128 
MAJORITY REPORT. 
whatever it might be, would be responsible for the efficiency of 
the service provided, and probably they would feel it was 
necessary that the service should be under their direct control ” 
(Q. 23,834). ‘ Whenever this question has been discussed, 
particularly when it was discussed with representatives of the 
Medical Profession in 1919, the greatest possible importance was 
attached to communication between the practitioner and the 
consultant with regard to the case . . . That, I think, is one 
of the weaknesses of the present system that you cannot secure 
that kind of close co-operation, and it is doubtful whether you 
could ever get the co-operation carried out satisfactorily unless 
the consultant and the practitioner were both responsible directly 
to the same body’ (Q. 23,835). °° While it would be very 
desirable to utilise hospital premises by renting them wherever 
possible, the system could not be so satisfactorily worked by 
entering into contracts with the hospitals to provide the service *’ 
(Q. 25,833). 
AVAILABILITY OF OUT-PATIENT TREATMENT AT HOSPITALS. 
272. It appears that the extent to which specialist treatment 
and advice are obtained at the hospitals varies greatly in different 
parts of the country, and even as between different medical men 
practising in the same area. These variations result from :— 
(1) differences in the accessibility of patients to hospitals; 
(2) the different customs of different hospitals, as a whole; 
(3) personal characteristics of particular members of the 
medical staffs of hospitals; 
(4) differences in the attitude of practitioners and in their 
relationships to particular consultants ; 
(5) differences of attitude of insured persons. 
273. In the large centres of population, in the neighbourhood of 
the great hospitals attached to medical schools, there is little 
difficulty in obtaining specialist treatment. Second opinions 
are also readily obtained in the majority of cases by those 
practitioners who take a not unreasonable amount of trouble to 
obtain them. At some of these hospitals, great pains are taken 
to convey to the practitioner information as to treatment which 
has been given, or advice as fo diagnosis or treatment, even 
though he should have himself failed to send particulars of the 
case to the hospital. The position is on the whole less satis- 
factory in places in the immediate neighbourhood of large 
hospitals not attached to medical schools. In such cases the 
general practitioners have probably less confidence in the opinion 
of the staff of the hospital, which includes a considerable propor- 
tion of men who are themselves general practitioners and the 
former, therefore, are not so ready to seek the advice of the latter. 
974. Distance from the hospital plays, obviously, a very 
important part in determining the extent to which insured persons