© City of London/London Metropolitan Archives

© City of London/London Metropolitan Archives

© City of London/London Metropolitan Archives

1965-2009

By Virginia Smith

In 1965 control of the Health Centre passed from the LCC to the newly formed London Borough of Hackney and its health department. In commemoration of this it was re-named the John Scott Health Centre after the hard-working Medical Officer for Health who opened it. Land was also bought at rear of centre as extra play-space for the day nursery. The Centre had clearly bedded down after the initial surge of activity and was a proud flagship for the Borough.

But direct borough control of health services was about to disappear after a century of development and expansion. In 1974, all UK public health organisation changed. Social services and medical services were split, with local authorities retaining social work and the NHS taking over health policy. The traditional local authority medical officer of health disappeared, and local hospitals, and primary care services such as health centres, came under the NHS and new NHS healthcare planning teams. In 1975 the Centre was transferred to the new NHS City and East London Area Health Authority.

Nothing much changed at John Scott, except that the NHS paid the bills, and NHS policy shaped its services. The purpose-built facilities of the Centre proved to be ideal for the new discipline of ‘community medicine’. In 1984, the former St Leonard’s Hospital became a centre for coordinating community services and supporting health centres. They organised the various district preventive medical services, including physiotherapy, chiropody, a disability resource centre and a diabetic day centre. John Scott was by then already developing new and successful services, such as the much-used family planning service – led by Dr Jane Leaver – which had a clinic, classes and a domestic visiting service. There was also a small homeless families unit, which treated people from streets and hostels in the 1980s housing crisis, described by Dr Leaver as "a very special place".
 
It was in the late 1980s that health management arrived, and in 1989 John Scott acquired its first practice manager. Previously it had been rare for doctors to have even a surgery secretary (other than a receptionist), and many doctors (or their wives) did all their own paperwork. The John Scott's GPs decided they would share a modern practice manager and they appointed Jane Haile ¬ who stills work there to this day. She soon found that managing four practices would not work, because the doctors were too independent; so she suggested that each surgery should have their own practice manager. Shortly afterwards the two group practices, 'Cedar' and 'Heron', were formed, led by Dr Richard Carver, and Dr Janet Millar. Dr Beerman's single-handed practice remained, assisted by an experienced locum, Dr Virbala Patel, who later took it over.
 
By the 1990s all the GP practices were flourishing, but the building was reaching the limit of its capacity. The choice was either to knock it down or adapt it. So in 1998-99, the ground floor was extensively re-modelled to provide more space for the GPs, and to separate the practice entrances. As a result the central revolving door was finally locked, and the central reception area was reduced and partitioned, and the Heron Practise occupied a new extension in the middle. More offices and consulting rooms were attached to the rear of the old GP suites on both wings. Upstairs, the canteen, the night-doctor’s flat, the caretaker’s flat, the operating theatre and the telephone exchange gradually went as the pressure for office space grew. A new early-years Sure-Start Children's Centre was built in the 1990s, next to the original nursery.

During the refurbishment a portakabin was built in the back car park for Dr Patel's practice, until she could move into her new rooms. Afterwards it was used for a few years as a renal dialysis unit. In 2002 it became The Sanctuary - a practice dedicated to asylum seekers and the homeless, run by Dr Angela Burnett, a doctor from the renowned Medical Foundation for the Care of Victims of Torture. This was prompted partly by the GPs themselves, who found that these patients had multiple problems that were not easy to deal with in a normal surgery. Hackney and the city of Derby thus provided the first and only dedicated practices in the UK for this purpose; although it also harks back to John Scott’s previous homeless families unit in the late 1970 and 80s.
 
The major administrative change of the 1990s was computerisation. This arrived piecemeal, introduced by the practice doctors themselves, who were being bombarded by computer salesmen, each with different systems. (In the end, the EMIS system proved to be the best, and is still in use). For the GP – and the patient - the computer became ‘the third person in the room’.

The worldwide web has helped GPs get access to a huge medical library, at the flick of a mouse. Doctors, nurses and midwives now extract information and input their data, immediately, in front of the patient. This is a big change to the old style of consultation. Computerisation has also revolutionised public health, as it has made tracking patients for vaccination programmes, referrals and 'follow ups' for specialist clinics (such as diabetes or heart disease) far easier. Computers have also improved patient reception procedures, and pathology test results coming from the hospitals. But they have also created a lot more paperwork and administration, with a lot more data ‘clerks’ and IT specialists employed.

The John Scott is currently run by the NHS City and Hackney Primary Care Trust (CHPCT), and is the base for a large NHS primary healthcare team on the second floor, but also assisting and integrated with the ground-floor GP practices. The current list of primary care trust services is remarkably similar to earlier services - except that the child guidance department (paediatric mental health services) has gone. There are instead far more nursing services – practice nurses, and specialist nurses, as well as community adult nurses (the equivalent of a district nurse). This is confirmed by oral evidence. Partly as a result of these developments, each practice at the John Scott employs more staff than ever before, with Christmas parties rising to 50-plus people.