Towards a better life: community health (1986)

for [Music] [Applause] [Music] Dawn breaks over Exmore in Southwest England bordering the village of porlock in suet to the north lie the Waters of the Bristol Channel 1200 people live in porlock it's a tranquil village with a 12th century church and a 13th century p morning Caroline not a bad day a couple of things would you remind me to do Keith liser has lived and worked in this area for most of his life he's 59 and will shortly be retiring I want to ring up Martin Elwood before I start um and can I have my P to the town kentish town is a bustling Cosmopolitan area of London about 60,000 people live here Iona Heath is at the start of her career she and Keith lisst are both General Practitioners or family doctors two different people in different areas working in different ways but with one common aim to provide for their patients the best possible Health Care Keith liser has worked in the National Health Service since it started 35 years ago when the idea of free health care for everyone was revolutionary but now people accept the fact that they will be registered with a general practitioner almost from the moment they're born and that they need never pay for treatment unless of course they want to by going as private patients there are 28,000 family doctors like Iona Heath in Great Britain whose job is to cure sometimes to heal often to comfort always they deal with 90% of all cases at a cost of only 6% of the National Health Service budget their responsibilities have increased over the years in the early diagnosis of disease in prescribing powerful drugs The Family Doctor holds the lives of patients in his hand hands we struck oil a think there hello Wesley yes I went to head the ball and someone went to catch it and po me in the eye so the ball didn't hit your eye his finger hit your eye yeah a Health Service which is free and available to everyone will inevitably have problems especially at times of economic constraint many people are concerned about its future but Keith liser and Iona Heath would not want to work in any other system very good indeed okay what is a general practitioner in the 1980s these are two doctors with different philosophies and practices but they both operate under the same free Health Service umbrella and it's not blurry at all just hurts a general practitioner is the the first point of call for the patient who wants to um make use of the services of the National Health Service so as soon as a patient feels themselves ill or has any concerns about their health or illness they will come and see the general practitioner and if it's a complaint or problem that's within the expertise of the general practitioner they'll be able to deal with them completely within the context of general practice but if not then the general practitioner is able to refer them to the whole range of national Health Service services this isn't a bit of a corneal braen that's I think a general practitioner is a friend of the people and he looks after them and he looks after their health and I see myself long standing here and I hope the patients in the village look upon me as a friend too last week this is Keith liser has a single-handed rural practice he's the traditional image of the paternal Country Doctor always available at any time of the day or night and in all weathers he's had both to take to his skis and fly out by helicopter to get to emergency cases on the snowbound MS yes he say yes here doctor oh well it's much more relaxed here it's a bit chaotic up there Iona Heath's team practice is in a health center with a staff of a 100 therapists nurses doctors receptionists all working together to provide free unified health care for about 30,000 patients obviously when things are going well in group practice is very stimulating and to have the constant stimulation of of a large number of people about you working in the same way it's very nice there are over 1,000 health centers in Britain their aim is to provide more efficient health care and to give the patients many facilities in one building the most obvious Advantage I think for patients coming here is the availability of the service to them in that they know there's going to be a doctor here from harer state in the morning until 7:00 at night this Center houses two team practices Dental practices sherop as well as physiotherapy doesn't hurt too good and a crash where children may be left for a few hours antinal Care Family Planning and child health can you build me one of those H can you build me one of those well that's one way of approaching it but can you build one over here we give you three braks well the problem is uh is a trouble with my feet right you know CU swelling SW if an examination is needed if it's very cursory we'll do it actually in the surgery if it's looking at a foot or a hand but if it involves a certain amount of undressing we put them directly over the examination room and go and examine them there and that's tender yes and that hurts does it yes but not in this joint yes that joint as well as well yeah okay no problems with your hands at all no I'm not going to give you any treatment at the moment if it involves some sort of nursing procedure particularly like having a blood test which is quite timec consuming for us or if they need a lot of little things done like weighing blood pressure having their urine tested having their Vision tested these sorts of things then we will send them round to wait for the nurse then the nurse will do her bit and then put them into an examination room for the doctor to come an examine and during that time we can be getting on with the rest of the surgery the informal approach and dress of nurses and doctors help patients to relax in this efficient well-planned building which has one drawback the medical record section medical records are vitally important the physical storage of our medical records is a problem they should have all the general practice records the handwritten notes that all their GPS have ever made and copies of the hospital letters that come back after a referral and then the results of all the investigations blood test urine test that we might have ordered I like to go out to fetch my patients from the waiting room myself because it makes the building more welcoming and I hope it puts them at their ease before they come into the Consulting room and have to sit down and divulge themselves how are all your extremities uh all the except for slight Mel formation yes yes we're uh back to normal thank goodness right no sess no with the help of the fibergel and prunes fiber gel and prunes yeah great carefully regulated qu it is right all I've got now is a nerve there step like a great sword sticking in a flaming sword some people need help to make the health center work best for them so they don't realize that they can ask for a