Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-03T00:20:21.826Z Has data issue: false hasContentIssue false
  • English
  • Français

The Informal Rationing of Primary Medical Care

Published online by Cambridge University Press:  20 January 2009

Peggy Foster
Get access Rights & Permissions [Opens in a new window]

Abstract

All social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.

Type
Articles
Information
Journal of Social Policy , Volume 8 , Issue 4 , October 1979 , pp. 489 - 508
Copyright
Copyright © Cambridge University Press 1979

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Forder, A., Concepts in Social Administration, Routledge and Kegan Paul, London, 1974, p. 80.Google Scholar

2 Department of Health and Social Security, ‘Mr Ennals Calls for £30m. Saving in Drugs Bill’, press release, April 1978.Google Scholar

3 Dunnell, K. and Cartwright, A., Medicine Takers, Prescribers and Hoarders, Routledge and Kegan Paul, London, 1972, p. 66.Google Scholar

4 Cartwright, A., Patients and their Doctors, Routledge and Kegan Paul, London, 1967, p. 31.Google ScholarPubMed

5 Fry, J., ‘Twenty-One Years of General Practice: Changing Patterns’, Journal of the Royal College of General Practitioners, 22:121 (1972), 521–8.Google ScholarPubMed

6 According to Fry, who has collated evidence from eight different surveys, 64 per cent of the conditions seen by GPs are ‘minor’ or self-limiting; 21 per cent are ‘chronic’ condi tions, and only 15 per cent are ‘major’, that is, potentially Me threatening. see Fry, J., ‘The Content of Practice’, in Royal College of General Practitioners, Trends in General Practice, 1977, British Medical Association, London, 1977.Google Scholar

7 See for example evidence cited in Davies, H., Modern Medicine: A Doctor's Dissent, Abelard, London, 1977, ch. 4.Google Scholar

8 See for example Stimson, G. and Webb, B., Going to See the Doctor, Routledge and Kegan Paul, London, 1975, ch. 2.Google Scholar

9 A summary of several surveys of GPs' working hours is set out in Office of Health Economics, The Work of Primary Medical Care, London, 1974, p. 21.Google ScholarPubMed

10 Gambrill, E., ‘We Have too Many G.Ps in the N.H.S.’, World Medicine, 21 09 1971, p. 22.Google Scholar

11 Data gathered by Intercontinental Medical Statistics and quoted in Cowhig, T., ‘Details of a G.P. Week’, General Practitioner, 9 12 1977, p. 10.Google Scholar

12 Figures collected by the British Medical Association and quoted in General Practitioner, 19 August 1977, p. 4.Google Scholar

13 Patients' Association, Patient Voice, 4 (1976).Google Scholar

14 Hodson, H., ‘Patients at Arm's Length’, Modern Medicine, 20 (1975), 4–8.Google Scholar

15 Results of this survey are quoted Ibid.

16 Report of the Joint Working Party on the General Medical Services, 1973, HMSO, London, 1974, pp. 13–15.Google Scholar

17 See for example Williams, W. O., ‘A Study of General Practitioners′ Work-Loads in South Wales, 1965, 1966’, in Council of the Royal College of General Practitioners, Reports from General Proctice No. 12, London, 1970.Google Scholar

18 see K. M. Macdonald, ‘Time and the Working Class’, a paper presented at the annual conference of the British Sociological Association, Manchester, April 1976.

19 Blaxter, M., ‘Social Class and Health Inequalities’, in Carter, C. O. (ed.), Equalities and Inequalities in Health, Academic Press, London, 1976, pp. 111–25.Google Scholar

20 see Smith, J. W. and O'Donovan, J. B., ‘The Practice Nurse: A New Look’, British Medical Journal, 4 (1970), 673–7.CrossRefGoogle ScholarPubMed

21 Hall, A., The Point of Entry, Allen and Unwin, London, 1974, p. 30.Google Scholar

22 Results of a survey carried out by Crewe Community Health Council and reported in Doctor, 6 July 1978, p. 2.Google Scholar

23 Report of a survey carried out by Sara Arber, in General Practitioner, 7 March 1978, p. 9.Google Scholar

24 Foster, Peggy, ‘The Rationing of Primary Medical Care: A Case Study of Supply and Demand in General Practice, 1975–1978’, Part 2, unpublished Master's thesis, University of Manchester, 1978, ch. 3.Google Scholar

25 Evidence given by the Patients' Association to the Godber working party and cited in White, D. ‘Receptionist Power’, New Society, 26:581 (1973), 453–4.Google Scholar

26 Suggestion made by Dr Arthur Maiden and quoted Ibid. p. 453.

27 Morrell, D. C., An Introduction to Primary Medical Care, Churchill Livingstone, Edinburgh, 1976, p. 131.Google Scholar

