ContentsIner Cities Conference; RCGP Research Fellow.423

^1 * w w*~~~~~~~~~~~~~~~~~~~~RCGP E;xamination .................................................. 424NE . WS w wComp u terGuidelines;Letters......................... 425

The Theatre of Violence ......................... 426Honorary Editor: Dr Edwin Martin AUTGP Annual Scientific Meeting ....... ............... 427Editor: Janet Fricker RCGP Obstetrics Exhibition ......................... 428

Inner Cities Conference..

THE RCGP and Royal College ofPhysicians held a joint conference in

July to highliht some of the more successfulinitiatives developed in the inner cities.

In his opening address Sir DonaldAcheson, chief medical officer of the DHSS,reminded participants that regeneration ofthe inner cities was a prime objective of thepresent administration. He identifiedunemployment, poor housing, crime and thehigh prevalence of mental illness and drugabuse as making the care of patients in in-ner cities difficult. He said that many of thepatients seen by doctors and other profes-sionals in the inner cities were young, mobileand without the normal support systems.The consequences were long hospital staysbecause of home conditions, an increasedprevalence and slower recovery from illness,and a decreased expectation of what theHealth Service can provide. Hospitals are us-ed inappropriately for primary care, and thegeneral practice system suffers from poorpremises, lack of team work and profes-sional isolation.

Sir Donald made the plea that plans forimprovement should be made in response -tolocal needs, rather than large scalereorganization which might be inappropriatein certain areas. He highlighted the need ofhospitals to develop their links with localpopulations and primary care teams.He commented that most teaching

hospitals were in inner city areas and thatthe attitude of medical schools to the com-munity and general practice would be a vitalfactor in improving inner city medicine.

Born in the Inner CityProfessor Sir Malcolm MacNaughton, presi-dent of The Royal College of Obstetriciansand Gynaecologists, described the work ofhis Glasgow unit in providing antenatal careto deprived areas. A consultant from the unitis attached to each health centre andantenatal clinics are conducted in health cen-tres near the patient's home by both con-sultants and GPs. Dr Langan, a GP fromGlasgow, said that the advantage was thatcare could be provided near the mother'shome by a team of doctors and nurses shecould get to know.Dr Leon Polnay, a community paediatri-

cian from Nottingham, said that the pro-blems highlighted for inner city children ina 1905 report were much the same as forchildren today. He gave the example of amother who turned up directly to hospital

with a sick child. She was given a telephonebook and asked to telephone her own doc-tor, but it was found that she was unable toread, unable to use the phone when giventhe number and unable to explain what waswrong with her child.Nottingham GP John Temple said that

the health visitor was often the first pointof contact in child illness, and that com-munication was made easier if health visitorsworked in the same building as GPs. DrTemple said that one consequence of theiropen access child health clinic was that im-munization rates had risen to as high as 85to 95 per cent.

Tbwer Hamlets. Primary CareDevelopment FundNancy Dennis described her work with theTower Hamlets Primary Care DevelopmentFund. For the last four years she has beentalking to GPs about how they would liketo see their services develop and what couldbe done about their problems. Many of theproblems centred round poor premises, theneed for information, poor communicationswith local hospitals and a need for jointplanning between the health authority andthe FPC. She had found GPs interested inimprovements, and since beginning her pro-ject the number of practices with realprimary care teams in the area had increas-ed from five to 25.

Accidents and Illnesses in theInner CityDr Terry Redman, an accident and emergen-cy consultant from Manchester, spoke of thecare of violent patients and the danger tostaff.With regard to rape cases, he said that the

care and investigation of patients who hadbeen raped could become another 'assault'if it is not carried out sensitively.Dr DJ Williams, accident and emergency

consultant at St Thomas' Hospital andchairman of the Society of Accident andEmergency Surgeons, said that in inner citieswhere tourists, commuters and homelesspeople had no GP, A&E departments hada dual role. Dr Williams produced figuresto show that fewer emergency admissions tohospital came through GPs than A&Edepartments. He said that patients choos-ing A&E departments for their primary careshould be ensured high quality treatment.Dr John Oldroyd told the conference that

of the 1,200 London GPs who had answeredhis questionnaire on violence, only 30 hadhad no experience or threat of violence.There were 150 cases of reception staff alsoexperiencing violence and two cases of thedoctor's family being attacked.

ConclusionIt was mentioned that immunization figuresand other indicators of good practice weresometimes better in the cities of third worldcountries such as Nairobi than in Britain.One delegate commented that if it was possi-ble to run an efficient child health clinicunder a tree in South East Asia, premisesshould not be considered a bar to runningefficient clinics in the UK. They could easi-ly be run in church halls and the backroomsof public houses.One factor that became obvious during

the day was that many of the projects hadnot been evaluated. It was decided to joint-ly set up a monitoring system between TheRoyal College of Physicians and RCGP toreport back on the progress of these in-itiatives and decide what further steps wererequired. [

Edwin Martin

New RCGPResearch FellowsTHE RCGP has appointed three GPs to

its new research fellowships. T'yneside GPDr Morris Gallagher will be assessing the im-pact of AIDS on general practice. He plans toestimate the number of new consultations GPshave with people who are worried about AIDS.He will be trying to find out what GPs think

about HIV blood testing confidentiality, giv-ing out sterile needles to drug addicts and theprovision of domiciliary terminal care.North London GP Dr Stephen Iliffe will

study the mental health of carers looking afterelderly patients in the inner-city areas of Brentand Islington. He will examine the relation ofthe mental health of the carers to the subse-quent use of health care facilities.

Leicester GP Dr Aly Rashid plans to assessthe extent to which ethnic minorities feel theirsymptoms are understood by health careprofessionals.The fellowships, which run for two years, are

aimed at helping young principals pursue anoriginal line of research and to learn aboutmethods and design. i

Journal of the Royal College of General Practitioners, September 1987

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L- i

RlCGP Examination Passes

The following candidates were successful in theMembership Examination of the Royal Collegeof General Practitioners in June/July 1987:-

(* denotes distinction)

P.R. Abbott, Patricia M. Abbott, Elizabeth V.Abernethy, Mairi C. Adam, P.J. Adams, R.N. Adams,S.P.R. Adams, *Gemma Adamson, Patricia YA. Ahl-quist, Margaret C. Ainger, Mazen Al-Bashir,Elizabeth M. Albiston, Julia M. Alexander, M.C.Aley, M.P. Allen, M.E. Allerton, Helen R. Alpin, D.J.Alston, Margaret Alty, S.J. Alvis, Fiona M. Anderson,T.J. Anderson, Rachel A. Angus, R.Y. Anthony, HelenAppleton, Gillian M. Arbuckle, M.I. Archer, Sally C.Archer, M.H. Ashley, *Charlotte E. Asquith, D.A.

