The Royal College of General Practitioners

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					 No035-8797
                                       The Journal of
   The Royal College of General Practitioners
                The British Journal of General Practice
                  Founding Editor: R. M. S. McConaghey, O.B.E., M.D., F.R.C.G.P.
    Volume 26                               Number 163                           February 1976

                                        HONORARY EDITOR
                        D. J. PEREIRA GRAY, M.A., M.B., B.Chir.Cantab., F.R.C.G.P.

                                             EDITORIAL BOARD
           S. L. BARLEY, M.B., B.S.Lond., M.R.C.G.P.
           LORD HUNT OF FAWLEY, C.B.E., M.A., D.M.Oxon., F.R.C.P., F.R.C.S., F.R.C.G.P., F.R.A.C.G.P.
           D. H. IRVINE, M.D.Newc., F.R.C.G.P., D.Obst.R.C.O.G.
           E. V. KUENSSBERG, C.B.E., M.B., Ch.B.Ed., F.R.C.O.P.
           PROFESSOR J. S. McCORMICK, M.A., M.B., B.Chir.Cantab., F.R.C.P.I., F.R.C.G.P.
           PROFESSOR M. L. MARINKER, M.B., B.S.Lond., F.R.C.G.P.
           G. N. MARSH, M.D.Newc., F.R.C.G.P., D.C.H., D.Obst.R.C.O.G.
           J. R. MILES, M.B., BS.Lond., F.R.C.G.P.
           R. J. F. H. PINSENT, O.B.E., M.A., M.D.Cantab., F.R.C.G.P., F.R.A.C.G.P.
           G. L. WATSON, O.B.E., M.A., M.D.Cantab., F.R.C.G.P., F.R.A.C.G.P., D.T.M. & H.
           H. J. WRIGHT, M.B., Ch.B.Leeds, F.R.C.S., F.R.C.G.P., D.C.H.



                                         CONTENTS
                                                                                                    page
Editorial
    Two types of training.                                  .             .     .                        81
The Team
    The contribution of a psychotherapist to general practice by Alexis Brook and Jane Temperley         86
    Social work and general practice by Hilary Graham and Mannie Sher .               .   .    .         95
Screening in general practice
    Assessment of the elderly in general practice by J. H. Barber and Joan B. Wallis.     .             106
News
    College news .        .      .     .           .      .    .     .    .     .     .   .   .         115
    Medical news           .     .     .     .     .      .    .     .    .          .    .   .         125
Obituary       .     .    .      .                 .      .    .    .    .     .     .   .    .         125
Correspondence .          .           .      .           .          .    .     .     .   .    .         126
Report
    The paediatric training required by the general practitioner. A report by a Joint Working
        Party of The British Paediatric Association and The Royal College of General
        Practitioners     .      .    .      .     .     .    .     .    .     .     .   .    .         128
Psychotherapy services
    Psychotherapy services outside the National Health Service by Una Kroll.         .   .              137
Alcoholism
    A general-practice study of the commonest presenting symptoms of alcoholism by B. D.
        Hore and R. H. Wilkins        .     .            .    .     .    .     .     .   .    .         140
Audit
    Medical records, medical audit, and community hospitals by Colin Kirk and M. Lee-Jones .            143
Contraception care in general practice
    Pregnancy in women using intra-uterine contraceptive devices by J. M. Henderson and
        F. M. Hull.       .     .     .     .      .        .                                           147
COLLEGE NEWS                                                                                    115

     ANNUAL GENERAL MEETING                        medical education. He noted with pleasure
                                                   that Dr Carne had recently been elected
The twenty-third Annual General Meeting            President-elect of the World Organisation
of the Royal College of General Practitioners      of National Colleges and Academies of
was held at Imperial College, London SW7,          General Practice and was a member of the
on 15 November 1975. Professor P. S. Byrne,
C._B.ii.,was re-elected President ofthe College
                                                   Standing Medical Advisory Committee of
                                                   the Department of Health and Social Security.
and took the chair.                                  Dr Stuart Carne was presented with the
Honorary Fellow                                    Foundation Council Award.
Dr G. I. Watson, O.B.E., introduced Mr Hilton       Upjohn Travelling Fellowships
Clarke to the meeting as a candidate for
Honorary Fellowship of the College. Dr              The following   were   awarded Upjohn Travel¬
Watson quoted from the Old Lady, the                ling Fellowships:
quarterly magazine of the Bank of England,          Dr I. R. M. Anderson to          study exercise-
which said in 1967 that Mr Hilton Clarke              testing techniques.
"must have been more widely and better              Dr D. J. G. Bain, to study child care in
known both in the bank and in the City                 developing countries.the nature of the
than any other bank man of his generation ".           problem.
He described Mr Hilton Clarke's career              Dr S. K. Chouksey, to study the social worker's
and his experience in foreign exchange                relationship with the family practitioner.
control. In 1950 he had moved to the Discount       Dr D. J. Hall, to study ultrasonic scanning.
