The changing interface between primary and secondary care.

The way that care of the population is shared, divided, and duplicated between community generalists and hospital specialists is changing. Whereas in 1959 35 % of babies were born at home, by 1983 this had fallen to less than 1 %. Dr Kirk Forsythe surveyed the 412 deaths in his Belfast city practice from 1946 to 1969: less than 40% died in hospital.' I have surveyed the deaths in my Welsh mining village practice: from 1964-1973, of 234 deaths, 32% died in hospital and 66% at home; more recently, from 1974 to 1984, the proportion dying in hospital rose to 40% of 229 deaths, and the proportion dying at home fell to 58%. Of all deaths throughout England and Wales in 1969, only 40% died at home and 57% in hospitals or institutions.2 Major life events, virtually all births and a rising proportion even of physiological deaths, appear to be moving inexorably from the responsibility of community generalists to that of hospital specialists.