Biomedical subjects
Publications and source records attributed to N Starey.
There are major governance issues for primary care trusts which need to be addressed now. Greater accountability to the community is needed. There should be clear and rapid moves towards a democratic model. Electing a third of board members every year for three years, with participation by the local population, would improve democratic accountability.
The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community.
In a radiological study of the pelvis in 66 adult subjects with Down's syndrome, 25 (38%) were found to have the classical pelvic sharpe associated with Down's syndrome in infancy and childhood. The appearance of the pelvis and hip joints was very variable and matched the variety of appearances seen in normal subjects, except that generally the pelvis was smaller than normal. The discriminating value of the iliac index (which is abnormal in up to 80% of affected infants) was lost in this group of affected adults. Subluxation and osteoarthrosis of the hips were very uncommon features. In addition to the primary morphological abnormalities in the pelvis in Down's syndrome that are described in the literature, posture probably plays a part in producing the variable radiological appearances of the pelvis.