28 Morrell, D. C., ‘Expressions of Morbidity in General Practice’, British Medical Journal, 2 (1971), 454–8.CrossRefGoogle ScholarPubMed

29 Buchan, I. C. and Richardson, I. M., ‘Time Study of Consultations in General Practice’, in Scottish Home and Health Department, Scottish Health Service Studies No. 27, 1973.Google Scholar

30 Hopkins, P., ‘The Time Factor’, in Balint, E. and Norrel, J. S. (eds), Six Minutes for the Patient, Tavistock Publications, London, 1973, p. 142.Google Scholar

31 See for example Malleson, A., Need Your Doctor Be So Useless?, Allen and Unwin, London, 1973, ch. 3.Google Scholar

32 Holden, H. M., ‘The Needs and Expectations of Doctors and Patients’, Journal of the Royal College of General Practitioners, 27 (1977), 277–9.Google ScholarPubMed

33 Cartwright, op. cit. p. 111.

34 This point is discussed in Robinson, D., Patients, Practitioners and Medical Care, second edition, Heinemann Educational Books, London, 1978, ch. 4.Google Scholar

35 Cartwright, A. and Brien, M. O', ‘Social Class Variations in Health’, in Stacey, M. (ed.), The Sociology of the N.H.S., Sociological Review Monograph 22, University of Keele, 1976, pp. 77–98.Google ScholarPubMed

36 Bain, D., ‘Doctor-Patient Communication in General Practice Consultation’, Medical Education, 10 (1976), 125–31.CrossRefGoogle Scholar

37 Byrne, P. and Long, B., Doctors Talking to Paticnts, HMSO, London, 1976, ch. 2.Google Scholar

38 Buchan and Richardson, op. cit.

39 See for example Wright, H. J., ‘General Practice in South-West England’, in Council of the Royal College of General Practitioners, Reports from General Practice No. 8, London, 1968.Google ScholarPubMed

40 Mechanic, D., ‘Correlates of Frustration Among British G.P.s’, in D. Mechanic, Politics, Medicine and Social Science, John Wiley and Sons, New York, 1974, ch. 10.Google Scholar

41 Cargill, D., ‘In Breadth or in Depth?’, World Medicine, 28 06 1978, pp. 38–9.Google Scholar

42 See Cartwright and O'Brien, op. cit. p. 92.

43 See for example Irvine, D. and Jeffreys, M., ‘B.M.A. Planning Unit Survey of General Practice, 1969’, British Medical Journal, 4 (1971), 535–43.CrossRefGoogle ScholarPubMed

44 Korsch, B. M., Gozzi, E. K. and Frances, V., ‘Doctor-Patient Interaction and Patient Satisfaction’, Pediatrics, 42:5 (1968), 855–71.Google ScholarPubMed

45 This claim was made in a speech given by Sharpe, David and reported in Doctor, 7 March 1977. P. 28.Google Scholar

46 Dunnel and Cartwright, op. cit. p. 43.

47 A personal communication from Geddes to Parish, cited in Parish, P. A., ‘The Prescribing of Psychotropic Drugs in General Practice’, Journal of the Royal College of General Practitioners, 21: Supplement 4 (1971), 1–77.Google ScholarPubMed

48 For example Manasse found that 30 per cent of drugs issued without a consultation were psychotropic – Manasse, A. P., ‘Repeat Prescriptions in General Practice’, Journal of the Royal College of General Practitioners, 24 (1974), 203–7.Google ScholarPubMed

49 Howie, J. G. R., ‘Prescribing’Google Scholar, in Royal College of General Practitioners, Trends in General Practice.Google Scholar

50 Parish, op. cit.

51 See White, op. cit.

52 Report of a meeting between Owen, David and a group of GPs, in General Practitioner, 9 09 1977, p. 8.Google ScholarPubMed

53 Final Report of the Committee on Cost of Prescribing, HMSO, London, 1959, p. 63.Google Scholar

54 Royal College of General Practitioners, ‘Evidence to the Royal Commission on the National Health Service’, Journal of the Royal College of General Practitioners, 27:177 (1977). 199–206.Google Scholar

55 See for example the Birmingham Research Unit of the Royal College of General Practitioners, ‘Self-Evaluation in General Practice’, Journal of the Royal College of General Practitioners, 27 (1977), 265–70.Google ScholarPubMed

56 Royal College of General Practitioners, ‘Evidence to the Royal Commission on the National Health Service’.Google Scholar

57 See ‘“Patient Power” Adds Plus Points to Group Service’, in Pulse, 8 April 1978, p. 18.Google Scholar

58 Cooper, M., Rationing Health Care, Croom Helm, London, 1975, p. 59.Google Scholar