Astley, R.C. Attree, Mary F. Backhouse, Christine deC. Baker, Hilary A. Baker, Kanwaljit Bakhshi, H.R.Bance, S.I.G. Barclay, R.J. Barker, C.R. Barlow, HelenC. Barlow, M.H. Barnes, Janet E. Barraclough, IanBarrow, M.P. Barry, A.D. Bartholomew, Hilary R.Barton, S.R. Barton, M.D.P. Bates, Helen J. Bayliss,W.R.J. Beales, D.C. Beattie, Helen E. Beaumont,Kathryn J. Beck, M.A.R. Beeney, G.J. Bell, SharonM. Bell, Mary E. Belton, P.R. Bendor-Samuel, A.G.Bennett, P.F. Bennett, Janet L. Benson, Helen C.

Beveridge, Maureen C. Birch, Wayne Birchall,Stephanie M.L. Birmingham-McDonagh, D.G. Black,Patrick Blackford, D.H. Blackwell, K.N. Blake, G.J.Bland, P.F. Bleiker, P.B.J. Boffa, P.F.M. Boland,Graham Bond, Margaret Bone, Colette J. Bonner,Walter Bonnici, Susan L. Boorman, Ruth Booth,G.PT. Bourke, JS. Boyd, Christine J. Bradley, *MA.Bradley, M.D. Brady, Sarah E. Brear, Elinor F.M.Brew, M.D. Brooke, P.R. Brough, L.J. Broughton,Harry Brown, Mary E. Brown, Audrey Bruce, R.N.Bryant, N.H.L. Bryson, B.E. Burke, Heather M.Burke, Lorraine M. Burns, C.R. Burr, Lee Burton,G.L. Busher, Lynne H. Butcher, Fiona A.M. Buxton,Lesley L. Cadzow, Eileen M. Cahill, Catherine J.Caird, J.F. Cairney, Peter Calveley, I.L. Cameron,Gillian L. Campbell, J.L. Campbell, Jennifer A.

Campbell, Susan E. Campbell, W.M. Campbell, P.J.Cansfield, R.S. Caplan, S.P. Capp, M.D. Cardwell,Nicola F. Carey, N.E Carr, R.G. Carr, Wendy M. Carr,P.J. Carragher, Ann-Marie Carroll, M.P. Carson,Yvonne H. Carter, Andrew Cartwright, M.J. Casey,S.C. Cayre, Jane M. Chalmers, Jacqueline Chapman,P.B. Charlson, Wai Chen, Frances E.M. Childs, Kit-Oi Chung, P.J. Chuter, D.P. Clark, Alexandra J.R.Clarke, D.R. Clarke, Sarah V. Clarke, N.M. Clayton,P.R. Coghlan, Susan L. Cohen, N.S. Coleman, C.N.Collier;T.H. Collins, BRJ. Conlon, J.M. Connolly, J.C.Conway, Victoria A. Cooke, J.F. Cooper, RosemaryCooper, S.F. Cooper, Denise Cope, Pamela K.A.Copp, R.F. Cordell, Susan L. Cordiner, M.H. Cor-field, J.W. Cotterill, Dilys A. Cowan, S.M. Cowles,Rachel M.G. Crabbe, Alison M. Craig, AndrewCrank, Alison Craven, M.R. Crick, Robyn D.Crighton, M.G. Cripps, Catherine F. Cronin, Sally L.Cronk, Pauline E. Crossland, P.G. Crow, Linda E.Crowder, JJ. Crowley, B.J. Cuddihy, A.A. Culhane,S.A. Cumming, G.A. Cunniffe, J.G. Curran, Ann L.Currie, M.A. Currie, C.R. Cuthbert, P.K. Dakin, J.R.Dale, W.F. Dalton, Avril F. Danczak, Marie C. David-son, Amanda M. Davies, M.C. Davies, T.A. Davies,Judith A. Davis, R.L. De Courcy, Paolo De Marco,*Anne C. Deans, Wendy E. Denning, Gregory Den-ton, M.J. Devine, Vini Dewan, Penelope J. Dexter,Mario Di Monaco, Phillippa J.N. Dickens, R.I.Dickson, Eamonn Dillon, Sarah Divall, JosephDjemal, M.J. Doherty, N.W. Doll, *J.F Donaghy, C.A.Donaldson, M.B. Donnelly, Anna M.R. Douglas,R.W. Drayson, Joanne L. Drew, JJ. Duffy, Diane F.Duke, W.K. Dunn, K.P. Dunphy, Kamran Durrani,G.W. Durston, A.H. Dutton, Wendy A. Dyke, MaryT. Easson, DA.H. Easton, J.M. Edwards, Sian A. Ed-wards, J.B. Elder, J.C. Elliman, Frances M. Elliot,*I.M. Elliott, Eunice M. Ellor, Penelope E.Elphinstone, *J.R. Emmanuel, A.J. Emslie, Hilary J.Entwistle, DA. Evans, JA.L. Evans, *P.H. Evans, B.J.Everett, S.J. Eyre, *Judith E. Fairweather, M.M. Fan-ning, Elizabeth A. Farnall, A.M. Farooqi, C.P. Far-relly, G.S. Faulkner, K.P. Fellows, A.E. Felton, S.R.J.Feltwell, R.J. Ferguson, N.J. Field, S.J. Field, SusanM. Field, Rowena D. Fieldhouse, A.S. Fielding, SimonFilose, N.G. Findlay, Hilary J. Fine, Sarah M. Finnie,Jacqueline A. Fisher, P.PJ. Flanigan, Martin Flatley,Mari Fleri, Rosemarie J. Flood, D.J.C. Flower, H.R.C.Ford, Jennifer E. Foster, N.J. Foster, Andrew Foulkes,