particular doctor each time if we find that a patient is tending to see different doctors every time we try to get them to see one particular doctor okay I'll be back in a minute right all right unaccustomed exercise yes that's right be here right all right yeah cool on doesn't hurt doesn't bring on this no right you tell me if it does never done the can can be that's right all right fine sit up for me right the health care there is so Splendid see when I had my heart attack 3 years ago although it wasn't very serious nobody knew I had four doctors come to see me in the first three days um which was really something you couldn't have had anywhere else in the past doctors who became Specialists needed more qualifications than those in general practice but now general practice is regarded as a speciality in its own right also requiring postgraduate training general practice is a primary concern do do you feel you've had any training uh in it since you joined um let's call it Community Care yes yeah yes I mean certainly here since 1982 these doctors after 5 years at Medical School have to do two years in hospital posts and one year as a trainee attached to a general practice they work as full members of the team they do the same number of visits and night calls they look after their own patience and have time off for seminars and tutorials good M those back up that's a man up you g good I do think the doctors ought to be Community Based much so um but I think we've got we a lot to learn their tutors are usually the doctors they work with who are qualified as trainers it is in fact a two-way process the trainees while learning from the practice bring with them all the latest ideas from their medical school and Hospital training to pass on to other members of the team I mean that's probably one of the most important things that we learning that that we have a role as doctors but and one of them is just being the first port ofal to pick up things we don't have to be the people who do everything much as we might like to although Keith liser is single-handed he can call in a specialist from the local hospital when he feels a second opinion would be useful you won't feel anything from it in this case The Specialist is doing an electrocardiograph for a patient who's complained of heart trouble well really I can find no evidence of any organic heart disease I think this abnormality is a an abnormality of function rather than anything else even a Rolls-Royce engine can miss a beat one once or twice thanks all right oh good morning doctor hello hello Jimmy not very well what sort of night not very good high temperature sore throat general practice is the unglamorous end of the medical profession and can involve a lot of routine visiting in patients homes especially in the country where buses are few and people find it difficult to get to the surgery shut don't eat it it's just open normal but a home visit can often tell a doctor a lot he can pick up Clues which in some cases can help to pinpoint the exact cause and nature of the illness I didn't leave anything behind here we go H still in polock it's very much part of the job Keith liser knows his patients their families and their problems often from the Cradle to the Grave you li on at night in return because they know he is committed to them the patients respond with trust and this trust he believes is a vital part of the healing process it's as laughing and saying you can use this hand if you want to I Keith lster accepts the fact that because of the role he is is chosen his private life will be constantly Disturbed he can never sit down to a meal take a bath go to bed without knowing that a phone call can summon him to an urgent case this that's right I'm going to help you there I'm going to hold your arm and I want to see you walk just here a step or two walk yes say he'll walk out in the garden would he or not I think if H is that nobody can avoid being ill from time to time in life and the worry of being ill associated with the cost of it is unacceptable in life well really poock is a goldfish Bowl in a Hill Country on the North side that's the sea there are Hills as you go west down into cor and Deon and mine head is an urban area 6 miles away and the Hill Country is immediately behind me on the South Side so the majority of my patient in a small area of about 3 4 miles I don't think I face anything like the problems that one would expect I think that the Hill Farms and the rural areas are not at all demanding I enjoy working the national health because I'm able to visit when I want to visit I never have to be worried as to what it will cost and to be honest that I'm cost conscious of of medicines and drugs which accept nowadays are very high indeed if I want to prescribe yes I can prescribe and I do I prefer it to Private Practice out of 10 for clean Toad the bane of most doctors lives is to be approached while they're off duty but to Keith liser it's almost a way of life he'd feel he was failing his patience if he held back from giving advice and help wherever and whenever it's sought no other problem not really no well yes I just did hit my hand the other day I always like to have a look at that a minute know that finger there it's very stiff and store there you could have cracked a little bone there I think nothing to do about it I'll give you something to rub in he carries with him in his car a complete set of medical drugs that might be needed at any time but he regards his intimate knowledge and the Personal Touch which he can offer as almost his most valuable contribution to the care of his patients this particular area is an interesting area to work in in that we do have a considerable social mix so there's a lot of poverty there's also quite a lot of wealth there's an enormous shifting population of young people between 18 and 35 it's difficult to provide any real sort of continuity you're just getting to know them and they move on what I can't quite what came out of the partners meeting about the 6575 well yes I think what we felt at the partners meeting was that we should have a a pre-retirement call up as it were where people approaching 65 should be asked to come in and their health needs discussed and assessed and then what we can do is if they're at risk if you can actually have your can population listed under their year of birth and under their sex it allows you to do positive health things as opposed to just the disease side well we have to be looking for a change of emphasis and I think that has to come in the field of health promotion getting people to look at their health what they're doing positively towards it what they're doing negatively keep fit classes they have a very obvious role in health promotion there's the language class I think that's very positive healthwise in that if people can't speak the language of the country they're living