1238 TWO UNIVERSAL NEEDS IN U.K. MEDICAL SCHOOLS Committee will descend on the groves of academe and take the pulse and temperature of university medicine. There are two areas which merit diligent inquiry by the U.G.C. The first is the wide gap between clinical and preclinical disciplines, a gap which is cemented by the harsh reality of a savage salary differential. The surgeon seeks parity with N.H.S. colleagues by virtue of his scalpel, the physician by his stethoscope, the bacteriologist by his culture-laden loops of platinum, and the pathologist by the use of the microscope. But let none of these forget they owe their very existence to their teachers of basic science. Basicscience workers make their contribution to the N.H.S. by producing the medically qualified graduate, and this alone merits a reversal of contemporary trends in salary. In this country we regard ourselves with much satisfaction and are reluctant to examine the better points of foreign centres of learning. In Berne I believe there exists a basic medicalschool salary, and consequently it is not unheard of for medical graduates to seek a career in one of the basic sciences. Furthermore, over the past 15 years there has been a growth of experimental laboratories, staffed by persons trained in preclinical science, within clinical departments. Expansion and extension of this pattern might lead to further sequestration of the academic preclinical
SIR,-Shortly
the
University Grants
departments. The second point deals with the increasing importance of non-medical staff in the day-to-day affairs of a medical school. The role of the science graduate in both teaching and service is steadily increasing, and rightly so. But what is done by medical schools to encourage our scientists in understanding the medical milieu ? Surely there is a need for short courses which will cover the nature of disease, the functions of specialties, and the outlines of health administration ? This might be done by just one medical school as an educational experiment. 27 Inverleith
Terrace, Edinburgh 3.
WOMEN
A. E. STUART.
DOCTORS’ RETAINER SCHEME
SIR,-Your correspondents (April 26, p. 974) highlight the problems of all women doctors accepting parttime work either as clinical medical officers or as clinical assistants in hospitals. These women will shortly find themselves out on a limb, junior to their contemporaries and to many less well-qualified, less experienced doctors. The time spent in their posts will not qualify them for any of the higher medical echelons. Clinical medicine in community health is not part of a community physician’s training, neither is it recognised training for any specialty; even senior clinical medical officers remain junior to all community physicians. Clinical assistant is not a hospital grade, neither is it recognised as a training post for specialist registration; but if the community clinical services were to be integrated with the hospital service then doctors working part-time in this field could be graded s.H.o., registrar, hospital practitioner, &c. ; and part-time work could be counted pro rata for specialist qualification. There are overriding reasons for the integration of family planning and cytology services in this way: all major complications and problems arising in these areas are dealt with in obstetric and gynxcological departments; familyplanning experience is a compulsory part of junior staff training and for trainee general practitioners; it is a requirement for the D.OBST. and is part of the nursing curriculum. The Royal College of Obstetricians and Gynaecologists
(in conjunction with the Royal College of General Practitioners) has already made itself responsible for medical standards in this field. How can it determine that standards will be maintained unless these services and the doctors providing them are included in obstetric and gynxcological departments ? The doctors would then become an integral part of the department with the opportunity for further specialist training. If the B.M.A. and the Royal Colleges wait until the Court Committee reports at the end of 1975, it will be very difficult to unscramble the system. The Warren, Elenors Grove,
Quarr,
near
Ryde,
DIANA EDWARDS.
Isle of Wight.
COOPERATION BETWEEN SOCIAL WORKERS AND GENERAL PRACTITIONERS JIlt,-At
a recent
ot social workers and
general decided that there is a need for a group whose special function is to foster cooperation between social work and general practice. It was thought that professional organisations involved in promoting cooperation were too remote to be able to monitor adequately the problems in the field. It was also pointed out that the professional organisations most intimately concerned, the British Association of Social Workers and the Royal College of General Practitioners, were limited to dealing with their own members when they tried to promote cooperation. The meeting therefore decided to constitute itself formally, and the title chosen for the group was General Practitioner and Social Worker Workshop. We have drawn up a constitution, and have appointed officers for the forthcoming year. It is unfortunately necessary for us to charge a subscription to cover the costs of postage, stationery, &c,, and some small-scale research projects that we envisage being undertaken. We would stress that we see ourselves not as a rival organisation to other professional bodies but rather as a body which has constituted itself to perform a special task. Should we find that the need for our existence no longer exists we would dissolve ourselves. Our experience so far, however, during 2t years of informal meeting, is that there is a need for a group which can act as a focal point for those interested in general practice/social work meetmg
practitionersin Manchester it
was
cooperation. If anyone is interested in joining the group, details of constitution and aims can be obtained by sending a reply-paid envelope to the Honorary Secretary.
our
G. KEELE, Darbishire House Health Centre, Upper Brook Street, Manchester M13 0FW.
Hon. Secretary, General Practitioner and Social Worker Workshop.
