Trained nurses could diagnose and treat a large proportion of patients currently consulting general practitioners about minor illness provided that the nurse has immediate access to a doctor.

The conclusions from recent analyses of the clinical worth of routine antenatal attendances have been used in the setting of a modern primary health care team. As a result the number of times a low risk nulliparous woman is seen by her general practitioner has been reduced from 15 to eight and a low risk multiparous woman from 15 to six. The number of consultations with a midwife has also been considerably reduced. The time saved is used in longer, more structured consultations and for more intensive care of high risk, usually socially deprived, women. Despite these reductions in consultations organised, well recorded care of this type renders antenatal attendances at a hospital virtually unnecessary for low risk women. Introduction Traditional, routine antenatal care that is, monthly attendances to 32 weeks, fortnightly to 36 weeks, and weekly to term-was promulgated in the 1930s to cope with the problems of the socially and medically deprived women of that time. The system is no longer relevant to the female population of the 1980s and its continuation is a meaningless and unnecessary waste of resources. The endless string of normal findings painstakingly recorded on cooperation cards in hospitals and general practices must suggest that some consultations might have been a waste of time for the midwife, doctor, and especially the mother. Careful and detailed statistical analyses of many thousands of antenatal consultations looking for the predictors of pre-eclamptic toxaemia and intrauterine growth retardation have shown that for the purposes of clinical detection the number of consultations could be dramatically reduced without decreasing predictive accuracy.' 2 In the setting of our modern primary health care team and with due regard to the psychosocial problems of pregnant women these ascetic statistical analyses have been injected with a modicum of "general practitioner humanity" and a new programme of antenatal care prescribed.3 The programme includes some of the newer investigations currently thought to be of value.

SUMMARY Two hundred and twenty eight deprived children were compared with a matched sample of more endowed children living in the same urban area. Both groups were served by the same experienced primary health care team. The deprived group had a significantly higher number of general practitioner consultations and admissions to hospital (aged under 5) and a significantly higher recorded prevalence of mental and psychological disturbance (aged 5-15). Accident and emergency attendances were significantly higher for the deprived group throughout childhood, as were non-attendances for medical care appointments. The deprived group had much worse rates of immunisation and significantly later immunisations; practical measures subsequently adopted to improve this uptake of immunisation are described.

A detailed comparison made in late 1984 of 587 matched pairs of patients from neighbouring deprived and more endowed urban communities, both served by the same experienced primary health care team, showed much worse morbidity, with almost three times as much mental illness, in the deprived group. This group also had 60% more hospital admissions and 75% more casualty attendances. In contrast, they had a much lower uptake of preventive health care, especially childhood immunisations and cervical cytology in older women. A much higher birthrate within the deprived group, contributing to ill health by worsening overcrowding and deprivation, indicates that family planning is ineffective where it is most needed. Practical measures have now been instituted to improve the preventive care of the deprived community.

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