iii Book: Bill Ross - 'Order and the Virtual'

'The Philosophy and Science of Deleuzian Cosmology'

My book 'reviews' are unconventional in that they are not journal fare (format and quality-wise...); the book, or my reading of it - invariably refers to Hodges' model. I could argue that is not my fault, but a quality, something built in to the model. Anyway, what of the physical book itself?

The cover image is a marvel: Stone Quartet 1 by Patrick Haughton. 
[ Did someone say 'quartet'!* 😉]

Cover design by www.paulsmithdesign.com

Typeset in 10.5/13 Sabon, the fonts and styling through the book is clear, and easy to read (without regard to the technical content). The paper is thick, the quality contributing to a high contrast. 

The contents:

Abbreviations
Preface by Robin Durie and David Webb
1. Chaos
2. Entropy and the Complete Concept in Leibniz and Deleuze
3. Order
4. Order as Complexity
5. Sufficient Reason as Dissymmetry and the Evolutionary Paradigm
Conclusion
Notes
Bibliography
Index

The EUP website only lists four chapters for Order and the Virtual, but the book clearly has five. The conclusion is similarly omitted online: running from pp.175-181, I wish I'd written it.

That nursing and healthcare practice are bound up in philosophical considerations, values and ethics is fairly obvious. Care dilemmas would arise, calling for a multidisciplinary approach, and cross-disciplinary advice. Through this book, Bill Ross keeps highlighting for me, the way that once the uniform is donned, or the clock denotes an inbetweenness '0900-1700' for community staff, philosophy goes on the back-burner. The heat of the issue, and first rule of first-aid is felt, but it is not the primary concern. There is an international group of scholars for philosophy in nursing (and journal), but practitioners have, by definition - a job to do. If time is chaos and complexity (or appears as), then in health it is continuity, avoiding disruption and more often trying to 'heal' it.

Although Hodges' model presents as a symmetry; it is anything but. If we wish to symmetry-break, Hodges' model may assist. The flux and dynamics of care [insert your context] means that Hodges' model constantly changes its shape, form. Not as an objective statement, but an interpretation. Bill Ross's discussion on Nietzchean chaos and the superior principle of sufficient reason, demands and rewards a close reading (as does the whole text). Whether it is chaos, equilibrium, law and possibility cognitive - conceptual spaces invite ergodic (a cyclic) exploration. The mix of Deleuze and Leibniz's system makes for complex ideas, one probably needs to swim in. The book's first chapters are deep, technical but also inviting. There are encouraging links to psychotherapeutic thought, in the philosophy of difference, and how this is recognised, and change negotiated.

The scale is cosmological, with a section on ergodicity; and (inevitably) time, as per the quotation (p.10):

'Everything which happens and everything which appears is correlated with orders of differences: differences of level, temperature, pressure, tension, potential, difference of intensity. Carnot's principle says this in one way, Curie's principle in another, Gilles Deleuze (DR, 222)' (DR - Difference and Repetition).

There is a ponderous sense when assessment is routinized: assessment must be comprehensive. Do: tick all the boxes. Don't miss anything! How many levels of assessment should there be? If you want this number of assessments, what should I leave out? It is fascinating how we can frame time, not just 'set' against the axes of  Hodges' model, but a product of lifestyle, bio-physics, and even bio-psycho-social-politics. Is back to Earth - back to the individual? Not now. Contrast chronological and pathological time and not just for humanity. Ross follows Deleuze, Poincare, Neitzche and others in the long-term diagnosis of the universe, no less. A heat-death: the anti-fever. Now there's the collective, while in mental health, a diagnosis (or two ...) is still (often) contested, at least on twitter/X.

'The distinction for me is that metaphysics lives in that plane above where the concepts are not tied specifically to one field, but remain free to mobilise the salient questions as they play out among several fields.' p.15.