Office, first as deputy, becoming Principal         Dr N. K. Leiper, to study the teaching of
of that office three years later. Here his             geriatrics to the doctors of the future and
greatest work was done. In the post sometimes          to compare and contrast methods of
described as the Governor's eyes and ears              teaching geriatrics in the community.
in the City he had the task of interpreting         Dr C. J. Leonard, to study National Health
to the Bank the actions and thoughts of the            Service problems encountered in the em¬
City and to the City, the policies ofthe Bank."        ployment of foreign doctors in general
   The College has been proud that Mr                  practice in the United Kingdom.
Hilton Clarke should have been one of the           Dr P. C. McNulty, to study psychotherapy
sponsors of our Endowment Appeal in 1972            Dr R. N. Midha, to study methods of moni¬
and had appreciated the immense amount                 toring the trainers in the teaching of
of work he had done for the College.                   trainees.
   Mr Hilton Clarke was elected an Honorary         Dr M. Modell, to study the teaching of
Fellow of the College with acclamation.                general practice at those medical schools
Foundation Council Award                               which do not have departments of general
Dr George Swift, O.B.E., read the citation
                                                       practice.
                                                    Dr C. H. Patel, to study hypertension.
for the Foundation Council Award for the
College. He noted that this award was for              This year a special prize was awarded
the highest merit of work in the realm of           for the best essay award from the 1974
general practice or for the services of the         Upjohn Travelling Fellows' reports. This
                                                    was awarded to Dr M. G. Sheldon of
greatest distinction in the cause of general        Oxfordshire for his essay on the problems
practice. In short it is the highest award          of problem-orientated records. (This will be
that the College can give to a doctor and
only nine awards have been made since the           published later in the Journal.)
College was founded and only once has it
been given to a serving member ofthe Council.       Undergraduate essay prizes
   Dr Stuart Carne had joined the Council           Professor M. L. Marinker, the Chairman
in 1960 and had been Honorary Treasurer             of the Education Committee, announced
since 1964. Dr Swift had himself appreciated        the winners of the College's prizes for under-
the Treasurer's advice whilst he had been           graduates: Mr R. Wilkinson (Leeds Univer¬
Chairman of the Council, but wanted to              sity), first prize; Mr R. M. Milne (Aberdeen
emphasise in addition Dr Carne's immense            University), second prize; and Mr A. P.
contribution to practice organisation and           Weetman (Newcastle University), third prize.
    Journal ofthe Royal College of General Practitioners, 1976, 26, 115-124
116                                                                                College news
Fraser Rose Gold Medal                            CHAIRMAN OF COUNCIL'S REPORT
Dr Austin Elliott, Chairman of the Awards         The report of the Council was delivered by
Committee, announced that the Fraser Gold         the Chairman of Council, Dr J. A. R. Lawson.
Medal had been presented to the College
in 1972 by the Merseyside and North Wales         Vocational training
Faculty for award to the most outstanding         The Council had considered during the year
candidate in the membership examination.          the Report of the Merrison Committee of
He announced that for the first time this         Inquiry into the Regulation of the Medical
year it had been won by a doctor who has          Profession. A Council Working Party had
not been vocationally trained and felt this       been formed, its report had been considered
was a sign of the times. More established         by the Council and published in the Annual
principals in general practice were coming        Report.
forward to sit the examination. The Fraser
Rose Gold Medal was presented to Dr A. Y.         Postgraduate Training Committee
                                                  About 15 months earlier the Council had
Ewing of Renfrewshire.                            formed a Postgraduate Training Committee
The British Migraine Association Prize            and the President of the College was Chairman.
                                                  Dr Lawson noted that this Committee had
The British Migraine Trust prize of £100,         already done a great deal of work and had
open to trainees in general practice at present   begun to establish standards of vocational
on vocational training schemes, was awarded
to Dr John Nightingale for his essay on the
                                                  training programmes. College visitors had
                                                  been appointed and visits to vocational
natural history of migraine and its manage¬       training schemes in nine regions had already
ment in general practice. Dr Nightingale          been carried out. Work was proceeding
graduated from Newcastle in 1970 and              towards forming a national data base.
attended the Wessex Regional training course.
                                                  Joint Postgraduate Training Committee
New Fellows                                       Subsequently the Council had implemented
The following members of the     College   were   its earlier declared policy that this Committee
elected Fellows:                                  would in due course become independent
Alexander, Benjamin L. Hawkins, Deric B.          of the College. The Chairmen of the Councils
Anderson, Adam S.        Herbert-Burns, Jack      of Postgraduate Medical Education in England
Assinder,FrankR.St.C Hirst, Geoffrey              and Wales, Scotland, and Northern Ireland
Beatson-Hird, John       Jeavons, Garth H.        had proposed that the Committee should
Blacklay, Francis W. Lee, Terence J.              become the Joint Postgraduate Training
Bound, Montague H. S. Lewis, Joseph N.            Committee for General Practice and should
Bourne, Isaac H. J.      MacDonald, George G.     stand in the same relationship to the Royal
Brill, Guy C.            Marks, J. H.
Brown, Arthur M.         Mills, George W.         College of General Practitioners as does
Brown, Kenneth F. C. Moses, Graham J.             the Joint Committee on Higher Medical
Cannon, David S. H.      Parish, Peter A.         Training to the Royal College of Physicians
Capstick, lan            Playfair, Henry R.       of London and the other Colleges of Physi¬
Darby, Peter G.          Pole, Karl F. M.      cians.
