1.       Fishy Tales Draw a Full House
2.       Last Practice leaves Church Street
3.       Kidderminster, A Trust Hospital ? - John Murray
4.       Why we chose to hold a budget - Peter Batty
5.       Merger Proposals Deferred

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The recent Medical Society meeting with Mr. Michael Fish, the B.B.C. weatherman, as guest speaker was in effect a full house. With 110 members and guests the Post Graduate centre was filled to capacity. This was in spite of the inevitable February fog which Mr. Fish did not warn us about! The speaker gave us a concise history of meteorology and a very interesting illustrated talk on modern weather forecasting techniques.

On his return to London , Mr. Fish kindly sent us some notes on his visit to Kidderminster , as follows: 'I often compare myself to a Doctor. We have many years of training before we are let loose solo. We work long hours throughout our careers, covering 24 hours a day, 7 days a week. We are the centre of attraction at parties when people want instant diagnoses (which we are unable to do without our computer anymore than doctors without their stethoscopes!).  

Having said all that, it is boring to be always right, and it came as no surprise that the journey from London through dense fog, having decided many weeks earlier not to drive. My forecast that it would turn out to be a very pleasant evening with a very intelligent audience also turned out to be correct, and I hope that the record attendance enjoyed themselves as much as I did: In case you have forgotten, his very apt Biblical quotation was - John 3, verse 8

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At the turn of the century, Church Street was the centre of medical activity in Kidderminster . When the editor arrived in the town in the mid 1960s there were five practices - Dr. Craig (by the parish church), Dr. Lurring and partners (opposite Thursfields), Dr. Porter ( number 27), Dr. Price and partners (now at Aylmer Lodge) and the present Church Street practice.

With the removal of its last medical incumbents, there are now no doctors practicing in Church Street . At the new premises, however, the partnership will still retain the name of 'the Church Street Practice".

The practice can trace its history back to 1872 when Dr. David Corbet arrived in Kidderminster . He movved into a Georgian house near the corner of Hall street and 'set up his plate'. He later became the town's first medical officer of health and soon had to contend with an outbreak of Typhoid fever. He succeeded in persuading the [local council of the need for a number of public health improvements and the town owes him a considerable debt.

Before retiring in 1909 he was joined by Dr. Hercules Miles and during the inter-war years the practice was served by Dr. Dykes and Dr. Hay. Dr. Dykes son-in-law, Dr. Nairac, joined him in 1938 but left after the war to become an eye surgeon.

Immediately after the war, the National Health Service was being set up and Dr. Dykes gave way to a trio of younger men leaving the forces. Dr. Ken Beatty and Dr. Sam Wadsworth came in 1946 and Dr. John Russel 2 years later. They were responsible for the growth in the practice over the next decade which necessitated the addition of Drs. Geoffrey Campion and Peter Dutton.

This group had the foresight to buy land behind the original Georgian frontage which gave space to expand the building in later years. During this period of growth, they also made their mark outside the practice, contributing to medica! and obstetric services at the hospital and to various committees.

Now they have all been replaced by a much larger company. The 9 partners include 3 women and are supported by an array of staff including nurses, secretaries, receptionists and managers totaling nearly 40. This change has been accompanied by a new emphasis on health promotion and hastened the need for extra space. February 1992 has seen the move to new purpose built premises on the opposite bank of the Stour wh.ich should give scope for further new initiatives but a firm link with the past has been preserved in naming the building David Corbet House.

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In 1991 the first wave of National Health Service Trusts was launched. Hospitals, Community Units and other segments of the Health service, such as Ambulance Services, were encouraged to become independent of their local health authority although they remained responsible to the Secretary of State.

When the first wave of trusts was proposed for 1991 a majority of the medical staff and managers at Kidderminster was against the application. There was suspicion as to the government's motives and concern about the effect on clinical freedom, quality of care and the hospital's ability to maintain certain services for the local community.

