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One of the avowed intentions of the creators of the National Health Service was to bring about an equitable distribution of doctors throughout the country. This thesis traces the history of general practice and although there is no doubt that the standards and structure of general practice have improved since 1948, it is also found that attempts to alter the distribution of general practitioners have proved remarkably ineffective. A computer model is constructed to simulate the geographical movements of general practitioners based upon the theory of Markov chains using data extracted from the lists of first admissions to, re-admissions to, and withdrawals from general practice compiled by the Department of Health and Social Security. The model demonstrates the fact that the forces underlying the mobility patterns of doctors have been invariant in time. It also shows that the various geographical regions of the country may be represented by a graded system in which the Southern non-industrial areas of the country exhibit a superior ability to attract doctors from most of the other regions. The vacancies in the industrial and urban areas are filled on the whole by immigrant doctors. Also shown by the model are the differing and greater mobility and early retirement rates of women doctors. The ability successfully to fit a stochastic process to the geographical movements of general practitioners implies that their distribution tends towards an equilibrium position. The thesis shows that this position has been virtually reached at the present time. Given the freedom of general practitioners to make appointments to their partnerships and group practices and their independent status within the National Health Service, it seems reasonable to conclude that the status quo is likely to remain in the foreseeable future.

This study explores the relationship between mother and health visitor through their perceptions of a home visit. The aims are to describe the interaction on a routine home visit, compare the perceptions of the participants, and explore their contrasting views. Through this exploration the worth of home visits is demonstrated. The theoretical framework was based in ethnomethodology, and multiple methods of data collection provided complimentary data. Fifteen volunteer health visitors carried out a routine home visit to three primiparous mothers with babies aged 2 and 6 months. This visit was tape recorded. Both client and health visitor were interviewed by the researchers and were asked to complete a short questionnaire after the visit. There was a similarity of views about the visit and their relationship. Both participants judged a successful visit in terms of the client's response and satisfaction. To the health visitors, a good relationship was not necessary to carry out their work. To the clients, however, a good relationship was of prime importance. A non-authoritarian approach was much preferred. The interaction revealed a number of verbal ploys whereby the participants guided the interaction. The health visitors, while possessing more power than they think they have, use many strategies to ensure acceptability. The home visit is demonstrated as an interaction of some complexity, providing possibilities for the exchange of information, with the client very much an equal participant. The research ends with recommendations for management, education, and practice, one of which is the use of a health visitor/client contract, which might effectively explain the service offered, and assist in forming good relationships.

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