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In an important sense, the clinical consultation is the primary activity of medicine, and its autonomy should be the basic principle around which the health service is organised.1
In the case of the individual consultation initiated by the patient, it is relatively clear where the doctor's responsibilities lie in terms of providing a quality service and how this is organised. However, when a consultation is initiated by one or more of the health care team, as part of a nationally prescribed screening programme involving a number of professionals, there is an issue of who takes ultimate responsibility for the quality and delivery of the preventive programme as a whole.
The UN Convention on the Rights of the Child places a clear responsibility on the state to provide access to preventive care, such as maternal and infant health clinics and immunisation (Article 24). The UK has a long history of setting up successful maternal and infant welfare programmes from the turn of the last century,2involving doctors and health visitors with a specific role in this field. The child health surveillance/health promotion programme in the UK is one such nationally prescribed programme developed from professional consensus.
The integration of doctors previously employed by the local authority as medical officers of health working in child health clinics and schools into the NHS structure in 1974 started the move towards a clearer integration of preventive and curative services. With the 1990 NHS Act, the preschool child health surveillance programme for children became an integral part of the general practitioner (GP) contract with the school health programme being maintained by medical officers and school nurses. Pre 1974, there was a strong tradition of child public health, often headed up at district level by a principal medical officer. One of the roles of …
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