P.S. Fox, D.C. Frank, A.W. Frankland, A.K. Fraser,M.C. Free, H.M. Freeman, S.P. Freeman, ChristineU. Freytag, J.E. Gaffney, C.J. Gallagher, *Paula M.Gallagher, Caroline G. Gamlin, J.K. Garland, J.F.P.Garnett, P.J. Garrod, D.A.H. Gerson, Janet P.Gillespie, J.R. Glenfield, P.S. Goffin, J.G.S. Goldie,D.R. Gorman, Judith A. Graham, W.M. Graham,A.J. Grant, C.M. Grant, Karen L. Grant, Deborah A.Gray, I.C. Greaves, R.E. Green, Nola C. Greene,Elizabeth R. Greer, *S.N. Gregson, Hannah M. Grif-fiths, P.J. Griffiths, Valerie A.M. Griffiths, RobertGrinsted, *Alison R. Groves, MA. Grubb, R.E. Grun-dy, Margaret B. Gunn C.C. Gunstone, Rex Haigh,D.A. Haines, I.M. Hall, K.G. Halpin, Sheila Halpin,Duncan Hambly, D.M. Hamilton, John Hamilton-Paterson, M.E. Hancocks, D.W. Hannah, Sally M.Hanson, K.G. Harding, P.N. Hargreaves, MaryHarland, D.S. Harper, P.M. Harrington, Sarah L.Harrison, Simon Harrison, Ishbel M. Hartley, H.J.Hawker, Barbara L. Hawkes, Gillian M. Haworth,A.G. Hay, Deirdre J. Hay, Justin Hayes, M.G. Hayes,S.C. Haywood, D.C. Hazelton, J.C. Healey, M.J.Heber, N.H. Helliar, P.A. Hemming, W.B. Hender-son, Pauline A. Hennell, Denise M. Hennessy,Josephine M.P. Herbert, M.J. Hewitt, JJ. Hickey, I.R.Hicks, O.J. Hidson, S.P. Hignell, P.J. Hill, H.R.Hilson, Marc Hinchcliffe, Elizabeth T.F. Ho, SarahJ. Hobson, J.P. Hogan, Wilma J. Hogg, R.I. Holmes,M.P. Hood, Brian Hope, Deborah Horton, Anne L.Howard, Catherine M. Howard, D.J. Howard,Christina A. Howie, Gillian M. Howie, M.J. Hudson,M.A. Hunt, Alison E. Hunter, D.C. Hurwitz, L.M.Hussain, P.G. Hussey, Elaine A. Hutton, M.G. Igoe,P.J. Inch, C.R. Ingamells, D.G. Irwin, J.A. James,Lauren A. James, Fiona A. Jamieson, B.R. Jani,Alyson S. Jarvis, Sheena A. Jay, D.J. Jeffries, JeanA. Jenkins, Barbara M. Jenner, B.S. Jheeta, D.H.John, Elizabeth A. Johnson, Helen M. Johnson, BW.Johnston, Fiona M. Johnstone, Susan P. Johnstone,G.C. Jolliffe, N.C. Jolly, A.C.N. Jones, A.M. Jones,Claudia A. Jones, D.G. Jones, G.V. Jones, I.G. Jones,Jill Jones, Judith E. Jones, R.G. Jones, C.N. Jordan,Anna Kalougin, Caroline R. Karanjia, Anne L. Keel-ing, Martin Keeling, R.N. Kelly, A.F. Kent, Paul Kerr,T.J. Kimber, N.A. King, Norma E. King, S.F. King,Joanna C. Kingsmill, Helen L.S. Kirkwood, D.C. Kir-rage, P.M. Knapton, R.L. Kneebone, Linda M. Knox,A.K. Kothari, Georgios Kouloumas, Morag C. Laing,P.F. Lane, Susan J. Langridge, J.H. Larcombe, Jen-nifer A. Lawn, F.J. Lawrenson, I.B. Lawson, S.J.Lawson, A.J. Leach, J.T.S. Leask, D.A. Leather, CarolLee, D.G.M. Lee, Margaret M. Lennon, R.A. Lestner,J.A. Lethem, Catherine Lewis, Gareth Lewis, HelenK.M. Li, Desiree A.S.L. Lie, A.J. Liggins, ChristineS. Lockwood, RA. Logan, B.R. Logie, I.R. Longhorn,J.F. Lucey, Elizabeth H.T. Lumsden, S.J. Lynch, T.D.Lynch, J.F. Lyons, Helen M. MacDonald, N.G.MacKillop, *JA. MacLean, Sheona M. MacLeod,Sheena L. Macdonald, I.G. Macgregor, C.J. Mackin-tosh, Lesley N.M. Mackintosh, Catherine Macleod,Rhona I. Macpherson, Stephen Macvicar, D.J. Mad-dams, J.R. Madden, W.K.H. Magee, R.J. Mageean,T.J. Mallon, Christopher Malony, Karen L. Manning,*Rajeshkumar Mapara, C.J.B. Marchi, Brenda M.Marshall, S.R. Marshall, S.W. Martin, S.H. Mather,Sandra D. Mather, T.G. Mathias, G.P. McBride, F.E.F.McBrien, C.G. McCabe, Charlotte P. McCaie, R.J.McCann, Jane M. McCarthy, D.J. McCartney, MarkMcClean, Mary A. McCloskey, Margaret B. McCon-nell, Maureen A. McFarland, Ethna C. McGourty,Aileen J. McGregor, G.C. McInnes, M.J. McKemey,R.D. McKeracher, G.L. McLaren, R.J.C. McLaughlin,M.S. McLean, G.A. McLeod, N.A. McLeod, C.P.McMahon, T.S. McMain, Winifred H. McManus,Lorna M. McMillan, Mary B. McQuillan, J.J.McSorley, Catherine M. McVeigh, Lesley C. Meakin,G.W. Meenan, PT. Menin, C.P. Mercer, Lyndon Miles,G.D. Miller, Catherine Mills, G.N. Mills, NLL. Milner,H.G. Mistry, W.J. Moffat, *Sandra Moffitt, G.I.D.Moles, Angela Montgomery, I.J. Moodie, S.P.G.Moore, M.S. Morrice, D.E. Morris, June Morris, P.T.Morris, Paul Morris, Alison M. Morrison, Hilary E.Morrison, T.J. Morton, D.P. Moss, Patricia A.Moultrie, J.R. Mowat, G.A. Moyse, J.E.L. Munday,Denise I. Munro, A.J.M. Murdoch, Catherine V. Mur-phy, Clara E. Murphy, K.E. Murphy, M.G. Murphy,Maria Murphy, J.L. Murray, R.M. Nairn, X.P.Nalletamby, Linda J. Nevin, Sheila M. Newport, BridM.T. Ni Chuinn, Maire U. Ni Rathaille, N.M. Nichol,R.C. Nicholson, Tbresa F. Nicholson, T.J.F. Nicholson-Lailey, Fiona H. Norcross, A.D. Nye, A.J.M. O'Brien,

DJ. O'Brien, G.TA. O'Brien, *D.P. O'Callaghan, B.P.O'Doherty, Johanna M. O'Donnell, T.G. O'Donnell,Patrick O'Donoghue, J.P. O'Driscoll, K.G. O'Dwyer,Jacinta B. O'Halloran, Rosemary O'Halloran, MaryG. O'Hara, P.R. O'Loan, J.E.G. O'Neil, *C.P. O'Neill,Mary M. O'Neill, Emer O'Reilly, Zita B. O'Reilly,A.G.P. Oakenfull, Elaine C. Ogg, Gillian A.Ollerhead, Bridget V. Osborne, Catherine J. Otty, Jac-queline Owens, Valerie A. Parker, M.J. Parks, SallyF. Partington, Sally J. Partridge, B.B. Patel, Jatin-kumar Patel, R.M. Patel, Aileen M.E. Paterson,*Shefla P. Paterson-Brown, *A.N. Paton, T.J. Patten,M.D. Patterson, Timothy Patterson, W.J. Patterson,Mary R. Payne, B.A. Pearl, Nina R. Pearson, M.J.Peat, R.G. Peckitt, M.A. Perera, H.M. Pert, T.R.Peskett, E.J. Peters, Eleanor B. Peters, KathleenPeters, Lynne Philip, N.J. Pickering, Anna C. Piking-ton, S.K. Pitalia, Karena A. Platts, Julia M. Pole,Elaine E. Pollock, M.S. Preskey, J.G. Preston,Dorothy M. Pretty, Philip Pue, Z.R.T. Qureshi, JaneM.S. Rajan, Mohilt Ramgoolam, Maureen W.Ramsey, N.G. Reed, FA. Reglinski, Nicola J. Reveley,Michele M.M. Rice, P.F. Rice, Gillian A. Richards,I.M. Richards, Clare D. Richardson, Janet A.Rickard, S.J. Roberts, D.K. Robertson, Laura M.Robertson, C.C. Robinson, Diane P. Robinson, Joan-na P.J. Robinson, Susan J. Robinson, T.A. Robinson,Julia M.P. Rochford, G.J. Rogers, Wendy A. Rogers,RW.D. Ross, Robert W.D. Ross, Sheila K. Ross, D.J.