Debson, Harry            Pritchard, William A.    The Council, after discussions with the
Duncan, Malcolm N. S. Richards, Margaret H. J General Medical Services Committee, had
Ewell, Ernest J.         Ross, Melvin          now agreed on the composition and functions
Foot, Herbert T.         Salkind, Melvin R.    of such a Joint Committee and had written to
Foot, Herbert T.         Spencer-Smith
Freedman, Wallace A. Stowell, Thomas E. S. the other constituent members and to the
French, William G.       Thomas, Henry A.      Councils of Postgraduate Medical Education,
Gibbons, Ebenezer R. Troup, Robert G.          asking that the Committee be established.
Gomez, George            Wand, Soloman
Grant, George B.         Warner, Charles W.       The proposed constitution will be:
Grant, Ronald N. R. Wood, Henry S. H.          The Royal College of General Practitioners
                                                                   6 members plus 1 trainee
James Mackenzie Lecture                        The General Medical Services Committee
The James Mackenzie Lecture was then                               6 members plus 1 trainee
delivered by Dr M. C. Stone of Leigh, The Conference of Regional Advisers in
Lancashire, the title being The most alluring     General Practice                3 members
of occupations. (This lecture was published The Conference of Postgraduate Deans   1 member
in the January Journal.)
College news                                                                                   117
The Association of University Teachers of           training and there are many, the MRCGP
                                                             "


  General Practice                     1 member     examination is at present the only method
The Armed Services General Practice Ap¬             available". The Chairman quoted again
  proval Board             1 member                 from paragraph 141 ofthe Merrison Committee
  making a total of 20.                             Report 1975 that every applicant for admis¬
                                                                 "



  In addition there would be observers              sion to the specialist register will have to
                                                    be individually assessed.it is an integral
from the Councils of Postgraduate Medical           part of the educational process ".
Education for England and Wales, Scotland,            He noted that the Council of the College
and Northern Ireland (3 members) and the            had endorsed this statement and believed
Health Departments for England and Wales,           that the assessment of trainees must be carried
and Scotland (2 members).a total of five          out. This was in fairness both to the trainees
observers.                                        themselves and the course organisers who
   Dr Lawson announced that the Joint             otherwise would have no means of knowing
Committee will be serviced from 14 Princes        how effective the training and teaching
Gate and the Deans of Study will be the           had been. While the College examination
Executive Officers of the Committee and one       is one method of end-point assessment,
of the Secretaries will be the Administrative     Professor Byrne and his colleagues had
Secretary of the College.                         reported on a form of continuing assessment.
   The functions of the Joint Committee           It was probable that a combination of both
will be:                                          methods might be required.
   (a) To establish criteria for the selection       Accreditation would be required from the
of teachers and their practices, for the guidance point of view ofthe EEC and a method needed
of the Councils for Postgraduate Medical          to be established to carry this out. Similarly,
Education and Regional General Practice           and quite independent of this, if the Merrison
Advisory Committees;                              Report is implemented, a means of assess¬
   (b) To evaluate training programmes in                                                 College
schemes to see whether they meet the educa¬ ment has to be arrived at. Part of thesuch an
                                                  examination might contribute to
tional goals for vocational training;
   (c) To recognise those schemes which do mean that the Collegedoes not necessarily
                                                  assessment, but this
                                                                            itself would
offer experience of the requisite content and this standard for continuing collegiate acceptmem¬
standards;                                        bership. This might require a different
   fd) To provide guidance to doctors seeking standard and would
advice about vocational training and to further consideration. in any case require
assist Regional Practice Advisory Committees
on questions of scheme recognition.                       standards
   It was to be called a Joint Committee in Setting
the sense that the constituents are the standard- Dr Lawson noted that the Board of Censors
setting body.the College, the universities was becoming one of the most important  and had an
through their postgraduate organisation and committees importantCouncil play in setting
                                                                of the
                                                                          role to
undergraduate teachers' association,     and the increasingly
profession through the General Medical standards. the work, the College could whole
                                                  undertake
                                                               While no committee
                                                                                      as a
                                                                                            alone
Services Committee.
   Both the College and the General Medical is well placed to do so.
Services Committee regard it as extremely            He noted that an increasing number of
important "  to establish the work of this doctors are taking the examination, the
Committee at the earliest possible moment". latest figures being:
   Dr Lawson noted that the existing Post¬           For the academic year ending October
graduate Training Committee had already 1975.454 candidates1975 examination.265
                                                     In the October
identified some weaknesses in vocational
training and that it was becoming clear that candidates.
the trainees "looked particularly to the             The Council had decided that the examina¬
College to ensure that the requisite standards tion must from now on be self-financing
of training are achieved ".                        and cannot continue to be subsidised to
                                                   the present extent of £7,000 a year. The
Assessment                                         Council had also decided that it will not
   He noted that for those trainees who wished be an additional source of revenue for the
to be assessed on completion of vocational College.
