- Email: [email protected]
ROYAL COMMISSION ON THE N.H.S.
1183 has her diabetic control
supervised.
All that
happens
of repeat prescriptions, and often the patient does even see the doctor. stream ‘
is
a
not
look at patients who are I believe that it is the role of the consultant to be consulted, but that the family doctor should undertake much more of the aftercare than happens at present. I also think that it is time that many hospital services were run on a regional basis so far as staffing ratios are concerned and that there should be more flexibility so that the changing needs of populations are catered for. I think that
we
have
to
take
a new
designated as having "hospital diseases".
North Middlesex Hospital, Silver Street, London N18 1QX
I. D. RAMSAY
hospitals and the regional postgraduate centres and are also more likely to be engaged in specialties wherein surgical and diagnostic procedures such as cardiac cathetensation occupy many hours of consultant and registrar time per week. In addition, I need not mention hours spent in correspondence to general practitioners and dare not mention research or medical writing. Comparison of the numbers of patients seen in outpatient consultations by hospital consultants and general practitioners is an irrelevant exercise. Why this blinkered and biased viewpoint ? Is Dr Fry really so naive or is he trying to confuse us? Either way this is a misleading argument from one of our most
own
prominent general practitioners who, we have already noted with dismay, are represented times two on the Royal Commission
SIR,-Dr Fry finds it extraordinary that
we have virtually reliable information on what consultants actually do in terms of their work load. One reason for this is that the Department of Health, regional health authorities, the King Edward’s Fund for London, and some medical research trusts are not interested in funding such information-gathering exercises. I know, because I have tried to raise a few hundred pounds to pay for the computer-time and minimal clerical assistance required to pursue this type of medical auditing. Research boards consider this an administrative or a medical-records exercise, whereas the nonmedical research bodies resent (I suppose) clinicians stepping into foreign fields-a demarcation issue. Attempts to fund a similar computer-oriented exercise’ also failed to obtain any financial support.
no
18 The Circus, Bath BA1 2ET
on
the National Health Service which numbers
not one
hospital consultant. Royal Postgraduate Medical School, Hammersmith Hospital, C. M. OAKLEY
London W12
ROYAL COMMISSION ON THE N.H.S.
SIR,—Is it not amazing that the membership of the Royal Commission on the National Health Service includes neither
hospital consultant, nor hospital nursing officer, hospital doctor, nor general dental practitioner? 11 Tanglewood, Alconbury Weston, Cambridgeshire PE17
nor
junior
K. R. STEWART
5LB
CLIVE A. C. CHARLTON MOBILITY OF MEDICAL MANPOWER
SIR,—Iwas interested in Dr Fry’s letter (May 15,
1073). Frankly, I do not believe the figures cited for weekly outpatient consultations. I have always suspected that these bizarre statisp.
tics have precious little basis in fact. I note that for general surgery, average new patient attendances are 20 and old patient follow-ups 40. In the week starting May 9,I saw 33 new patients and 110 old patients at my surgical outpatient clinics. In addition I saw 4 new private patients and 5 private patients for follow-up. Finally, I did 2 domiciliary visits. I appreciate that my figures might have been a little lower for the year 1974, but I doubt it, and this week has not been exceptional, in my experience. If the official figures are accurate, then it appears to me that someone somewhere is not pulling his weight. The General Infirmary Leeds LS1 3EX
at
Leeds,
F. A. BENSON
SIR,--Dr Fry refers to the consultant’s work load as "a forbidden topic" (is it? why?) and compares the number of outpatient consultations made weekly by hospital specialists and by general practitioners. Whereas "outpatient consultations" represent nearly the whole of a general practitioner’s work load Dr Fry seems to believe that hospital consultants have nothing else to do but outpatient consultations either. But the hospital consultants have to examine inpatients as well as outpatients. According to his specialty these patients may be large in number, include many acutely ill, or be those who come in for surgery or other special investigative or treatment procedures. In non-teaching hospitals the paucity of junior staff means that many or all operations or special procedures are either carried out by the consultant himself or by his junior supervised by his consultant. In the teaching hospitals where there are still registrars who have not yet been redeployed the consultants have heavy teaching commitments both in their
most
1. Wickham, J.
E.
A., and others Br. J. Urol. 1975, 47, 345.
SIR,—Ivery much enjoyed Dr Owen’s article on clinical and freedom (May 8, p. 1006). He raises issues which we have all, to a greater or lesser extent, been forced to face
professional
over the past years. The expectations of health care by the general public have increased at a very much greater rate than the nation’s ability to meet them. Currently, the N.H.S. is in a position of small growth in real
terms, whilst at the same time there is to be a movement of resources between the various sub-heads of health care and also between different geographical areas. The consequences of this must be substantial changes in the pattern of health-care delivery which, in turn, will result in quite major needs for redeployment of all resources, including manpower. This means that the mobility of manpower in all grades, including medical, within the N.H.S. is likely to have to become far greater than it has been in the past, and it may be. that the only way in which this mobility can be achieved is by planned redeployment from certain overprovided areas with movement to those which are less well provided. This is the natural corollary to all that the Minister of State has said. There are likely to be some
redundancies, although
of staff, and the N.H.S. has dealing with this. to
amongst professional grades yet no formal machinery for
not as
Philosophies are pleasant to expound: the actions required implement them are sometimes more traumatic.
North East Thames Regional Health 40 Eastbourne Terrace, London W2 2QR
Authority, A. S. MACKENZIE
EMIGRATION AND INTERNAL LOSS OF PATHOLOGISTS
SIR,-In some ways, the survey undertaken by Sir John Dacie and Professor Campbell (May 15, p. 1071) on emigration and internal loss of pathologists may be regarded as
supervised.