Rout, Bernadette M.M. Rowan, Kathryn B.L. Rud-deli, Audrey S. Russell, I.C. Russell, Susan G. Russell,J.G. Ryan, Mary C. Ryan, Carolyn J. Sadler, J.M.Sager, N.S. Sahota, Alison Sands, P.E. Sawney, D.T.Say, Elizabeth A. Scales, J.G. Scanlon, M.A. Scar-borough, G.J.C. Scott, W.G. Scott, C.A.N. Sears,Linsey C. Semple, Jane E. Senior, A.E. Sensier, JuliaC. Shanahan, Kalpana Sharma, S.C. Sharma, P.G.Shepherd, C.T. Sheppard, Mary F. Shields, R.W.M.Shiggins, Chandran Shishodia, *Fiona M. Short, B.S.Sidhu, A.G. Sills, J.M.W. Simpson, Peter Simpson,Rosalind M. Simpson, Alison A. Sinclair, R.V.J.Singer, Amarjit Singh, Alison M. Slater, J.N. Slorach,I.R. Small, D.I.A. Smith, G.Y. Smith, L.F.P. Smith,Nicola J. Smith, P.G.D. Smith, *Penelope E. Smith,Ann E. Sneddon, E.A. Spagnoli, Elizabeth A. Sparl-ing, C.S. Spence, Fiona J. Spens, H.P. Spiteri, A.L.Spooner, Katherine M. Spowart, Joan M. St. John,Anne V. St. Joseph, C.A. Stanford, N.R.Y. Stanger,Helena J. Stanley, *T.J. Stannard, Elizabeth A. Steed,Sarah S. Steed, M.A. Steel, Fiona C. Stein, G.G.Steinbergs, R.E. Stephenson, *M.A.J. Stevens, N.B.

Stevens, P.R. Stevenson, Anne E. Stewart, K.W. Stirl-ing, R.N. Stones, J.C. Stout, S.J. Straughan, I.M.Stuart, Dorothy B. Sullivan, Mark Sullivan, P.A.Sullivan, A.G. Swann, K.J. Swann, Bernadette F.T.Sweeney, GA. Sweeney, AJ. Sword, J.L. Synnott, IJ.

Thit, *A.P.S. Takhar, N.P. Tallant, Catherine J. Tar-rant, Patricia A. Tate, E.P. Tattersall, D.L. Taylor, H.W.Taylor, Jane H. Taylor, C.P. Thackray, N.J.A.Theobald, Kathryn P. Thomas, P.WV. Thomas, S.W.Thomas, Anne T. Thompson, H.E. Thompson, S.A.Tickle, Ninawatie V. Tiwari, I.M. Todd, D.M. Tole,A.R. Tollast, I.R. Tooley, A.R. Toovey, Carolyn V.Travers, Bonnie S. Tse, Lynda J. Tulloch, G.N. Turk,Colin Turner, M.J. Valentine, Aileen J. Van Der Lee,Kishorchandra Vasant, John Veale, A.R. Verghese,Ajaykumar Vora, J.W. Wagstyl, Claire S. Walford,E.D. Wallace, Kim D. Wallace, J.N. Walters, R.T.Walton, *D.G. Ward, Lindsay Ward, Beverley J.Watkins, Timothy Watkins, N.F. Watson, P.A. Wat-son, S.P.A. Watson, Ruby M.J. Watt, C.S.A. Wayte,Barbara A. Weatherill, Patricia A. Webster, J.P.Wedgwood, Clare A. Weekes, Rachel M. Weeks, I.R.J.Weir, A.J. Wells, Mary R. Wenley, Anne P. West,A.H.S. Weston, *Elen Wharton, Robin Wheatley,Katharine A.H. Wheeler, J.A.J. Whitaker, A.A.J.White, T.M. White, M.R. Whiting, Ian Whitley, P.S.Whyman, P.C. Wiehe, D.J. Wilcock, Jane Wilcock,P.R. Wilkes, A.R. Wilkinson, Janet M. Wilkinson,Andrew Williams, D.T. Williams, Dorothy J.Williams, H.G. Williams, Janet M. Williams, R.J.Williams, Lyn Williamson, G.M. Willis, C.A. Wilson,Christine S. Wilson, D.G.F. Wilson, D.L. Wilson,Elizabeth Wilson, *N.L. Wilson, N.R. Winslow,A.N.B. Winter, P.J. Wiseman, Hannah E. Wishart,Jacqueline M. Witt, A.P. Wolpe, H.W. Wong, AlisonJ. Wood, Hilary J. Woodhead, R.B. Woodhead, I.G.Woollands, C.T. Worth, *Sara K. Wraight, A.

Wright, J.G. Wright, Keith Wycliffe-Jones, AngelineM. Young, D.R. Young, V.S. Zammit. E

Journal of the Royal College of General Practitioners, September 1987

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424

Computer

GuidelinesRCGP/GMSC joint guidelines for the

extraction of data from GP computersystems by organizations external to thepractice.

These guidelines are designed to ensurethe confidentiality of GPs' medical recordswhen data is supplied by GPs to externalorganizations, whether for commercial orother purposes. They do not, however, app-ly to the normal transfer of clinical and ad-ministrative data from one doctor to anotheror between a doctor and other appropriatehealth professionals; nor are they intended*to restrict the statutory requirements fornotification of data.They should be viewed in conjunction

with the. JCG guidelines on GP dealings withpharmaceutical companies and shall be opento amendment in the light of futureexperience.1 Any organization seeking to obtain data

from GP computer systems should haveappointed a medical officer assumingoverall responsibility for the confiden-tiality of the data, and for maintainingthe validity of its analysis. The medicalofficer must also provide personal andorganizational guarantees to this effect.

2 Whenever a GP or group of GPs entersinto a contract for the release of data toan external organization, the operationshould be monitored, and the uses towhich data will be put by that organiza-tion, and by third parties, should bescrutinized by an independent advisorybody acceptable to the profession. Eachmember of this group should declare anypersonal interest.

3 Ownership of the data contained in thepractice computer remains with the GP,who must have access to it and be ableto analyse it as he/she wishes, and be ableto share it for purposes such as educa-tion, service and research.