118                                                                               College news
Education                                        for the  College and the Council and the
About 100 of the College's Tutors had            College were deeply grateful to him.
attended the College Tutors'ConferenceandDr        He finished his report by predicting that the
John Woodall was congratulated for his           next year or two would be "momentous
work on this.                                    for general practice". The College at times
   It was pleasing to hear that the Nuffield     was accused of being an elitist organisation,
Course was now in its second year and was        which he thought was inevitable in any body
over-subscribed. Dr Lawson paid tribute          which was carrying out pioneer work.
to Dr Paul Freeling's energy and enthusiasm        However, he believed that the aims of the
as Nuffield Tutor and gratefully acknowledged    College were common to all good doctors
the continuing contribution from the Nuffield    and that an important task now was for the
Organisation and from the Department of          members of the College to convince their
Health and Social Security.                      colleagues that what we are doing in simple,
                                                                "



Research                                         uncomplicated terms was to try to involve
Two new research units had formed from           those who criticise us, in the work that we
                                                 are doing" and that the need was now to
the old Epidemic Observation Unit. The           communicate better.
first had been established at the University
College of Swansea with Dr W. O. Williams,                  BUSINESS MEETING
O.B.E., as Director, and the second at the
University of Surrey in Guildford, with Dr       A proposal was made by the Honorary
Paul Grob as Director.                           Treasurer that permission should be sought
   Dr Clifford Kay, the Chairman of the          from the Privy Council that the upper limit
Research Committee, was congratulated on         of the subscription should be raised to
the first publication of Research Intelligence   £70. The Chairman ruled that this required
which had already interested the European        a two-thirds majority and the motion was
Division of the Worlid Health Organisation.      carried nem con.
Practice Organisation Committee                  Contribution of £10
This Committee had published two important       Dr G. I. Watson then proposed that every
studies during the year, Appointment Systems     Fellow, Member and Associate, should be
in General Practice and Nursing in General       invited, perhaps through a letter from the
Practice, both of which were available from      President, to give the £10, tothe College, this
14 Princes Gate.                                 being the difference between the current and
                                                 the new subscription, He then handed his
Education Committee Board of Censors             own contribution to the Honorary Treasurer
The Chairman stated that in view of the          amid applause. This was seconded by Dr
close links between the Education Committee      E. V. Kuenssberg and carried.
and the Board of Censors and in view of the      Next meeting
great need to save expenses, a proposal was      The next Annual General Meeting will be
going to be considered to amalgamate these       held on Saturday 20 November 1976.
two Committees of the Council.
Awards                                            SUMMARY OF COUNCIL MEETING
The Chairman was pleased to announce that At the Council meeting immediately after
Dr lan Tait, m.r.c.g.p., had been appointed the Annual General Meeting the following
the third Sir Harry Jephcott Visiting Professor Officers were elected:
at University College Hospital, London. Chairman:                      Dr J. A. R. Lawson
He was also announced that Dr Clifford Kay, Vice-Chairman:             Dr M. J. Linnett, O.B.E.
f.r.c.g.p., had received the James Mackenzie Dep. Vice-Chairman: Dr A. G. Donald
Award of the Royal College of Physicians Honorary Treasurer: Dr S. J. Carne
of Edinburgh.                                   Honorary Secretary: Dr D. H. Irvine
Conclusion
   Dr Lawson concluded by noting that one HONORARY TREASURER'S REPORT
of the members of the Foundation Council The Honorary Treasurer, Dr Stuart Carne,
was retiring this year after continuous welcomed the Annual General Meeting as
service on the Council. Dr George Swift had Chairman of the North and West London
given unstintingly of his time and energy Faculty as this was the first time any general
College news                                                                                 119
meeting of the College had been held in his Deputy Vice-Chairman: *A. G. Donald, m.a.,
faculty's area.                                    f.r.c.g.p., 30 Cramond Road North,
   He then presented his report for the year       Edinburgh, EH4 6JE. (Tel: Home: 031
and proposed the dismal resolution that
                   "                    "
                                                   336 3824, Surg: 031 554 0559).
there should be an increase in the subscription. Honorary Treasurer: *S. J. Carne, f.r.c.g.p.,
   Last year had been extremely traumatic ".
                           "
                                                   d.c.h., 5 St. Mary Abbots Court, Warwick
Inflation had been way beyond the possi¬
                       "
                                                   Gardens, London, W14 8RA. Tel: Home:
bilities that most of us were talking about a      01 602 1970, Surg: 01 743 7153).
few years ago" and the expenses during Honorary Secretary: D. H. Irvine, m.d.,
the year under review had increased by about       f.r.c.g.p., D.Obst.R.c.o.G., Redesdale, Wans-
£35,000.                                            beck, Road, Ashington, Northumberland.
