Changing patterns in the organization of the venereal diseases service in Great Britain.

The venereal diseases services in Great Britain was established over half a century ago in 1916 as a result of a report by a Royal Commission set up to advise the government. An Act of Parliament, the Venereal Diseases Regulations of 1916, instructed local authorities to build, equip, and staff clinics in all areas of the country, where treatment was to be free and confidential. Further legislation, the Venereal Diseases Act of 1917, made it an offence for anyone to advertise treatment or for anyone other than a qualified doctor to treat those with venereal diseases. After 30 years under local authority control, the clinics were incorporated into the National Health Service in 1948 and became the responsibility of the Boards of Governors of Teaching Hospitals or of the Regional Hospital Boards. Gradually a comprehensive service has been built up covering the whole country with the major centres at the teaching hospitals (Table I). There are about 200 clinics in England and Wales and twenty in Scotland and Northern Ireland, a total of 220 clinics serving a population of 55,711,000. They are staffed by consultants, medical assistants, and junior doctors in all the usual training grades. In addition there are nurses, technicians, and clerical staff, as well as TABLE I Structure of the venereal diseases service in Great Britain medical social workers and specially trained contact tracers. Many clinics are open for long hours each day-often up to 9 hours-in order to make it as easy as possible for those who may be infected to receive medical attention as early as possible. Some of the smaller clinics are open for only a few hours each week. Notices advertising the clinics are usually posted in public buildings such as town halls, and in public lavatories, health departments, and some post offices. A venereal diseases telephone service giving the address, telephone number, and hours of opening for medical consultation is available in some areas. Venereology is now an independent medical specialty, completely separate from dermatology and close to general internal medicine. It is recognized as a specialty within the field of medicine by the Royal Colleges of Physicians and the universities, but it is still the only medical specialty in Britain without a university chair. A suitable plan for the training of future consultants has been accepted by the Royal Colleges of Physicians and arrangements are well advanced for the establishment of …