4 No patient should be identifiable, otherthan to the GP, from any data sent to anexternal organization without the in-formed consent of the patient. It is sug-gested that a link number should be usedthat would enable the patient to be iden-tified by the GP only. Disclosure to anyother body, ofa) the patient's name or addressb) the full postcode orc) the full date of birthis not acceptable. However, the electoralward, postcode sector (provided thepopulation of the ward or sector is notless than 100), sex, and year of birth areadmissable. Studies requiring morespecific data will require specific proto-cols which should be agreed by properlyconstituted medical ethical committees.

5 Before supplying data to an externalorganization, that organization should berequired to provide the GP with a state-ment, which he/she should retain, ofwhat data are to be taken from his/herrecords and for what purpose they are tobe used. The GP must give informedconsent to the use of the data by the ex-ternal organization or by the third par-ties. The usage of the data must be defin-ed and if the external organization wishesto change or extend this usage it mustprovide the GP with a fresh statementdefining the new usage subject to his/herapproval.

6 The automatic remote interrogation ofthe practice computer by the externalorganization's computer is not accep-table. There are, however, two acceptableways in which data can be transmittedto an external recipient:a) the external organization's technicians

may extract the data from the prac-tice computer if supervised by the GPor an approved member of his staff.

b) the GP, with appropriate training, canextract the data himself and send theverified extracted data to the externalorganization. This can be done byeither mail or practice supervisedelectronic data transfer, provided theGP has full knowledge and control ofwhat data is transferred.

The GP must be provided with a copyof all data being sent outside the prac-tice and must be able to examine andverify the data-being sent.

7 The purposes for which data will be us-ed, the classes of data and the sourcesand disclosures, must be registered underthe Data Protection Act 1984 by the datausers.

MedicalWomen'sFederation

PEAKERS at The Medical Women'sJFederation's 70th Anniversary Sym-posium on Women, Health and Work in-clude Baroness Warnock and AnnaRaeburn. Programme and registration formsfor the symposium, which will be held at theRoyal College of Obstetricians andGynaecologists on Thursday November 26,are available from: Mrs Aileen Goldhill, 65Century Court, Grove End Road, London,NW8 9LD. Telephone 01 289 2060. 0I

Prison MedicineSir,The article on prison medicine by Dr EdwinMartin in your August issue of the Journalmentioned the frequent occurrence ofpsychiatric illness in prison and the estimatethat up to 30 per cent of prisoners could benefitfrom psychiatric treatment. This is an issue ofgreat concern to the National SchizophreniaFellowship as we are hearing of more and morepeople with schizophrenia who are ending upin prison either because they have broken thelaw as a last desperate attempt to get some care,or because they have committed a more seriousoffence as a result of allowing their illness togo untreated in the community. Either wayprison is not a good environment for peoplewith schizophrenia and, as Dr Martin pointsout, prison officers would require the skill andpatience of a saint to help them, not to men-tion some knowledge of the serious psychosesand the kind of treatment and care they require!

Following up the House of Commons SocialServices Select Committee investigation intoprison medicine would it not be a good ideafor the Royal College of General Practitionersto investigate the numbers of mentally ill peo-ple held in prison (including those on remand),the quality of their treatment and the trainingof the staff dealing with them? In our ex-perience prison officers have been given littleor no training in psychiatric medicine and wedaily witness the seriously mentally ill beingdischarged from mental hospitals and admit-ted into prisons with only a varying period ofdeterioration in between.

JUDY WELEMINSKYDirector

National Schizoprhenia Fellowship,78 Victoria Road,Surbiton, Surrey KT6 4NSRepresentatives from the RCGPI The RoyalCollege of Physicians and the Royal Collegeof Psychiatrists are currently examining thetraining requirements of prison medicalofficers.

Practice ComputersSir,I think I should point out that the title givento the article about a faculty computer (Vol 37August, 1987) was misleading.As an honorary secretary of one of the two

college faculties using a computer I felt thatother college members might be interested toknow the background of the faculty's computerproject and how we were progressing.

Unfortunately, the title, (not my own), givento the article indicated that I was writing aboutcomputers in general practice, which I obviouslywas not.

JACKY HAYDENUnsworth Medical CentreParr LaneBury BL9 8JR

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So You Think You're SafeIN 1984 a female GP was bludgeoned to

death while making a routine home visitto a patient in Leytonstone. General prac-tice is a high risk profession and a surveyby the Health and Safety Commission hasestimated that one in three GPs have beenvictims of threatened or actual violence. Thesurvey of 3,000 health service staff including300 GPs showed that the risk of injury wastwice that to building workers, and the pro-blem appears to be on the increase.

But Dr Frank Wells, who represented theBMA on the Health and Safety Commis-sion's Working Party looking at violence tohealth staff, believes that most GPs areunderaware of the potential threat tothemselves and their staff of both verbal andphysical attack."The most important message for GPs

and their staff is don't believe it won't hap-pen to you, because it could. Forewarned isforearmed" said Dr Wells, who was himselfthe victim of an assault when he was a GPin East Anglia.The case of Suzy Lamplugh highlighted

this problem. Last July in broad daylightand the middle of a working day MissLamplugh, 25, disappeared in the course ofher work as an estate agent. Although therehave been plenty of theories there have been

:7'=7_-:_

no positive reasons as to how or why shewent missing.The Suzy Lamplugh Trust was set up in

December last year by her mother DianaLamplugh: it aims to reduce the risks involv-ed for people who put themselves intodangerous situations through the nature oftheir work.

After Suzy's disappearance Mrs Lam-plugh received calls from vets, doctors, jour-nalists and accountants who had experiencedfeelings of fear and threat without knowingwhat to do."We hope to reduce physical, sexual and

verbal abuse so as to achieve a less aggressiveworkplace, where everyone is able to workat the job they wish to do to the best of theirability," explained Mrs Lamplugh.The trust recognizes that violence includes

not only physical attacks but also verbalabuse and threatening behaviour. Prolong-ed exposure can have a serious effect on staffmorale and efficiency, with both mental andphysical health being damaged.Mrs Lamplugh, a teacher and author of

books on relaxation and exercise, is a for-midable lady who has used her specialtalents for communication to mastermindthe trust. She has emerged as a media figure,the 'darling' of the popular press, contradic-

Paul and Diana Lamplugh, founders of the Suzy Lamplugh Trust, surrounded by pictures oftheir missing daughter Suzy.

ting the stereotyped image of the grievingparent."When Suzy disappeared I asked a

psychiatrist friend what I should do. He gaveme two options, I could either put my headunder a pillow or work so hard that I drop-ped every night'Mrs Lamplugh believes that GPs, health

visitors and social workers are particularlyvulnerable to attack because of the isolationcaused by visiting patients at home.Through research, education and training

the trust aims to reduce the risk of personalvulnerability. It believes that if you want togo into a dangerous situation you should beable to do so, but you should be equippedto cope."A doctor cannot refuse to go to a home

where there may be a violent mental case,they have to go, but they should learn thetechniques to deal with the situation"'

But few health staff are taught the techni-ques of how they should avoid thesesituations."Communication skills, relaxation and

avoidance techniques are all life skills whichnot only help people avoid potential pro-blems, but also to work better:' said MrsLamplugh.She explained how when people are under

stress in a stationary situation they lose theiradrenalin and become incapable of perfor-ming at their best.