All that
happens
of repeat prescriptions, and often the patient does even see the doctor. stream ‘
is
a
not
look at patients who are I believe that it is the role of the consultant to be consulted, but that the family doctor should undertake much more of the aftercare than happens at present. I also think that it is time that many hospital services were run on a regional basis so far as staffing ratios are concerned and that there should be more flexibility so that the changing needs of populations are catered for. I think that
we
have
to
take
a new
designated as having "hospital diseases".
North Middlesex Hospital, Silver Street, London N18 1QX
I. D. RAMSAY
hospitals and the regional postgraduate centres and are also more likely to be engaged in specialties wherein surgical and diagnostic procedures such as cardiac cathetensation occupy many hours of consultant and registrar time per week. In addition, I need not mention hours spent in correspondence to general practitioners and dare not mention research or medical writing. Comparison of the numbers of patients seen in outpatient consultations by hospital consultants and general practitioners is an irrelevant exercise. Why this blinkered and biased viewpoint ? Is Dr Fry really so naive or is he trying to confuse us? Either way this is a misleading argument from one of our most
own
prominent general practitioners who, we have already noted with dismay, are represented times two on the Royal Commission
SIR,-Dr Fry finds it extraordinary that
we have virtually reliable information on what consultants actually do in terms of their work load. One reason for this is that the Department of Health, regional health authorities, the King Edward’s Fund for London, and some medical research trusts are not interested in funding such information-gathering exercises. I know, because I have tried to raise a few hundred pounds to pay for the computer-time and minimal clerical assistance required to pursue this type of medical auditing. Research boards consider this an administrative or a medical-records exercise, whereas the nonmedical research bodies resent (I suppose) clinicians stepping into foreign fields-a demarcation issue. Attempts to fund a similar computer-oriented exercise’ also failed to obtain any financial support.
no
18 The Circus, Bath BA1 2ET
on
the National Health Service which numbers
not one
hospital consultant. Royal Postgraduate Medical School, Hammersmith Hospital, C. M. OAKLEY
London W12
ROYAL COMMISSION ON THE N.H.S.
SIR,—Is it not amazing that the membership of the Royal Commission on the National Health Service includes neither
hospital consultant, nor hospital nursing officer, hospital doctor, nor general dental practitioner? 11 Tanglewood, Alconbury Weston, Cambridgeshire PE17
nor
junior
K. R. STEWART
5LB
CLIVE A. C. CHARLTON MOBILITY OF MEDICAL MANPOWER
SIR,—Iwas interested in Dr Fry’s letter (May 15,
1073). Frankly, I do not believe the figures cited for weekly outpatient consultations. I have always suspected that these bizarre statisp.
tics have precious little basis in fact. I note that for general surgery, average new patient attendances are 20 and old patient follow-ups 40. In the week starting May 9,I saw 33 new patients and 110 old patients at my surgical outpatient clinics. In addition I saw 4 new private patients and 5 private patients for follow-up. Finally, I did 2 domiciliary visits. I appreciate that my figures might have been a little lower for the year 1974, but I doubt it, and this week has not been exceptional, in my experience. If the official figures are accurate, then it appears to me that someone somewhere is not pulling his weight. The General Infirmary Leeds LS1 3EX
at
Leeds,
F. A. BENSON
SIR,--Dr Fry refers to the consultant’s work load as "a forbidden topic" (is it? why?) and compares the number of outpatient consultations made weekly by hospital specialists and by general practitioners. Whereas "outpatient consultations" represent nearly the whole of a general practitioner’s work load Dr Fry seems to believe that hospital consultants have nothing else to do but outpatient consultations either. But the hospital consultants have to examine inpatients as well as outpatients. According to his specialty these patients may be large in number, include many acutely ill, or be those who come in for surgery or other special investigative or treatment procedures. In non-teaching hospitals the paucity of junior staff means that many or all operations or special procedures are either carried out by the consultant himself or by his junior supervised by his consultant. In the teaching hospitals where there are still registrars who have not yet been redeployed the consultants have heavy teaching commitments both in their
most
1. Wickham, J.
E.
A., and others Br. J. Urol. 1975, 47, 345.
SIR,—Ivery much enjoyed Dr Owen’s article on clinical and freedom (May 8, p. 1006). He raises issues which we have all, to a greater or lesser extent, been forced to face
professional
over the past years. The expectations of health care by the general public have increased at a very much greater rate than the nation’s ability to meet them. Currently, the N.H.S. is in a position of small growth in real
terms, whilst at the same time there is to be a movement of resources between the various sub-heads of health care and also between different geographical areas. The consequences of this must be substantial changes in the pattern of health-care delivery which, in turn, will result in quite major needs for redeployment of all resources, including manpower. This means that the mobility of manpower in all grades, including medical, within the N.H.S. is likely to have to become far greater than it has been in the past, and it may be. that the only way in which this mobility can be achieved is by planned redeployment from certain overprovided areas with movement to those which are less well provided. This is the natural corollary to all that the Minister of State has said. There are likely to be some
redundancies, although
of staff, and the N.H.S. has dealing with this. to
amongst professional grades yet no formal machinery for
not as
Philosophies are pleasant to expound: the actions required implement them are sometimes more traumatic.
North East Thames Regional Health 40 Eastbourne Terrace, London W2 2QR
Authority, A. S. MACKENZIE
EMIGRATION AND INTERNAL LOSS OF PATHOLOGISTS
SIR,-In some ways, the survey undertaken by Sir John Dacie and Professor Campbell (May 15, p. 1071) on emigration and internal loss of pathologists may be regarded as