There was also a major worry about the financing of phase VI of the hospital's building plan. Furthermore, there had been a considerable increase in the workload of administrators as a result of the implementation of the government's business reforms, and the addition of the work involved in acquiring trust status, added to that necessary for phase VI development was thought unreasonable. No interest was expressed in the second wave which commenced in April 1992 for many of the same reasons.

The attitude of the medical staff had not changed greatly when an application for April 1993 was proposed at the end of 1991. One obstacle had been removed - it was clear that phase VI would be financed by the Regional Health Authority whether or not trust status had been obtained. Two factors influenced the subsequent decision of the medical staff. The first of these was the Regional Health authority's proposal to amalgamate the Bromsgrove / Redditch and Kidderminster health Authorities. This was something the medical staff had been assured to be out of the question a year before and it was most unpopular for historical and financial reasons. T ahere was a fear that Kidderminster would be landed with the debts incurred by the sister district. The second was a visit from a clinician and a manager from Weston who both eulogised on the benefits of trust status. Undoubtedly the fear of a Bromsgrove / Redditch takeover had a major influence and a cynic might suggest that this was the purpose of the proposal.

The way was now clear for an 'expression of interest' to be forwarded to the Secretary of State in September 1991. He managed a business evaluation and consultation with local opinion within 2 months, leaving the way clear for a draft application and business plan by the end of January 1992. The draft comprises a description of the hospital and community units, the local geography and

demography, and the services to be provided by the trust. General proposals for new service developments and buildings are included. All this entailed a great deal of work and help is provided by a regional team. If plans come to fruition a 'shadow' trust will be running by October 1992, followed by full implementation by April 1993.

John Murray

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We were not in a position to consider entry into the first group of fund holders because of extensive building alterations. The new GP contract was also a 'distraction' at the time! However, we were interested to explore the details of fund holding and finally made the decision in principle, subject to a satisfactory budget allowance, after a 'day-away' at a local hotel involving 14 members of staff and doctors.

  The health service reforms are based on the concept of dividing the purchaser and provider roles which seemed to us to be a logical and sensible way forward, and GP fund holding was an extension of that. Certainly, one of the main reasons was in order to maintain choice of referral by our patients and by the doctors on their behalf. This would allow us to continue practising medicine with at least some clinical control - particularly pertinent when considering the implications of the possible merger of the health authority with Bromsgrove / Redditch .

We were already having to review our working arrangements within the practice, and the fund holding exercise acted as a catalyst to further this review. This has led us to divide our staff into departments, each of which interlinks so that communication is maintained, and to more clearly define individual doctor's responsibilitie


There will have been a general election between me writing this and you reading it which may or may not be relevant as far as fund holding is concerned, but there appeared to be a favourable move towards fund holding and we therefore felt that it was  going to be inevItable in due course for all GPs to be fundholders. We would therefore have more influence on the 'shape' of fund holding if we became involved earlier rather than later. Time will tell.

 Peter Batty


Editor's note: The editor is aware of at least three other practices now applying to hold a budget in the 3rd wave. Now that the general election is over I suspect that we shall soon have a 75% fund holding district, plus possibly a Trust Hospital at Bewdley Road .

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At a recent meeting of the Health Authority, the following resolution was passed:

1. 'In view of the current uncertainties and the many views which have been expressed, the Authority agrees that further consideration of a possible merger between Kidderminster and District health Authority and Bromsgrove/Redditch Health Authority should be deferred. Kidderminster and District Health Authority indicates its preference for a local Kidderminster based purchasing Authority'. In commenting upon this, Mr. Malcolm Cooper, Chairman of the Authority said:

2. 'One of the points that we have continually sought to stress is that it is a false analogy to liken the merger proposal to the days of the Mid-Worcestershire Hospital Management Committee. It is inappropriate because of the revised means of funding health services these days and because of the establishment of separate roles for purchasers and providers. Whatever our views on the merger, clearly the whole issue is on ice until after the General Election. I am sure further discussions will be held post the election, because both major parties appear to be committed to a merger of the DHAs and FHSAs. In this country this policy will force us to consider the scale on which such a merger should take place.'


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