"If you use relaxation techniques you re-tain the adrenalin and can bring in yourcommunication skills to change the level ofthe conversation so that you can talk to youraggressor and diffuse the situation" said MrsLamplugh.The one thing that always concerned Mrs

Lamplugh about estate agents was the waythey took their social behaviour into theworkplace.

"If it was a male client Suzy would allowhim to show her into the house. Immediatelyshe was trapped with no electricity, atelephone cut-off and a house barred up:'

Mrs Lamplugh feels that it is importantfor people in a work situation to learntechniques where they can politely declineto sit, and that they should automaticallybecome aware of their position in the roomand their get away."Suzy did not take 'Mr Kipper's' name,

address and telephone number, ask him tomeet her at the office or inform her col-leagues when she meant to return"'She says that all these points should

become automatic.Finding that the trust could not meet the

enormous demand for its courses DianaLamplugh devised the Awareness coursepacks which they hope will eventuallybecome standard induction material for newstaff. They are being designed as distancelearning programmes and consist of fourbooks and four videos which can either beused in sequence or taken separately. Thefifth module will be about making your own

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procedures so that an organization candecide for itself which it should be adopting.

"This will enable GPs and practice staffto study together and learn to understandeach others problems."

But it appears that for both doctors andnurses, policies for dealing with violence arenot backed up by training. The Health andSafety Commission's Violence To Staff inthe Health Service recommends that train-ing in the prevention and management ofviolence should be available to all healthstaff and cover the causes of violence,recognition of the warning signs, relevantinter personal skills and details of ar-rangements devised by management.The report suggests that GPs should in-

stall panic buttons in their consulting rooms,carry two way radio links when on homevisits, keep detailed plans of staffwhereabouts and movements and issuepersonal shriek alarms.They recommend that attention should be

given to the general design and physical en-vironment of waiting rooms and receptionareas, for "even small changes within aroom can make it seem less hostile and morewelcoming". Specific changes include glarefree lighting, sufficient personal space sothat patients do not feel crowded, reductionin noise levels, 'subdued' colour schemes,homely touches such as flowers and pic-tures, comfortable furniture designed sothat it cannot be used as a weapon and ac-cess to pay-phones to enable people to ringfriends and relatives.Many more attacks occur than are

reported. Mrs Lamplugh believes that GPsdo not all report attacks because they feelnothing can be done or that the attack wasin some way their own fault.

"People fear that the reporting will beworse than the offence itself. Women aresometimes afraid that it will affect theiremployer and that they may lose the oppor-tunity to go out during the course of theirwork," said Mrs Lamplugh.Some partners are now stopping female

colleagues from going on night visits. DrLotte Newman, the president of the MedicalWomen's Association, is concerned that ifsuch practices become too widespread theymight lead to a reluctance to appoint femaleprincipals."Women going into general practice

should show complete commitment and notaccept such offers however kindly they maybe meant," she said.Mrs Lamplugh is hoping to interest doc-

tors and their staff in the trust's'Vulnerability And The Workplace' con-ference at the University of London onNovember 20 which, among other things,will be identifying ways of protecting healthworkers from assault."We will be bringing together experts in-

volved in many different disciplines such aspsychology, criminology, and architectureand will look at the issues raised by the trust.I'm only the instigator - a catalyst - I don'tknow the answer to these questions. I'mwanting people of calibre to go out and findthem."

Further details can be obtained by writingto Diana Lamplugh at 14 East SheenAvenue, London SWJ4 8AS. EL

Janet Fricker

AnnsualScientific Meeting

of AU¶UPTHE Association of University Teachers

of General Practice held their annualscientific meeting at the MiddlesexHospital Medical School from July 15 to17.

The Association was founded in 1974 withthe object of promoting the developmentof general practice as a universitydiscipline. An important function hasbeen to encourage all forms of researchin general practice including the develop-ment and assessment of teachingmethods. The annual scientific meetinghas now been hosted by most UK depart-ments of general practice and provides op-portunities for the presentation of bothcompleted and ongoing research, and forthe exchange of ideas about futuredirections.One hundred and thirty doctors took

part in the three day meeting which wasopened by welcome addresses from boththe provost of University College Londonand the dean-elect of the University Col-lege and Middlesex Hospital School ofMedicine. Both emphasized the centralrole of teaching and research in a com-munity setting and the importance ofdepartments of general practice andprimary health care in ensuring excellence.The first paper, given by Professor An-

drew Haines, provided a critical appraisalof research in general practice. He review-ed general practice papers published in theBMJ and the RCGP Journal from 1984to 86 and looked at the pattern and designof projects, the origin of research and fun-ding. Several authors, principally Pro-fessor Ian Mcwhinney in 1966 and Pro-fessor John Howie in 1984, proposedagendas for research in general practiceand Professor Haines related his findingsto these ideas and outlined the implica-tions for future research priorities.The papers which followed addressed

some of the present preoccupations ofgeneral practice research workers in theareas of health education and health pro-motion, the role of departments of generalpractice in the continuing education oflocal GPs, the teaching of communicationskills to undergraduates and the interfacebetween medical and social problems.

Lively discussion is always a hallmark ofAUTGP meetings and this session was noexception, with particular emphasis on theutilization of different research paradigmsfor exploring general practice problems,and in particular the tensions between thepopulation and the individual approach.The contributions of anthropologicalmethods were felt to be both valuable andunder used, and this was one of the ma-jor themes within both the formal and in-formal discussions.

Several other papers excited intense in-terest. Dr Roger Jones, of Southampton,outlined a review of recent work in deci-sion making theory and then presentedpreliminary data and ideas for work onthe nature of uncertainty and its effect onclinical decision making for individualdoctors. Dr George Freeman, from thesame department, took the opportunityto discuss the classification and choice ofappropriate outcome measures for assess-ing the effect of continuity of care in themanagement of epilepsy. In addition tolong term clinical outcome measures, theuse of psychological and social outcomessuch as changes in the degree to which a

patient feels in control of himself in rela-tion to his epilepsy and levels of perceiv-ed stigmatization, again demonstrated theimportance of drawing on the work ofother related disciplines.

Poster presentations and workshopswere an important part of the meetingwith the workshops offering a wide choicefor participants including: the OSCE -a method of medical student assessment,new technology in teaching, diagnosis,medicine in a multicultural society, andprimary care development projects.The social programme included an op-

portunity to see Les Miserables and a tripdown the Thames with food, drink, a jazzband and, for some, a chance to let theirhair down and dance a little! This was asuccessful and stimulating scientificmeeting which demonstrated thatacademic general practice is alive, well andengaged in relevant and productiveresearch. eh

John Cohen and Lesley Southgate

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The Best Kept Secret

THE RCGP Museum is currently holdingan exhibition of historical obstetrical and

gynaecological instruments which have beendonated to the College.These coldly metallic objects acquire much

more interest when you consider theirfascinating history, full of intrigues and shadydealings.