I don't think this just applies to metaphysics, but the extent (now) to which problems (clinical and generally) are multi- inter- and transdisciplinary (Ross acknowledges the pragmatic). Otherwise, with each step across a disciplinary boundary, our concepts lose their meaning, and the ergodic action (the around and around, back and forth ... our models and frameworks) is more akin to a drunken random-walk.

More to follow ...

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press. 
https://edinburghuniversitypress.com/book-order-and-the-virtual.html

*And is that the fifth domain floating above?

The preface is titled 'Playing Cortázarian Hopscotch':
https://en.wikipedia.org/wiki/Hopscotch_(Cort%C3%A1zar_novel)

There is also a brief  'Series Editor's Preface'

Improving University Teaching - July 2026 Glasgow

Dear Colleagues

A reminder that you are cordially invited to participate in the 52nd International Conference on Improving University Teaching, to be held this year in Glasgow, Scotland. Our conference theme is “Connecting Across Cultures: Collaboration, Compassion, and Creativity,” with a focus on the links that sustain teaching and learning. IUT welcomes proposals in a variety of formats — papers, posters, workshops, and roundtables. More information about theme, subthemes, and presentation formats is available on our website, https://iutconference.com, where you will also find a link for proposal submissions.

This year’s proposal submission deadline is Monday, January 26th.

The dates for IUT 2026 are July 15-17, 2026. Our in-person host is the University of Glasgow in Scotland — the fourth oldest university in the English-speaking world, with a student enrollment of almost 40,000 and a strong tradition of both research and teaching excellence. Once again, this year’s conference will be a hybrid event. We hope many participants will attend the conference in person in Glasgow, but also warmly welcome those who choose to participate remotely.

Whether you prefer to join us online or in person, we hope you will consider a submission. Please contact us at iutconference AT gmail.com with any questions.

With best wishes,

Anne Tierney
President, IUT

Jim Wilkinson
Treasurer, IUT, and President emeritus

Book: Bill Ross - 'Order and the Virtual' ii

'The Philosophy and Science of Deleuzian Cosmology'

Now I can say: "This year, Hodges' model will be presented at WCCS 6th World Conference on Complex Systems", so current reading needs to match this project. And, it does. In spades, in fact c/o and with thanks to Edinburgh University Press. Look at chapter 1! 'Chaos' with Mandelbrot fractals, smooth space drawing from Deleuze and Guattari's A Thousand Plateaus. For readers unfamiliar with the Deleuzian oeuvre, abbreviations of texts that feature in Bill Ross's book Order and the Virtual are listed (xii) and includes key sources by Michel Serres, Henri Bergson and Alfred North Whitehead. This works as you mentally take a note, of work to lookup. Almost twenty years ago, I related some ideas of Michel Serres to Hodges' model:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109. 

Ross discusses the extent and proximity of Deleuze's thought to chaos, complexity theory and science more generally as identified by commentators. Now up to chapter 4, it would have helped to have a look at the bibliography at the book's end. Deleuze saw how his work resonated with chaos theory. Steve Strogatz's book (now in a 3rd edition):

Strogatz, S.H. (2015) Nonlinear Dynamics and Chaos: With Application to Physics, Biology, Chemistry and Engineering. 2^nd edition. Perseus Books Publishing, Cambridge. 

- explains in the introduction how 'home computing' contributed to the aesthetic appeal of fractals, which could display incredible patterns derived from seemingly simple mathematics. Even though, the programs often required many hours of running to deliver their results.