   As a result of the previous increase in         (Tel: Home: 067 081 3139, Surg: 067 081.
subscription the College's net total on a          2772, Dept: 063 228511 (Ext. 3446)).
running cost basis is about £3,500, but un¬                          Members
fortunately the forecast for the current year
was a deficit of about £20,000. Dr Carne         *R. MacG. Aitken, f.r.c.g.p., D.obst.R.c.o.G.,
noted that much of this was due to an increase     Woodlands, 80 Pinchbeck Road, Spalding,
in salaries and all the College staff had, of      Lines. (Tel: Home: 0755 2055, Surg:
course, received an increase that was awarded      0755 2189).
to those with whom they have parity, i.e. *T. B. Anderson, m.d., m.r.c.g.p., 1 Hunting-
the Civil Service.                                 don Road, Cambridge. (Tel: Home: 0223
   He noted the economies that the Council         59357, Surg: 0223 53436).
had started which had included reducing the *R. J. Bennison, m.a., f.r.c.g.p., D.obst.
number and frequency of Council and Com¬           r.c.o.g., Eden End, Hatfield Broad Oak,
mittee meetings.                                   Bishop's Stortford, Herts, CM22 7HD.
   Dr Carne underlined the advantage to            (Tel: Home: 027 970 245, Surg: 027 970
the College of paying the subscription by          466).
variable direct debit. Every member had J. F. Burdon, f.r.c.g.p., d.a., Ponoko, 5,
been sent a letter and he emphasised that this     South Street, Denbury, Newton Abbot,
will reduce administrative costs to the College    TQ12 6DH. (Tel: 0803 812071).
considerably. It would also save the College *I. Burns, m.r.c.g.p., Medical Centre, Bank-
money by enabling the subscription to be           head Road, Wick, Caithness. (Tel: Home:
collected promptly.                                Wick 3225, Surg: Wick 3477).
   There were no questions and the financial D. L. Crombie, O.B.E., m.d., f.r.c.g.p., 54
report was formally approved.                      Lordswood Road, Birmingham 17. (Tel:
                                                   Home: 021 454 7867, Surg: 021 426 2030,
College Council                                    Dept: 021 426 1125).
The following members were elected to the *G. S. Duncan, m.r.c.g.p., D.obst.R.c.o.G.,
Council of the College: Drs P. Freeling,           19c The Esplanade, Ryde, Isle of Wight.
J. Fry, J. A. R. Lawson, and R. J. F. H.           (Tel: Home: 0983 3088, Surg: 0983 5225).
Pinsent.                                         *T. S. Eimerl, D.S.C., V.R.D., m.d., f.r.c.g.p.,
                                                   48 Lyndhurst Drive, Sevenoaks, Kent,
        COLLEGE COUNCIL 1975-76                    TN13 2HQ. (Tel: Home: 0732 56816,
                     Officers                      Dept: 01 388 1188 ext. 807/923).
                                                 *A. E. Elliott, F.R.C.G.P., D.Obst.R.C.O.G.,
President: Professor P. S. Byrne C.B.E.,           Waterside Lodge, Barrel Well Hill, Chester.
   p.r.c.g.p.. Darbishire House Health Centre      (Tel: Home: 0244 26539 (ex. dir), Surg:
   Upper Brook Street, Manchester, M13,            0244 46981, 0244 25421).
  0FW. (Tel: Home: 061 224 3646, Dept: *D. E. Fraser, f.r.c.g.p., 11 Glen Road,
   061 224 7499).                                  Dyce, Aberdeen, AB2 0FB. (Tel: Home:
Chairman: J. A. R. Lawson, f.r.c.g.p.,             022 472 2595, Surg: 022 471 2138).
  The Ridges, 458 Perth Road, Dundee, ?Sheila E. Fraser, f.r.c.g.p., Cornerways,
   Scotland. (Tel: Home: 0382 67408, Ex.           Dragonswell Road, Brentry, Bristol, BS10
   dir: 0382 67728).                               7BU. (Tel: Home: 0272 622003, Surg:
Vice-Chairman: *M. J. Linnett, O.B.E.,             0272 625916).
  f.r.c.g.p., 82 Sloane Street, London, SW1. *S. C. Freedlander, f.r.c.g.p., 24THector
  (Tel: Home: 01 736 2487, Surg: 01 245,           Road, Glasgow, G41 3RL. (Tel: Home:
  9333).                                           041 632 6968, Surg: 041 632 9141).
122                                                                                  College news
P.    Freeling, f.r.c.g.p., 150 Lady Margaret        f.r.c.g.p., f.r.a.c.g.p., 145 Birchfield Road,
     Road, Southall, Middlesex. (Tel:    Home:       Birmingham. (Tel: Home: 021 427 1142,
    01 428 8358, Surg: 01 574 2812 or 01 574         Surg: 021 554 0705, Dept: 021 554 1081).
    8371).                                         *J. Rose, m.r.c.g.p., 69 Muirfield Crescent,
J. Fry, O.B.E., m.d., f.r.c.s., f.r.c.g.p., 138      Dundee, DD3 8QA. (Tel: Home: 0382
    Croydon Road, Beckenham, Kent, BR3                86706, Surg: 0382 25634).
    4DG. (Tel: Home: 01 650 3962, Surg:            ?Katalin Schopflin, m.r.c.g.p., 198 Cable
    01 650 0586).                                     Street, London, El. (Tel: Home: 01 638
*D. G. Garvie, f.r.c.g.p., 5 Repton Drive,            8291, Surg: 01 790 2962).