Forceps were kept secret by the Chamberlenfamily for one and a quarter centuries in oneof the most supreme acts of selfishness in thehistory of medicine. This deprived countlesswomen of assistance in childbirth, with manybabies being lost and women dying undeliveredor developing fatal injury or sepsis.The Chamberlen family came to Britain in

1569 as refugees from the Hugenot rising. Thefather William, and two of the sons, referredto by historians as 'Peter the older' and 'Peterthe younger' set up practice as barber surgeonsdespite repeated altercations with theauthorities about their qualifications to do so.

'Peter the older' acquired such a reputationthat without even a medical degree he becamesurgeon to Queen Anne, and when thrown in-to Newgate Prison by the Royal College ofPhysicians for the practice of 'physick' he wasreleased by Royal order.Dr Peter Chamberlen, son of 'Peter the

Younger' was the first member of the familyto obtain medical qualifications. He graduatedfrom Padua in 1619, from Oxford in 1620, fromCambridge in 1621 and in 1628 became amember of the Royal College of Physicians. Hehad a large obstetrical following and it wasrumoured he had special instruments withwhich he assisted women in labour.

His son Hugh, a doctor in London duringthe plague, visited Paris in 1670 and offered tosell the 'family secret' to Mauriceau, physicianto the king of France, for 10,000 crowns.Mauriceau tested his boast that he could deliverany woman in 15 minutes by giving him a dwarfwith an impossible pelvis. After three hours he

admitted defeat and returned to England withthe secret intact.He eventually sold the idea some 20 years

later to a Roger Roonhuysen who was able tomaintain an obstetrical monopoly over Amster-dam for the next 60 years. He formed a cor-poration and sold the instrument to eachmember for a fabulous fee, and by 1747 forcepshad become so popular that a municipal lawwas passed making it obligatory for everyobstetrician to possess them. One doctorbecame so angry when he was refused a licenceto practice that he managed to obtain a lookat the instrument and published the design.

But the full secret was only uncovered in 1813when examples of the Chamberlens' in-struments were discovered beneath the floorboards at Woodham Mortimer Hall in Essex,the last home of Peter Chamberlen who diedthere in 1683.Although the Chamberlen family invented

the forceps, William Smellie (1697-1763) waslargely responsible for the British pre-eminencein midwifery and refinements to the design.The Chamberlen forceps had a cephalic curve

and were only effective for outlet deliveries.Smellie introduced the pelvic curve whichallowed the blade to grasp the head high in thepelvis and avoided perineal damage. Smellie'sother contribution was the lock, known as the'English lock' abroad and 'Smellie's lock' athome, which helped steady the blade.The delivery room acquired such an air of

Victorian proprietary that for the sake ofmodesty births took place under the cover ofa sheet that stretched from the mother'sshoulders with its ends tied round the doctor'sneck; the idea being that the only part he eversaw of her was the head. But forceps becamea strictly male domain. For many years onlydoctors could use forceps and only men couldbe doctors.

Nineteenth century obstetricians were reluc-tant to use forceps unless absolutely necessary.

Some of the gruesome instruments in the RCGP collection.

J. Siegmund, Die Konigi. preussische und chur-brandenb. Hof-Wehe-Mutter, Berlin, J.A.Rudiger, 1723. ch. 4 pl. 20.

William Hunter would frequently pull his ownfrom his pocket saying: "Where they save one,they murder many'" This attitude was carriedto such extremes that in 1819 Princess Charlotte,the daughter of the Prince Regent, was left inlabour for 52 hours without intervention. Asa result the mother and baby died and the doc-tor, Sir Richard Crofts, shot himself.

"In the past obstetrical and gynaecologicalinstruments only tended to be used if the babywas dead in a last effort to save the mothee,'said Professor Bryan Hibbard from the RoyalCollege of Obstetricians and Gynaecologists.The RCGP collection contains some

gruesome objects. There is a decapitating hookwith a sharp blade that was passed into thevagina and round the foetus' neck to enable thehead and body to be removed separately.

"Poking inside the pelvis caused mayhem,with the danger of making holes in the mother'sbladder and rectum" said Professor Hibbard.

There is a perforator which was used onhydrocephalic babies to allow the fluid to drainand so assist delivery; and a set of bone scalpelswhich were used before caesarean sections tocut through the pubic symphsis and splay thepelvis to increase the capacity of the birth canal.One of the older instruments in the College's

collection is a whale bone fillet, which Pro-fessor Hibbard believes dates from the seven-teenth to early eighteenth century. "Before thedevelopment of forceps, fillets were hookedover the back of the neck or under the chin andused like a lasso to drag the baby out' heexplained.The case displays a number of more com-

mon instruments like Simpson's long forceps,Anderson's forceps and Braithwaite's forceps,which were especially designed to be carried byGPs in their overcoat pockets and are shapedto fit easily together

Janet Fricker

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FACULTY NEWS

ContentsA First For Scotland; rTainees Social Evening ............................. 429Gleneagles '87 .......................... 430The Retired Faculty Member....................... 431GP Meets the Candidates.....................,.,.,..432

A First for Scotland?TAST year six practice managers from

the North East.Scotland faculty metto share ideas and discuss problems. Anumber of common issues arose and theyrecognized the need to initiate a trainingcourse.

In November 1986 they approached DrWilliam Reith, the chairman of the facultyboard, who was also enthusiastic aboutthe idea. The appointment of Mrs MoragBalchin as the faculty's administrativesecretary allowed for appropriateorganizational support. They decided toarrange a three day course, with a differenttheme for each day.The organizers, who had felt they would

be pleased if as many as 20 practicemanagers expressed an interest, weredelighted when 50 people attended. Thedelegates came from Tayside andHighland Regions, as well as Grampian,with some travelling as far as 138 miles.

It was hoped that the theme for the firstday of administration would set the courseoff on a practical note. Completion of thevarious NHS claim forms was discussed,as was the importance for GPs and theHealth Board in submitting claim formspromptly. The final speaker of the day wasMrs Susan Bates, the secretary of theLHC. Many practice managers knew on-ly vaguely of its existence and were unclearof its function. Following a resume of theHistory of Health Councils, Mrs Bateswent on to highlight some of the recurr-ing problems and complaints that she hadencountered. Issues such as the length ofconsultation times, being kept waitingwithout an explanation, and hospitalwaiting lists were all raised. The possibilityof an informal complaints procedure andthe need for closer liaison with patientswere also discussed.The second day was on the broad theme

of management. Mr George Reid, a seniorlecturer in communication studies atAberdeen College of Commerce, gave athought provoking presentation of theprinciples of management. He asked par-ticipants to complete a questionnairewhich highlighted tlHeir management style- whether it be people or task orientated.Then Mrs Merrill Whalen, a practicemanager from Edinburgh who is jointauthor of Management in General Prac-tice, covered time management and com-munication. She introduced members ofthe group to role playing which wasdesigned to improve assertiveness and thehandling of difficult situations. The after-noon finished with the video BehaviourBreeds Behaviour, a lighthearted butpointed look at how our behaviour canaffect others.The third day was taken by Mr Peter

Graves, the national sales trainingmanager for Ciba-Geigy Pharmaceuticalswho sponsored the event. He covered in-terviewing and selection and stressed theneed for effective staff training and ap-praisal. Most of the managers went awayintent on incorporating some of his ideasinto the day-to-day running of their prac-tices. They thoroughly enjoyed hisdelightful sense of humour and widevariety of teaching methods. One partici-pant later wrote: "I would have liked totake this man home in my case, and letthe rest of the staff share his enthusiasm."The general feeling coming from the

three days was one of renewed en-thusiasm. For many it was their first op-portunity to meet other practice managersand, as always, the informal discussionsproved just as valuable as the formal pro-gramme. Several managers from Taysideand Highland are now hoping to developgroups in their own areas. We are sure that

this course will beconme an annual eventand look forward to further trainingopportunities.