In the late 1980s I was fascinated with a subscription to Fractal Report:

https://stephen.shawweb.co.uk/Fractalreportindex.html

The relevance for me of Order and the Virtual is apparent on page 1, Deleuze and Guattari's thought having an immediate transdisciplinary application, crossing boundaries, and the creation of regions of bifurcation. Ross connects Deleuze's thought and Ilya Prigogine & Isabelle Stengers' text:

Order Out of Chaos: Man's New Dialogue with Nature. London: Heinemann, 1984 

Ross is encouraging (to me and for Hodges' model), as he notes how the notions may be inexact, but they are nonetheless rigorous. Spanning as they do, philosophy, science - what is scientific(? - itself a boundary - demarcation) and artistic. I've often thought of Hodges' model as filled with folds, and multiple bifurcations. It looks like Bill Ross is going help me to isolate several, and possibly make my search more efficient (the latter really would assist). The memorial event held in Manchester last September was revalatory. Since the early 2000s I'd grown to  really appreciate the availability of books by Michel Serres. I was not aware of the force behind the Clinamen Press, which Bill Ross established in 1999. 'Clinamen' is a useful concept too, which I have encountered previously, through Serres and Lucretius. 

Readers new to philosophy, sociology and the development of ideas must often grapple with a new and specific vocabulary. This is a primary purpose of such texts. On page 2 the springboard is sprung, the Event is key in Deleuzian scholarship. The Event is a force for creative and disruptive force for thought,  idea generation and creativity. The Event is experienced in our current 'realities' of: time and space (Kronos) where things are actualised, and the virtual (Aion) - the pure Event. This lack of hesitation is welcome. Our 'virtual' world quickly provides access to reading:

parrhesia 27 · 2017 · 1-12
extract from the birth of physics
michel serres, translated by david webb, with an introduction by bill ross
https://parrhesiajournal.org/wp-content/uploads/2023/10/parrhesia27_serres.pdf

Where you have bifurcations, you have convergences and divergences, stasis, state - stasis or not, paths, a series and metrics. We are reminded that science is not just about theory - metaphysics, it is, sleeves rolled-up about doing too; as I've noted in subsequent reading. As 'chaos' predicts, there is no let up,  the Choasmos, quickly follows. I'm thinking of a 'situation' clinically as a rollercoaster - 'constant displacement' seeking a difference, and repetition, the ravages of alcohol, dementia, low mood, psychosis, obsession and compulsive 'states'. The chaosmos is central in Hodges' model, although as both continua and oppositions. Ross explains how Deleuze's chaosmos is not necessarily scientific, but belongs to the ancient cosmologies of the Greeks (p.3). I thought of flux here. 'Parity' is not just a physical metric, but a quality that acts, seeks resolution - equilibrium(?) - between the mental chaos and physical chaos.*

Thinkers like Deleuze 'trap' words, concepts, in boxes, drawing from other other sources (for chaosmos - with Guattari again); then they can be examined and tested for their scope, application, meaning and association. Hodges' model provides a trap, for any situation. Not as specific as a physicist's ion (or Penning) trap, but the model can act as a series of holistic traps. To provide a metric of holistic bandwidth.

*Of course, equilibrium is never found - until the 'End'; such is the nature of flux. 

More to follow...

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press. https://edinburghuniversitypress.com/book-order-and-the-virtual.html

Space for Medicine - ISS

NASA - International Space Station

Space Medicine

International Space Station Update: Thursday, Jan. 8, 2026

Individual

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

ETHICS CONFIDENTIALITY CONFIDENCE   'COMMS'    MENTAL HEALTH   BEHAVIOURAL HEALTH & PERFOIRMANCE   PRIVATE PSYCHOLOGICAL COMMUNICATION    CIRCADIAN HEALTH PERSON-CENTRED HEALTH/DISABILITY	INTERNATIONAL SPACE STATION  distance - remoteness EARTH orbit  LAUNCHES - RE-ENTRY WINDOWS   TRAINING MEDICAL EMERGENCY in SPACE HEALTH - EMERGENCY CONSTRAINTS - CONTIGENCIES PLANNING - TIME - PROBABILITY 'MONTE CARLO' MODELS/SIMULATIONS DIAGNOSIS: INJURY, RADIATION, MUSCULOSKELETAL, NEUROLOGICAL, VISION, microGRAVITY
CREWS WELFARE - PRIORITY  SOCIAL - WELL-BEING	NASA POLICY - PREPAREDNESS MEDIA RELATIONS

NASA Spaceflight Human System Standard Volume 1: 
Crew Health

'NASA-STD-3001 Volume 1 covers the requirements needed to support astronaut health and provide medical care while Volume 2 covers human-related vehicle system design and operations requirements that will maintain astronaut safety and promote performance.'