    Newcastle, Staffs. (Tel: Home: 0782 619795,    *J. Spiteri-Gonzi, m.d., p__d., m.r.c.g.p.,
    Surg: 0782 562488).                              289 Zabbar Road, Fgura, Malta.
 *G. Jessup, f.r.c.g.p., 462 Palatine Road,        *C. G. W. Sykes, f.r.c.g.p., d.c.h., D.obst.
    Northenden, Manchester, M22 4DJ. (Tel:           r.c.o.g., Bryansford, 62 Acre Street, Lind-
    Home: 061 998 2472, Surg: 061 437 1467).         ley, Huddersfield, Yorks. (Tel: Home:
C. R. Kay, m.d., f.r.c.g.p., 8 Barlow Moor           0484 25995, Surg: 0484, 21740).
    Road, Didsbury, Manchester, M20 0TR.           *K. H. Trigg, M.R.C.G.P., D.Obst.R.C.O.G.,
    (Tel: Home: 061 445 9686, Surg: 061 445           Middle Fell, Rockshaw Road, Merstham,
    4649, Unit: 061 445 7771).                        Surrey, RH1 3BZ. (Tel: Home: 01 649
E. V. Kuenssberg, C.B.E., f.r.c.g.p., 191             2128, Surg: 01 649 3313).
    Crewe Road North, Edinburgh, EH5 2NT.          *C. Waine, m.r.c.g.p., 37 Cockton Hill,
    (Tel: Home: 062 082 2529, Surg: 031 552           Bishop Auckland, Co. Durham. (Tel:
    5711,031 552 5544).                               Home: 0388 3266, Surg: 0388 2050).
 *J. D. McCaldin, m.r.c.g.p., Box 384, Nairobi,    *E. A. Waldron, f.r.cg.p., St. Anne's,
    Kenya.                                            Ballyhaunis, Co. Mayo, Eire. (Tel:
Professor J. S. McCormick, f.r.c.p.i.,               Ballyhaunis 16).
    f.r.c.g.p., Holmhurst, Greystones, Co.         D. M. Wilks, m.r.c.g.p., 27 Castletown Road,
    Wicklow, Ireland. (Tel: Home: 0001 874113,       London W14 9HF. (Tel: Home: 01 381
    Dept: 0001 761617).                              0374, Surg: 01 602 6700).
 *A. G. McKnight, m.r.c.g.p., D.obst.R.c.o.G.,     *D. G. Wilson, O.B.E., f.r.c.g.p., 19 Chiltern
     88 Downview Park West, Belfast 15. (Tel:        Avenue, Bushey, Herts, WD2 3PU. (Tel:
     Home: 0232 776889, Surg: 0232 777972).          01 950 1316).
 J. J. McMullan, V.R.D., m.d., m.r.c.g.p.,         ?Denotes Faculty representative.
     d.i.h., 26 High Street, Chesham, Bucks.
     (Tel: Home: 02403 6842,Surg: 02405 2101).                        Observers
 Professor M. L. Marinker, f.r.c.g.p., Depart¬
     ment of Community Health, University          J. F.    Gowen, f.r.c.g.p., Strand House,
     of Leicester, 161 Welford Road, Leicester,       Youghal, Co. Cork, Eire. (Tel: 2253).
     LE2 6BF. (Tel: Home: 0533 706149,             Valerie Graves, O.B.E., f.r.c.g.p., Kitts Croft,
     Dept: 0533 59785).                               Writtle, Nr Chelmsford, Essex. (Tel: 0245
  *J. O. Mason, m.r.c.g.p., Coill Glas, Church        421475).
     Road, Ballybrack, Co. Dublin. (Tel: Home:     D. J. Pereira Gray, m.a., f.r.cg.p., Alford
     0001 852248, Surg: 0001 855800, 0001             House, 9 Marlborough Road, Exeter EX2
     854897).                                         4TJ. (Tel: Home: 0392 55235, Surg: 0392
 D. H. H. Metcalfe, m.a., f.r.c.g.p., Depart¬         51661, Journal Office: 0392 57938, Dept:
     ment of Community Health, The Medical            0392 31159).
     School, Nottingham University, Notting¬       J. P. Horder, O.B.E., m.a., f.r.c.p., f.r.c.g.p.,
     ham, NG7 2RD. (Tel: Home: 0602 256368,           98 Regent's Park Road, London, NW1.
     Dept: 0602 56101 ext. 3148).                     (Tel: 01 584 6262, Home: 01 722 3804).
  *G. J. Moses, b.Sc., f.r.c.g.p., Garth House,    Wing Commander H. A. Hunt, m.r.c.g.p.,
     Pontyclun, Mid-Glamorgan. (Tel: Home:            c/o Regional Medical Centre, RAF Lyne-
     0443 223641, Dept: 0222 28066 ext. 360).         ham, Chippenham, Wilts., SN15 4PZ.
 *M. O'Sullivan, m.r.c.g.p., 74 North Street,      J. S. Norell, m.r.c.g.p., 44 Mackenzie Road,
     Skibbereen, Co. Cork. (Tel: Skibbereen 29).      London, N7 8RD. (Tel: 01 584 6262,
 *R. B. Parker, m.r.c.g.p., 42 Old Way,               Home: 01 607 4611).
