entrusted to us but on the other we are not to be trusted regarding the relative priorities of patients' admissions. All we can say is that this treatment and lack of faith in us engender infinite bitterness. It augurs bad times ahead for a failing service. J J SHIPMAN



Lister Hospital, Stevenage, Herts

'Common Waiting Lists for NHS and Private Patients in NHS Hospitals: Report of the Health Services Board made under section 6, Health Services Act 1976. Cmnd 6828. London, HMSO, 1977.

Health centre running costs

SIR,-The experience of this group practice of five doctors is similar to that described by Dr C C Griffiths and his partners (16 July, p


When we moved into this health centre in 1973 we were told that the running costs would be approximately £1500 per annum. This figure was increased in 1975 to £2440, but this July, without any warning or discussion, the service charge was increased to £8380 per annum. When the local family practitioner committee was asked to justify these figures they informed us that they had been unable to obtain any information from the treasurer of Salop Area Health Authority. They had therefore estimated the expenses, and to arrive at the figure of £8380 they had applied a factor of 20° compound per annum increase in our expenses from 1973 onwards. Following the most vigorous representations the sum of approximately £1000 has been reimbursed to us, but the size of future service charges remains unsettled. We feel that all doctors considering entry into a health centre should take notice of the unhappy experiences of at least two group practices in

Shropshire. J GASK G HAYSEY A BREMNER R A HARES R G B WOOD The Health Centre, Market Drayton, Salop

Levy on the self-employed SIR,-I wonder how many general practitioners are aware of the infamous nature of the tax known as NIC Class IV contribution? This tax was imposed on the theory that the employer/employee contribution was subsidising the self-employed. In one year the total benefits paid to employees was C6383-9m. The total employer/employee contributions were C4662 9m, thus producing a deficit of L1721m. The total of pensions and benefits paid to the self-employed was £400-3m while contributions paid amounted to £467 1m, thus producing a credit of C66-8m. The theory is thus totally wrong and shows the Act for what it is: discrimination against one sector of society. The self-employed constitute only onefourteenth of the total number of employees and yet they produce one-quarter of the wealth of the country. The reward for their

industry is limited benefits, a weekly stamp of £2 66 for men, and £2 55 for women, and the NIC Class IV contribution. As this levy has to be paid from already taxed income, a GP paying £250 per year will have to earn nearly double that amount to pay this tax. Being a single-handed country GP, I do not have many opportunities to meet my colleagues. However, on the few occasions that I have been able to discuss this levy with them I have met with total lack of interest. Yet the abolition of this tax would give us a considerable rise in income and this could be achieved with no disruption of patient care, as the other suggested methods such as working to rule would produce. I have already refused to pay my contribution and if even half of the rest of my colleagues would follow suit the Act would not survive very long. The defenders of this levy say that it is law, and the law must not be broken. But on the very day the Act was passed members of Parliament declared themselves to be civil servants and renounced their self-employed status. I wonder how lawful that move was. If anyone is interested I would be very willing to supply all the facts and figures in detail that prove that the statements made by the Government when they introduced this Act were not true. I hope very much to hear that there are others who feel as strongly about it as I do. M H AYLWARD Bourne House, Leamington Road, Broadway, Worcs

How many medical students? SIR,-I have read with some apprehension the deliberations of the recent BMA meeting when statistics were produced to suggest that a freeze should be placed on new entrants to medical schools. The majority of consultants will be aware that, outside of teaching hospitals, the bulk of junior staff are from overseas. We have not had a British graduate apply for a registrar post at my hospital for some years. Two things require to be done, and cutting down entry into medicine at this time is not one of them. Firstly, a revision of the structure of medical staffing in hospitals should be urgently undertaken so that doctors who wish to can stay in the hospital service full time, even if a consultant grade is not attained. No other profession has a system whereby one must become a general or quit the service. Not every teacher becomes a headmaster; not every lawyer a judge; not every priest a bishop. Yet those who don't seem, nevertheless, to succeed in pursuing a contented career. Psychiatry and many other specialties are already feeling the effect of the progressive abolition of senior hospital medical officer and medical assistant grades. At my hospital four trained assistants have been replaced in the past five years by untrained senior house officers (there being a freeze on registrars), with obvious deterioration of the service we can provide. Secondly, the preregistration year should be expanded to include posts at present inaccessible to the newly qualified doctor. There is no logic, for example, in excluding psychiatry (which will occupy a -sizable proportion of the general practitioner's work) while including some surgical specialties such as ENT or ophthalmology (without general sur-

6 AUGUST 1977

gery). This preregistration difficulty is one of the main reasons that so-called unpopular specialties become so, since the doctor often develops interests in the subject he does in the preregistration year. M T HASLAM Clifton Hospital, York

SIR,-I was distressed and angered to hear that at the BMA's Annual Meeting on Saturday 23 July the representatives had called for a freeze on the number of students entering medical school. The reasoning behind such a proposal may at first seem quite acceptable-namely, the lack of preregistration house jobs for medical graduates. This is a fact that concerns me personally, since 1981 has been named as the year when between one-fifth and one-eighth of the graduating medical students will find no job to go to, and I will graduate in 1981. So to prevent this unemployment from getting out of hand in the years to come the solution is simple-cut back on medical students. But is it that simple? Surely this would lead to an acute shortage of doctors, further, probably quite justified, claims for higher salaries, increased costs, etc, and while we do not want to follow a similar path to that of the teachers, this is not the solution. Critics of the NHS say that it is falling apart at the seams, and with cuts in expenditure this trend will continue unless its problems are sorted out now. I am not an advocate of the "right to something" type of philosophy, but it would seem that the answer to this problem is not producing fewer doctors but in making sure the jobs are available, since the public demand is definitely there. Unless the situation is dealt with now there will also be an increased loss of British doctors overseas and we will find ourselves in a vicious circle from which it will be very hard, and probably too late, to find a way out. A further consequence of fewer medical students may well be the development of a medical profession of the future becoming so elite that it becomes blind to the needs of the individual. This is an attitude this country cannot afford to adopt, though it is very undesirable, but it can be prevented if the right steps are taken now and the situation is not left until it is hopelessly out of control and too late. NEIL SCHEURMIER Medical Student Fernhurst, nr Haslemere, Surrey

Foreign graduates' entry to general practice

SIR,-In reply to the inquiry of Dr V S Neild (23 July, p 268), I trust that careful reading of my letter will establish my main point. I sought to underline the difficulties facing foreign graduates seeking permanent appointments in the NHS. I reject the insinuations expressed in the letter. One of my partners is Chinese, another a part-time woman re-entrant to general practice. My trainee qualified in Colombo, Sri Lanka. Both I and my group have excellent relationships with them all. J B DAVIS Harlow, Essex

How many medical students?

392 BRITISH MEDICAL JOURNAL entrusted to us but on the other we are not to be trusted regarding the relative priorities of patients' admissions. All...
273KB Sizes 0 Downloads 0 Views