Additional reading:
Farrell, R.M., Fogarty, J.A., Covington, M. et al. A moonshot for female astronaut health, a win for all astronauts and space exploration. npj Microgravity 11, 38 (2025). https://doi.org/10.1038/s41526-025-00495-8

 

Marshall Porterfield, D., Tulodziecki, D., Wheeler, R. et al. Critical investments in bioregenerative life support systems for bioastronautics and sustainable lunar exploration. npj Microgravity 11, 57 (2025). https://doi.org/10.1038/s41526-025-00518-4

  

Rizzo, A., Borra, E.M., Ciciani, L. et al. Foundations of radiological protection in space: the integrated multidisciplinary approach for next manned missions in deep space. Eur. Phys. J. Plus 138, 1001 (2023). https://doi.org/10.1140/epjp/s13360-023-04572-3

The National Space Institute -  
https://nss.org/the-national-space-institute/

During the 1990s I was a member of the 
Space Nursing Society -
https://nss.org/space-nursing-society-chapter/ 

London Institute of Space Policy and Law - 
https://www.space-institute.org

 

See also: 'NASA' : 'astronautics'

 

Hodges' model: An algebra for care - seeking axioms?

Although Oliver had been brought up by philosophers, he was not theoretically acquainted with the beautiful axiom that self-preservation is the first law of nature.
                                                                                    
- Charles Dickens, Oliver Twist

Coady, C. A. J. (1990). Hobbes and “The Beautiful Axiom.” Philosophy, 65(251), 5–17. 
http://www.jstor.org/stable/3751240

"It is an axiom in therapeutics that the more remedies there are proposed for a disease the less likely is any of them to be effective."

[- William Osler]

Mountin, J. W. (1943). Nursing: A Critical Analysis. The American Journal of Nursing, 43(1), 29–34. https://doi.org/10.2307/3416264

Individual

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

'One of the core tenets of pragmatism, despite its various formulations by William James, Jane Addams, John Dewey, and neo-pragmatists like Rorty, Habermas, and Putnam, is an epistemological axiom first formulated in 1868 by Charles Sanders Peirce. This maxim, often dubbed the pragmatic maxim, states that the meaning of our ideas is best expounded when we can spell out the implications or the effects of these ideas in real-world experience and practice (Peirce 1878).' pp.105-106. (Racine, 2024).

physical - SELF - My body[?]

'The lack of consideration of downside risks applies to all COVID-19 countermeasures, including mass-masking (e.g. the social and psychological consequences of mask-wearing for all kinds of social interaction, most notably in educational and childcare settings) and to the accelerated approval of vaccines. The latter is particularly noteworthy because the need for rigorous testing of new medications to guard against the risk of side effects is a standard axiom of contemporary ethical medical practice. Given that the vaccines in question employed novel mechanisms, not testing them sufficiently to assure their longer term safety was stratospherically risky: it meant that the possibility that this vaccination programme would do more harm than good could not be excluded. Yet, the medical establishment stood foursquare behind it, insisting on the safety and efficacy of the vaccines and pillorying any, including those within it, who demurred.' p.55. (Kelly, 2023).

'“Never have we been so free. Never have we felt so powerless”: this, according to Bauman, is the paradox of our time. Verhaeghe writes with a variant: “Never before have we in the West had it so good, and never have we felt so bad.”33 Because neoliberal axioms determine the standards of what is healthy and normal, society sees those who do not want to participate as sick or abnormal.' pp.97-98. (Vanheste, 2023).

My emphasis

Racine, E. (2024). What Participatory Research and Methods Bring To Ethics: Insights From Pragmatism, Social Science, and Psychology. Kennedy Institute of Ethics Journal 34(1), 99-134. 
 https://dx.doi.org/10.1353/ken.2024.a943431.