in they tend to become very isolated from the yeah um I've come to get some more contraceptives we provide a whole range of Family Planning services within the building with the exception of sterilization perfect as usual the crash when used as a treatment is promoting health and that it's relieving stress within families I do a baby Clinic once a month which is vaccination immunization I get an opportunity to see all the babies in the village and chap to the mothers Keith liser believes that the single-handed doctor may be a Dying Breed because of the strain it puts on both the doctor and his family though there's not a lot of pressure in his job the hours can be very long and he has only two free nights a month when his calls are taken by a colleague in another Village I chose to be a single-handed doctor I think that um I very much like the theme of the oldfashioned general practitioner who I have very happy memories of childhood and perhaps would like to imitate it's lovely morning how are you though his practice lacks many of the immunities available to IA Heath he's just as concerned with preventative medicine through tests he's discovered many unsuspected diabetics and he's managed to reduce the number of Strokes in his practice from seven or eight a year down to only one or two partly by visiting every month and taking blood pressure of all his elderly patients who can't get to the surgery pills it's just that I want some of those um the hospital at minad offers him and other country doctors open access to a number of beds so that he can if he wants to always get his patients into hospital and care for them there himself to talk to Dr sh to ask him really whether you would be well enough to look after yourself I should think so there are very good facilities here in the village the council have built bangers for elderly people they won an award there's a warden who lives in the center and they're all heated and they're extremely efficient I have a district nurse who works closely with me she is a district nurse Midwife and health visitor all combined thanks in part to Better Health Care people in this country are living longer and care of the elderly is stretching the National Health Service to the Limit a lot of people retired to porlock which means that many of Keith List's patients are over 65 it's looking better yes ksh Town doesn't have above the average of L patients but a lot of them haven't got families nearby and live alone in small Flats one of the aims of Community healthc Care is to make sure that they all have the support they need to help them to live comfortably and safely on their own oh you can I come in yes fine and are you feeling better yes thank you you are you signed a little bit puff this morning yes well that's a bit of heart trouble uhhuh and have you got we very privileged in this area to actually have geriatric visitors in most primary healthc care teams the work that we allocate to the geriatric visitor is done by either the health visitor or the district nurse or a combination of the two that's the most the worst one one I was wondering had you got the stand for your Kettle yes you know the one I ordered for you yes and it's most useful is it yes good we use the well baby clinics both as a place where people can come to just have their babies wait and to talk to their health visitor the health visitor is always available within the well baby Clinic you didn't think to wer at 10 make sure you get an undisturbed night is when you stop Wai the health visitor has responsibility for all children under five she'll visit families to make sure they're coping with the problems of new babies and toddlers and also to help out where there are difficult social conditions there's a fine line between responsibility for health and general welfare but if social conditions are poor the physical and mental state of the families can be affected and the health visitor's job is to try to prevent this happening and it is actually two bedroom isn't it and the real reason you want to move is this lift business isn't it being so high up what's the worst thing about the lift in case it got stuck and the mess is always in and so just within new baby you feel it's soft and un hygiene [Music] I personally visit almost only on one half day a week where I concentrate all my visits a sharp contrast to Keith list who is out visiting his patients for several hours every day but here the need is much less most patients in ksh town live within walking distance of the health Center and frequent buses make traveling easier also because Iona Heath is part of a team of seven doctors they take it in turns to be on duty each day and at nights and weekends to do any emergency visits which takes the strain off the individual doctor and means that their family and social life is much less disrupted giving Iona time to spend with her two young children fine I haven't got bronchitis yet no I've had to do a lot of standing over the last three weeks why cooking you're cooking why what's the matter with Mr she's absolutely down tell you a lot of the family doctor's life is routine tests prescriptions visiting but there is always the chance that the routine call or test will throw up some hidden problem of which the doctor and patient were quite unaware hello hello good morning the now he tells me you've been flat on your back and he's having to be doing all the cooking is that right I hardly believe a word of it though IA Heath can't know all her patients as intimately as Keith list knows his she equals him in her determination to preserve their health and in her concern for their well-being yes I wasn't well enough to come and see you funnily enough all right take it from the end of November your appetite went still bad or pick well it's I eat my dinner but I don't eat much during the day I have to eat my dinner cuz I can't bear to disappointing okay so pain anywhere I've had terrible pains in my stomach yes really so you find it a sore spot there somewh you there may be fewer single-handed doctors like Lista in the future over the past 10 years there's been a steady growth in the number of Team practices doctors can as a rule make their own choice one of the strengths of the National Health Service is its flexibility which keeps it one of the best in the world thanks also to the Sterling work of people like Keith liser and Iona Heath and then this funny thing on here on there see as well oh I would find it very difficult to work in any other another situation I I believe fundamentally that Medical Care has to be free at the time of need and if it's not free at the time of need I don't know how I could possibly work as a doctor I'm a Storch advocate of the National Health Service I think it's here to stay and it must stay I would be very sad to see any other form medicine here in England I think it does a good job [Music]