The introduction of the NHS in 1948 changed this picture radically. PH was separated from clinical practice and remained under Local Authority control. This was a profound disappointment to many PH practitioners. Some PH doctors became full- time medical administrators. Between 1948 and 1974 PH in many areas began to acquire new roles and identify gaps that had occurred as a result of the radical changes. Perhaps the most important of these was the co-ordination of services between GPs and hospitals for example for maternity and child health. Despite advances in some parts of the country, this was a period of turmoil and uncertainty for PH. The differences between Local Authorities became greater - in some, such as the counties, MOHs were treated as professionals and given freedom, while in many urban areas elected councilors played a far more active and interventionist role. At the same time social workers and environmental engineers (sanitary officers) became restive and achieved independence under their own directorates.

The 1974 reorganization integrated all health authorities. The Todd Commission of 1968 had suggested a change in name - community medicine - and the creation of a unifying faculty, responsible for education and standards. This has not been the end of reorganizations. In 1982, the area tier was abolished, and in 1989/9 1 the number of districts and regions was reduced, and the purchaser/provider split introduced. In 1995/6 regional directors of public health effectively became civil servants as employees of the NHSE.

A common concern over this period has been the difference in relationship between trained medical practitioners. Once the position of consultant or partner has been achieved practice is essentially controlled only by themselves. Historically PH has worked within a hierarchy, with the MOH or DPH as leader. One of the effects of the 1974 reorganization was the gradual disappearance of this hierarchical relationship.

A major contrast between PH and clinical practice is that the former is usually concerned with the health of populations, whereas the latter with the health of an individual. To influence the latter requires diagnosis and prescription of treatment. To influence the health of a population also requires diagnosis - but the provision of a remedy is more complex. It is rare for a public health remedy to be administered by an individual. It is essential to recruit the help and resources of others.

One of the most effective tools for the PHP is the public annual report of health, which can highlight problems, possible solutions and assess progress. The requirement for these annual reports was abolished in the 1974 reorganization but reintroduced in 1988. After a generally poor start, these reports have improved greatly, but in more recent years have become less effective.

One major organizational issue involving PH as a key player continues to demand skilled attention - how to allocate limited resources within the context of exploding demand for health care.