Kelly, M.G.E. (2023). Securing the Pandemic: Biopolitics, Capital, and COVID-19. Foucault Studies 35, 46-69. https://muse.jhu.edu/article/940834.

Vanheste, J. (2023). Half a Century of Exhaustion and Madness: The Fiftieth Anniversary of Pink Floyd's The Dark Side of the Moon. Soundings: An Interdisciplinary Journal 106(1), 87-109. 
https://muse.jhu.edu/article/950363.

See also: 'axiom' : 'algebra' : 'pragmatism'

Person-centred care = care axiomatics at a collective and individual level?

The first rule (axiom?) of first aid is...?

Healthcare Evolution through AI and Digital twins - HEAD 2026

Dear colleagues,

We do hope this Call for Papers may be of your interest.
We do apologize if this CfP reaches you more than once.

Yours sincerely
HEAD Organizers

=========================================================

Healthcare Evolution through AI and Digital twins - HEAD 2026

18 - 21 May, 2026 - Sydney, Australia

https://www.head.icar.cnr.it/

- in conjunction with the 26th IEEE International Symposium on Cluster, Cloud and Internet Computing (CCGrid 2026) and in-cooperation with ACM SIGHPC

Submit your paper by using the link:

https://easychair.org/conferences/submission_new?a=35863199

=======================================================

MISSION:
------------

All over the world, the number of investments in Information and Communication Technology (ICT) for healthcare and wellbeing (eHealth) is rapidly increasing. GLOBE NEWSWIRE has predicted that the Global eHealth market is expected to reach $123.78 billion by 2030. This means that digital health is of considerable interest worldwide, as it has the potential to improve both the quality of services and users’ access to health information, while also saving time and reducing the workload and associated costs for health service providers in the long term.

In this context, an increasing interest is growing around eHealth and ICT technologies, such as Artificial Intelligence (AI), Digital Twins, Cloud computing, Edge and Fog computing, and Internet of Things (IoT),

which are at the basis of revolutionising healthcare by bringing innovative network applications and services. In fact, modern healthcare applications are becoming increasingly dependent on heterogeneous infrastructures, including IoT and edge medical devices, as well as High-Performance Computing (HPC) backends, to support the execution of AI-driven models and patient-specific Digital Twins.

The HEAD workshop would explore the open challenges and current issues surrounding the application of these technologies, while bridging the gap between healthcare innovation and the hardware and software systems that support scalable and reliable computing. HEAD aims to encourage interdisciplinary discussion about how technologies such as HPC, distributed systems and performance optimisation can facilitate the deployment of reliable and scalable Digital Twins for healthcare. The workshop will highlight the role of computing infrastructures as key enablers of future digital medicine by linking algorithmic advances with architectural and systems-level innovations.


TOPICS:
----------

■ AI Algorithms and Learning Frameworks for Healthcare
■ Modeling and Simulation Methodologies for Healthcare
■ Programming Techniques and Architectures for Healthcare
■ Data Management, Analytics, and Knowledge Extraction
■ ICT Infrastructure and Tools for Healthcare Digital Twins
■ Cloud Computing, Edge and Fog Computing for Healthcare
■ Internet of Things (IoT), Big Data, and Wearable Devices for Healthcare
■ Ethical, Legal, and Societal Implications of ICT for Healthcare
■ Accelerator-based architectures (GPUs, NPUs, FPGAs and DPUs) for Healthcare
■ Parallel and Distributed Training and Multi-GPU/Multi-Node Execution for Healthcare Applications
■ Energy-Efficient, Sustainable, and Optimization-Oriented Computing for AI in Healthcare


IMPORTANT DATES:
--------------------------

• Submission deadline: February 01, 2026
• Notification of paper acceptance: February 28, 2026
• Submission of camera-ready papers: March 15, 2026
• Registration: March 15, 2026


PAPER SUBMISSION:
---------------------------

Manuscripts should describe original work and should be formatted according to the IEEE conference proceedings format. 