     Bishopston, Nr. Swansea, Glamorgan.           J. H. Owen, f.r.c.g.p., 159 West Road,
     (Tel: Home: 044 128 2229, ex. dir. 044 128       Nottage, Porthcawl, Glamorgan. (Tel:
     3584, Surg: 0792 66955).                         Home: 065 671 3032, Surg: 065 671 4875,
 R. J. F. H. Pinsent, O.B.E., m.a., m.d.,             065 671 4573).
College news                                                                               123
                                        tice in the United Kingdom of at least three
C. J. Wells, O.B.E., T.D., m.r.c.g.p., 28
  Wentworth Avenue, Whislowdale Park,   years' standing, but who are under 38 years
  Sheffield Sll 9GX. (Tel: 0742 369349).of age at the time of their application.
                                           Enquiries should be made to the Secretary
BUTTERWORTH GOLD MEDAL 1976 of the Royal College of General Practitioners,
The title for the 1976 Butterworth Gold 14 Princes Gate, Hyde Park, London SW7
Medal Essay Competition is: Quality of 1PU. The closing date will be 31 May 1976.
Care in General Practice.Can it be assessed?
  This competition is open to all members       APPOINTMENT SYSTEMS IN GENERAL
and associates of the College. Entries should                    PRACTICE
consist of not more than 10,000 words, be       A report of the Study Group of the Practice
typed on one side of the page only, and be      Organisation Committee of the Royal College
entered under a nom de plume accompanied        of General Practitioners has now produced
by the author's name and address in a sealed    a booklet on Appointment Systems in General
envelope.                                       Practice. This is available from the Adminis¬
  They should be addressed to: The Secretary,   trative Secretary at 14 Princes Gate, Hyde
Royal College of General Practitioners,         Park, London SW7 1PU, price £1 50 including
                                                                                  .



14 Princes Gate, London SW7 1PU, and postage.
marked 'Butterworth Gold Medal Essay
Competition'. The closing date is 1 August    BANBURY          LINKED VOCATIONAL
1976.                                                      TRAINING SCHEME
  UNDERGRADUATE ESSAY PRIZE                     The Royal College of General Practitioners
               COMPETITION                      has approved the Banbury Linked Vocational
                                                          Scheme for
The undergraduate essay prize competition Training examination the purposes ofaddi¬        the
is open to all medical undergraduates of tional certifications subject local
                                                MRCGP                          to some
medical schools in the United Kingdom and Adviser.                    by the         Regional
Eire who have not yet passed their final
examination.                                      MEDICAL RECORDING SERVICE
  The prizes are: first prize, £70 (plus £10                  FOUNDATION
in book tokens); second prize, £50; third
prize, £40.                                     The Medical Recording Service Foundation
   Particulars of entry and application forms reports a considerable increase in the number
can be obtained from the Dean's office, or of tapes distributed in recent years: 1968,
The Royal College of General Practitioners, 10,000 a year, 1970, 15,000 a year, 1973,
14 Princes Gate, Hyde Park, London SW7 20,000 a year and 1974, 25,000 a year.
1PU. The closing date is 31 May, 1976.            The most popular tapes during 1974 have
                                                been: Health Service Re-organisation, Stepping
RCGP/STANNING OVERSEAS FELLOW¬ Stones in Development, Progressive Relaxation,
                  SHIP 1976                     Roadside First Aid, and The Battered Baby.
Through the generosity of Mr Ellis Stanning,            M.R.C.G.P. EXAMINATION
the Royal College of General Practitioners
offers overseas fellowships for younger doc¬ The next examination for membership of
tors to be awarded annually, with the following the College will start on 21 May 1976. The
aims:                                           written papers may then be taken in London,
  To provide an opportunity to study and        Newcastle, Manchester, Edinburgh, Cardiff,
compare general practice abroad; to enable      Belfast and/or Dublin. The orals will take
them to study some particular aspect of         place in the week ending 3 July 1976, and the
general practice abroad; to learn about         closing date for applications is 23 April, 1976.
other systems of medical care; to report on        The November/December examination will
their experience to the profession in the       consist of written papers on 4 November
United Kingdom.                                 1976 with orals in the week ending 18 Decem¬
  Applications for these fellowships are now    ber 1976. The closing date for applications
invited from members or associates of the       for this examination will be 7 October 1976.
College who are principals in general prac¬     The oral examinations are held in London.
124                                                                             College news
  Further details may be obtained from the                        DEATHS
Membership Secretary, Royal College of Fellows
General Practitioners, 14 Princes Gate,  B. N. Adsett, Wavell Heights, Queensland,
London SW7 1PU.                             Australia.
                                         J. J. Doherty, Enniskillen, Co. Fermanagh.
                                         J. C. T. Sanctuary, Laleham-on-Thames,
  PRACTICE ORGANISATION ROOM                            Middlesex.
                                                   Founder members
The main display is on smoking and health.           J. C. Alexander, Kirby Muxloe, Leics.
