3.500; the average is about 2.500. Patients have free choice of the physician with whom they register, with the proviso that they cannot be accepted by one who already has a full list and that a physician can refuse to accept them (though such refusals are rare). In remote rural places there may be only one physician within a reasonable distance.

Until the mid-20th century it was not unusual for the doctor in Britain to visit patients in their own homes. A general practitioner might make 15 or 20 such house calls in a day. as well as seeing patients in his office or "surgery," often in the evenings. This enabled him to become a family doctor in fact as well as in name. In modern practice, however, a home visit is quite exceptional and is paid only to the severely disabled or seriously ill when other recourses are ruled out. All patients are normally required to go to the doctor.

It has also become unusual for a personal doctor to be available during weekends or holidays. His place may be taken by one of his partners in a group practice, a provision that is reasonably satisfactory. General practitioners, however, may now use one of several commercial deputizing services that employs young doctors to he on call. Although some of these young doctors may he well experienced, patients do not generally appreciate this kind of arrangement.

United Stales. Whereas in Britain the doctor of first contact is regularly a general practitioner, in the United States the nature of first-contact care is less consistent. General practice in the United States has been in a slate of decline in the second half of the 20th century especially in metropolitan areas. The general practitioner, however, is being replaced to some degree by the growing field of family practice. In 1969 family practice was recognized as a medical specialty after the American Academy of General Practice (now the American Academy of Family Physicians) and the American Medical Association created the American Board of General (now Family) Practice. Since that time the field has become one of the larger medical specialties in the United States. The family physicians were the first group of medical specialists in the

: 11/11/2009