REGION II.

The Use of the District Medical Officer in a Consultant Capacity. The opportunity afforded, under the District Medical Officer Scheme, to panel practitioners of referring cases on their own account has been little used; in point of fact many do not know that such a facility exists.

Further, the swelling number of Approved Society references has made it quite impossible to attempt any extension in this direction. In some districts advances towards such an extension have had to be deprecated, as the necessary time has not been available. The work, therefore, especially in industrial areas, has largely come to be the assessment of fitness or unfitness for work, and the clinical examination of the patients has been directed to that end exclusively, an end undoubtedly of great economic value, but one that would appear to fall far short of the ideal, and that may tend to an unfortunate shifting of the responsibility.

In the Northern District a certain amount of consultant work. has been overtaken. The number of Approved Society references is not in any way comparable with that in the industrial areas; the district is wide and scattered, containing many rural one man" practices, and most important of all, the necessary time is available for coming into personal contact with the general practitioner. This tends to establish mutual trust, confidence and understanding.

66

An analysis of the practitioner references since the commencement of the scheme has been attempted with a view to gaining some idea how far a district medical officer can supply the place of a consultant; to what extent his usefulness in that direction would be increased if full facilities for laboratory and specialist aid were available; and how far such work is a part of the problem of hospital facilities for the insured persons and the class of case on which a general practitioner seeks advice.

66

Practitioners' References.-During the past five and a half years 40 practitioners have referred cases on capacity for work"; 98 practitioners have referred cases on state of health"; 111 different practitioners have referred cases.

66

Five hundred of the above cases have been analysed, and each

of these is an individual case.