It has been arranged in conjunction with ASH         E. L. Graff, Roedean, Sussex.
and it is planned to coincide this display           P. H. Perkins, Barry, Glamorgan.
with a circular to all general practitioners         H. B. Porteous, Beadnell, Northumberland.
and also to provide any interested general           A. S. Porter, Hitchin, Herts.
practitioner with the necessary leaflets and R. H. A. Ritchie, Tadworth, Surrey.
posters to mount his own anti-smoking                Richard Kirschner, Johannesburg.
campaign. The display outlines the main Members
points to be made against smoking, and has           Emyr Ap Cynan, Holyhead, Anglesey.
been arranged in order to brief general              W. H. Bradley, Wargrave, Berks.
practitioners  in their campaign.                    Mary Doherty, Enniskillen, Co. Ferma¬
   A number of practices have kindly joined             nagh.
the practice organisation study. The purpose         C. G. Harper, Port Macquarie, New South
of this study is to outline the internal organisa¬      Wales.
tion of some of the most highly organised            W. J. Hendry, Victoria, Australia.
practices in Great Britain. The interested Leslie Levy, Johannesburg.
practitioner can thus identify a practice John Magnier, Cork.
similar to his own and arrange to visit it,          Jonas Mikuris, Adelaide, S. Australia.
as all participants in this study have said          E. H. Milner, Driffield, Yorkshire.
they would welcome visitors. We would be             W. L. Stewart, Grampound, Cornwall.
grateful to hear details of any other practices S. H. Thomas, St. Peter, Jersey, Channel
willing to participate in this study.                   Islands.
   A new set of displays has been arranged           C. J. L. Wells, Witney, Oxon.
by Messrs Keeler in the cabinets, and the Associates
Epidemic Research Unit and also the Educa¬ M. J. Hannan, Ballybunion, Co. Kerry.
tion Committee of Council have contributed           J. W. Harwood, London, N.l.
displays of some of their activities.                Ulick O'Sullivan, Rathgar, Dublin.
                  COLLEGE ACCOMMODATION
  Charges for college accommodation are reduced for members (i.e. fellows, members and
  associates). Members of overseas colleges are welcome when rooms are available. All charges
  for accommodation include breakfast and are subject to value added tax; a service charge of
  12i per cent is added. Members are reminded that children under the age of 12 years cannot be
  admitted and dogs are not allowed.
  From 1 January 1976, charges are:
                                Members                            Others
                                  £                                   £
  Single room                    5.00                                9.00
  Double room                    9.00                              14.00
  Flat 1                        11.00 or 70.00 per week             14.00 or 90.00 per week
  Flat 3                        12.00 or 75.00 per week             15.00 or 95.00 per week
  Charges are also reduced for members hiring reception rooms compared with outside organi-
  sations which apply to hold meetings at the College. All hirings are subject to approval and
  VAT is added.
                                Members                            Others
                                  £                                   £
  Long room                     30.00                              40.00
  Damask room                   20.00                              30.00
  Common room and terrace 20.00                                    30.00
  Kitchen                                                           10.00
  Dining room                   10.00                              10.00
  Enquiries should be addressed to the Accommodation Secretary, Royal College of General
  Practitioners, 14 Princes Gate, Hyde Park, London SW7 IPU. (Tel: 01 584 6262). Whenever
  possible bookings should be made well in advance.


                                  Editorial Notice
The Journal is published monthly. Articles must be original and should not have been
published or submitted to any other journal. Articles should be typed with double or triple
spacing, on one side of the paper only, with 25mm margins. The paper size should be A4 or
quarto. Graphs and other line drawings must be in Indian ink and drawn to size or capable
of reduction to 63 mm.sq. Metric units, S.I. units and the 24-hour clock are preferred. All
references must be in the style of the Journal. Authors are requested to submit two copies
of their articles with a stamped addressed envelope and the approximate number of words
should be stated.
     The Editor welcomes letters for publication. Authors and correspondents are asked
to state their qualifications.
     All correspondence to the Editor should be addressed to: The Journal of the Royal
College of General Practitioners, Alford House, 9 Marlborough Road, Exeter, EX2 4TJ.
Telephone (office hours only) 0392 57938.
     Circulation. The Journal is circulated to all Fellows, Members and Associates of the
Royal College of General Practitioners and to a growing number of private subscribers
including universities, medical schools, hospitals, postgradaute medical centres and
individuals in over 40 different countries of the world.
     Subscriptions. The annual subscription is £20*00 post free, including the Reports
from General Practice and Journal supplements when published. Single copies £2 00.
Orders and payments should be sent to The Longman Group Ltd., Journals Division, 43
Annandale Street, Edinburgh, EH7 4AT, Scotland.
     Supplements and back numbers. The Reports from General Practice and Journal
supplements are distributed with the Journal to all college members, associates and sub-
scribers. A list of those still available is published regularly in the Journal. Over 40 of
these publications, dealing with many different aspects of general practice are still in print
at prices ranging from 25p-£l 75p. They can be obtained from 43 Annandale Street,
Edinburgh, EH7 4AT, Scotland.
     Advertising enquiries should be made to Longman Journals Division, Longman House,
Burnt Mill, Harlow, Essex. Telephone: 0279 26721.

				
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