Papers will be submitted through the CCGrid 2026 submission system.

Submit your paper here:

https://easychair.org/conferences/submission_new?a=35863199

All submissions will undergo a rigorous peer-review process. Each paper will be reviewed by at least three members of the Technical Program Committee. Reviews will be double-blind.

Accepted papers will be published in the CCGrid 2026 workshop proceedings and will be submitted for inclusion in IEEE Xplore.


BEST PAPER AWARD:
---------------------------

A Best Paper Award certificate will be conferred on the author(s) of a paper presented at the workshop, selected by the Chairs based on scientific significance, originality, and technical quality, as evaluated by the Program Committee.

Please visit https://www.head.icar.cnr.it/  for more information and if you have any questions kindly get back to us by sending an email

Kind regards,
HEAD 2026 Organizers

My source: Dr. Giovanna Sannino

KU Leuven - LCHH2 Health Humanities Lecture Series 2025-2026

Dear all,

The Leuven Centre for Health Humanities organises a yearly lecture series and we would love to invite you!

This year’s lecture series explores the entangled relations between nature and health. Bringing together perspectives from medical history, psychology, disability studies, colonial studies, and environmental humanities, the talks examine how ideas of nature have shaped — and have been shaped by — practices of care, control, and coexistence. Topics range from the rise of disposable medical technologies and their environmental costs, to colonial disease management at the cattle frontier, and from the ambivalent role of “nature” in the lives of people with disabilities to contemporary debates on the restorative effects of natural environments. The series also turns to the microbial world, challenging human exceptionalism and rethinking health as multispecies interdependence rather than biological mastery. Together, these lectures invite critical reflection on sustainability, vulnerability, and care, and offer new ways of imagining health in a world where human and nonhuman lives are profoundly interconnected.

Join us online and on campus, at KU Leuven, for a series of inspiring health humanities talks.

You can find more information about the lectures and how to register here:

Health Humanities Lecture Series 2025-2026 — 
Leuven Centre for Health Humanities (LCH²)

Best wishes,

Lore Delahaye (she/her)
Administrative Support

KU Leuven
Doctoral School for Humanities and Social Sciences
Blijde Inkomstraat 5, box 3000
3000 Leuven

https://ghum.kuleuven.be/phd

Primary & Secondary Health Care - How long...?

THE DAWSON REPORT

MINISTRY OF HEALTH.

CONSULTATIVE COUNCIL ON MEDICAL AND ALLIED SERVICES.

Presented to Parliament by Command of His Majesty. [... selected extracts]

3. The general availability of medical services can only be effected by new and extended organisation, distributed according to the needs of the community. This organisation is needed on grounds of efficiency and cost, and is necessary alike in the interest of the public and of the medical profession. Measures for dealing with health and disease become, with increasing knowledge, more complex, and, therefore, less within the power of the individual to provide, but rather require combined efforts. Such combined efforts to yield the best results must be located in the same institution. As complexity and cost of treatment increase, the number of people who can afford to pay for a full range of service diminishes. Moreover, enlightened public opinion is appreciating the fact that the home does not always offer the best hygienic conditions for dealing with serious illness, which requires special provision in order to give the patient a full chance of recovery.

4. In days gone by such conditions as appendicitis were treated with poultices and drugs in the patient’s home. Now they are treated by operation, which is more effective, but requires more equipment, a team of workers, and a larger expenditure. Such conditions as diseases of the lungs formerly received clinical examination and treatment by drugs. They now may require, in addition, the attention of the pathologist and the radiologist. This means greater efficiency, but more organisation and higher cost.

5. Preventive and curative medicine cannot be separated on any sound principle, and in any scheme of medical services must be brought together in close co-ordination. They must likewise be both brought within the sphere of the general practitioner, whose duties should embrace the work of communal as well as individual medicine. It appears that the present trend of the public health service towards the inclusion of certain special branches of curative work is tending to deprive both the medical student and the practitioner of the experience they need in these directions.