MEDICAL AUDIT
SIR,-Dr Garber (May 10, p. 1086) quite rightly points the fact that a major medical priority is to establish " what more surely, quickly, and cheaply improves the quality of medical care ", but contrary to his line of argument the only means at his disposal is bound to be some
to
form of " output " audit. His claim that the quality of surgical care in the best U.S. centres compares favourably with the best in Britain may well be true but can only be validated by assessment of results in comparable centres according to appropriate " criteria-i.e., an output audit. " The input recommendations he quotes in relation to improving care in general practice seem laudable but are "
"
SIR,-Shortly
the
University Grants
departments. The second point deals with the increasing importance of non-medical staff in the day-to-day affairs of a medical school. The role of the science graduate in both teaching and service is steadily increasing, and rightly so. But what is done by medical schools to encourage our scientists in understanding the medical milieu ? Surely there is a need for short courses which will cover the nature of disease, the functions of specialties, and the outlines of health administration ? This might be done by just one medical school as an educational experiment. 27 Inverleith
Terrace, Edinburgh 3.
WOMEN
A. E. STUART.
DOCTORS’ RETAINER SCHEME
SIR,-Your correspondents (April 26, p. 974) highlight the problems of all women doctors accepting parttime work either as clinical medical officers or as clinical assistants in hospitals. These women will shortly find themselves out on a limb, junior to their contemporaries and to many less well-qualified, less experienced doctors. The time spent in their posts will not qualify them for any of the higher medical echelons. Clinical medicine in community health is not part of a community physician’s training, neither is it recognised training for any specialty; even senior clinical medical officers remain junior to all community physicians. Clinical assistant is not a hospital grade, neither is it recognised as a training post for specialist registration; but if the community clinical services were to be integrated with the hospital service then doctors working part-time in this field could be graded s.H.o., registrar, hospital practitioner, &c. ; and part-time work could be counted pro rata for specialist qualification. There are overriding reasons for the integration of family planning and cytology services in this way: all major complications and problems arising in these areas are dealt with in obstetric and gynxcological departments; familyplanning experience is a compulsory part of junior staff training and for trainee general practitioners; it is a requirement for the D.OBST. and is part of the nursing curriculum. The Royal College of Obstetricians and Gynaecologists
(in conjunction with the Royal College of General Practitioners) has already made itself responsible for medical standards in this field. How can it determine that standards will be maintained unless these services and the doctors providing them are included in obstetric and gynxcological departments ? The doctors would then become an integral part of the department with the opportunity for further specialist training. If the B.M.A. and the Royal Colleges wait until the Court Committee reports at the end of 1975, it will be very difficult to unscramble the system. The Warren, Elenors Grove,
Quarr,
near
Ryde,
DIANA EDWARDS.
Isle of Wight.
COOPERATION BETWEEN SOCIAL WORKERS AND GENERAL PRACTITIONERS JIlt,-At
a recent
ot social workers and
general decided that there is a need for a group whose special function is to foster cooperation between social work and general practice. It was thought that professional organisations involved in promoting cooperation were too remote to be able to monitor adequately the problems in the field. It was also pointed out that the professional organisations most intimately concerned, the British Association of Social Workers and the Royal College of General Practitioners, were limited to dealing with their own members when they tried to promote cooperation. The meeting therefore decided to constitute itself formally, and the title chosen for the group was General Practitioner and Social Worker Workshop. We have drawn up a constitution, and have appointed officers for the forthcoming year. It is unfortunately necessary for us to charge a subscription to cover the costs of postage, stationery, &c,, and some small-scale research projects that we envisage being undertaken. We would stress that we see ourselves not as a rival organisation to other professional bodies but rather as a body which has constituted itself to perform a special task. Should we find that the need for our existence no longer exists we would dissolve ourselves. Our experience so far, however, during 2t years of informal meeting, is that there is a need for a group which can act as a focal point for those interested in general practice/social work meetmg
practitionersin Manchester it
was
cooperation. If anyone is interested in joining the group, details of constitution and aims can be obtained by sending a reply-paid envelope to the Honorary Secretary.
our
G. KEELE, Darbishire House Health Centre, Upper Brook Street, Manchester M13 0FW.
Hon. Secretary, General Practitioner and Social Worker Workshop.
MEDICAL AUDIT
SIR,-Dr Garber (May 10, p. 1086) quite rightly points the fact that a major medical priority is to establish " what more surely, quickly, and cheaply improves the quality of medical care ", but contrary to his line of argument the only means at his disposal is bound to be some
to
form of " output " audit. His claim that the quality of surgical care in the best U.S. centres compares favourably with the best in Britain may well be true but can only be validated by assessment of results in comparable centres according to appropriate " criteria-i.e., an output audit. " The input recommendations he quotes in relation to improving care in general practice seem laudable but are "
"