6. Any scheme of services must be available for all classes of the community, under conditions to be hereafter determined. In using the word “available,” we do not mean that the services are to be free; we exclude for the moment the question how they are to be paid for. Any scheme must further be such that it can grow and expand, and be adapted to varying local conditions. It must be capable of comprising all those medical services necessary to the health of the people.

7. The foregoing are some of the considerations which have guided us in drawing up the scheme outlined below.

The services maybe classified into-

Those which are Domiciliary as distinct from those which are Institutional.

Those which are Individual as distinct from those which are Communal.

1. We begin with the home, and the services, preventive and curative, which revolve round it, viz., those of the doctor, dentist, pharmacist, nurse, midwife, and health visitor. These we style domiciliary services, and they constitute the periphery of the scheme, the remainder of which is mainly institutional in character. A Health Centre is an institution wherein are brought together various medical services, preventive and curative, so as to form one organisation. Health Centres may be either Primary or Secondary, the former denoting a more simple, and the latter a more specialised service.

2. The domiciliary services of a given district would be based on a Primary Health Centre -an institution equipped for services of curative and preventive medicine to be conducted by the general practitioners of that district, in conjunction with an efficient nursing service and with the aid of visiting consultants and specialists. Primary Health Centres would vary in their size and complexity according to local needs, and as to their situation in town or country, but they would for the most part be staffed by the general practitioners of their district, the patients retaining the services of their own doctors.

3. A group of Primary Health Centres should in turn be based on a. Secondary Health Centre. Here cases of difficulty, or cases requiring special treatment, would be referred from Primary Centres, whether the latter were situated in the town itself or in the country round. The equipment of the Secondary Centres would be more extensive, and the medical personnel more specialised. Patients entering a Secondary Health Centre would pass from the hands of their own doctors under the care of the medical staff of that centre. Whereas a Primary Health Centre would be mainly staffed by general practitioners, a Secondary Health Centre would be mainly staffed by consultants and specialists. It would be a consultant service in function and would be carried out by specialists or by general practitioners acting in a consulting capacity.

4. Secondary Health Centres must of necessity be situated in towns, where alone an efficient consultant service and adequate equipment could be expected, and the necessary means of communication exist. The selection of these towns will need careful consideration, and full information will be required as to the extent of existing provision of hospital and allied facilities, and of its distribution in relation to population and means of public conveyance. In rural areas the natural currents of traffic and business and existing medical facilities will usually indicate the town or towns in which a Secondary Health Centre may best be placed. In this connection we would like to point out the importance of carrying out a “Hospital Survey” at an early date. The results of this survey would afford data for recognising the areas in which the existing provision is inadequate, and the degree of the inadequacy. The Secondary Health Centres would vary in size and elaboration according to circumstances.

5. Secondary Health Centres should in turn be brought into relation with a Teaching Hospital having a Medical School. This is desirable, first in the interest of the individual patient, that in difficult cases he may have the advantages of the highest skill available, and secondly in the interest of the medical men attached to the Primary and Secondary Centres, that they may have the opportunity to follow the later stages of an illness in which they have been concerned at the beginning, to make themselves acquainted with the treatment adopted, and to appreciate the needs of a patient after his return to his home. In those towns where Teaching Hospitals exist, Secondary Health Centres would sometimes be merged in them. 

Continued at: 

https://sochealth.co.uk/national-health-service/healthcare-generally/history-of-healthcare/interim-report-on-the-future-provision-of-medical-and-allied-services-1920-lord-dawson-of-penn/

LONDON PUBLISHED BY HIS MAJESTY'S STATIONERY OFFlCE

1920. Price 2s. Net. Cmd. 693

See also:
https://www.adph.org.uk/resources/175th-anniversary-timeline/ 

My emphasis.