Maureen Campbell, Esther Greig,Edna Ledingham, Eleanor McLeod,Joan McKenzie, Hermione Youngs.

rfrainees SocialEvening

THE Leicester faculty's Educationl Committee organized a trainees'

social evening at the Leicester Royal In-firmary at the end of April.The aims were to publicize the areas in

which the College helps GPs, and to getfeedback from those we hope will soonbecome members. Members explained theorganization of the College centrally andlocally in small group discussions, andthen opened the floor to the trainees. In-evitably, many questions relating to the ex-am and its recent troubles were asked, andtrainees were able to hear the differingopinions of 'grass root' members.

After the discussions a buffet supperwas served.

Allan Thomas, the faculty liaison of-ficer, was present throughout the eveningwith his display and a wide range of Col-lege publications. This input from centralCollege was most welcome andinformative.Over 30 doctors attended, and we hope

that as a result the trainees will havegained useful information about theCollege.

Dick Hurwood

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Gleneagles '87 -an

educational initiative

proving its worthWHEN the East Scotland faculty of

the RCGP proposed a residentialResearch and Education Workshop atGleneagles Hotel three years ago, severaleyebrows were raised in disbelief. Surelyit would not be possible for one of theColleges smallest faculties to successful-ly generate a programme from its ownmembers' work that would be sufficientto sustain a weekend meeting.

Despite such scepticism Gleneagles '85,the first Spring Workshop of the EastScotland faculty, was held with over 50GPs attending. It was so successful thatit was decided to attempt the ventureagain this spring. This was a test to seewhether such workshops were sustainableand educationally worthwhile.

Three main sessions were organized forGleneagles '87: 'Drugs and Abuse, 'Col-laborative Research in General Practiceand 'The Problems of ContinuingMedical Education' A draft programmewas drawn up nine months in advance,with 14 speakers, all of whom worked inTayside and came from the East Scotlandfaculty.Dr James Dunbar has developed a na-

tional reputation for his work on drink-ing and driving. His paper, contrasting hisexperiences in Scotland and Finland,highlighted the need for random breathtesting.Dr Andrew Orr presented an excep-

tionally neat piece of research on the ef-fects of alcohol on the foetus at the timeof conception.The problems of heroin addiction with

its medical and social consequences weredescribed in a study from the Dundeedepartment of general practice, by DrRonald Neville.Dr Albert Jacob's multiple publications

reflect the acute intellectual enquiry thatgeneral practice can generate. His abilityto sustain a unique approach to an ex-haustive computer analysis of multiplevariables in home visiting problems, ex-

emplified the man and his work. It wasa contribution not to be missed.The problem of leg ulcers plagues us all.

In his study on alternative ulcer therapiesDr James Laird demonstrated that an

organized, simple approach usually pro-duces the best results.The second session of the meeting was

devoted to collaboration in general prac-tice. Dr Alastair Wright's work on theGeneral Health Questionnaire is wellknown, having recently been presented atthe European Conference of the Interna-tional Society of General Practice (SIMG)in Austria. This work has been the mainstimulus behind what is hoped to be thedevelopment of a faculty research project.Humour was provided by Dr John

Mackay, who had looked at the effects ona large country practice of a migratoryfruit picking population. A neatly con-ceived piece of work which contrasted wellwith the other speakers.

After suffering years of neglect the GPhospital is becoming much more topical.Dr James Grant has spent five years look-ing at all aspects of these hospitals inScotland. He gave a thought provokingdescription of the outcome of myocardialinfarctions over a five year period in Scot-tish GP community hospitals. His presen-tation challenged GPs to give furtherthought to this important aspect of care.

It was appropriate that Dr FrederickProudfoot, provost of the faculty, shouldpresent a paper on his own research work.His study on the value of throat swabsprovided the meeting with a challengewhich was met in a good humoured andenjoyable way.The work of the East Scotland facul-

ty's Diabetic Group and its protocols forthe management of type II diabetics inpractice was presented by Dr Sandy Youngand Dr Robin Scott. The use of a plann-ed record insert and the need for adequateskills in fundoscopy were highlighted.

Free Standing Papers were presented onvarying subjects including 'Managementof Gout' 'Significance of ConsultationTimes' 'Diabetic Management Protocols'and 'Laboratory Investigations An Un-necessary Expense?". It was felt that thiswas a very valuable part of the programmesince it provoked stimulating discussionsbetween the delegates.Dr Jeremy Gillingham confronted the

meeting with the crisis as he saw it in Con-tinuing Medical Education. Will the

developments in this field alleviate thiscrisis in the future? Only time will tell.A paper from Dr James McKellican on

'The Problems of Organizing Drug Trialsin General Practice illustrated the workhe had been involved in with anti-hypertensive agents in multi practice drugtrials.A lesson on how to conduct 'Audit and

Research' in an organized and methodicalway was given by Dr Sandy McKendrickwho analysed six annual projects whichhe and his trainees had conducted. Heshowed both the positive and negativeaspects of such a systematic approach.The last presentation was given by Dr

Alastair Shaw. His use of clinicalphotography is well known locally and histechnical expertise provided a humorousand educationally useful end to theproceedings.

ConclusionsFrom the academic point of view, theworkshops have been widely regarded assuccessful because of the number of GPspresenting work, the quality and varietyof research, and the interest shown byboth members and non-members.One problem of GP research is lack of

confidence as well as content. Given thefacilities and the venue, GPs rise to the oc-casion and see it as a means of presentingwork which might otherwise be left un-seen. The East Scotland faculty's abilityto run such a meeting, twice, suggests con-tinuing support even though the facultyis one of the smallest within the College.The East Scotland faculty has a total of250 GPs within its area, 63 of whom at-tended Gleneagles '87. Surely the EastScotland faculty is not unique? ShouldGPs continually under-rate their work andthink it inappropriate for a conference?

There have been problems, organiza-tional and presentational, but these wereinevitable given the number of speakersand the size of the meeting. Despite thesewe concluded that research and the educa-tional process can be legitimately and pro-fitably combined in such workingweekends. With families able to enjoy the

Continued on page 432

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The Retired CollegeMember and his FacultyWHEN I retired it seemed unthinkable

not to remain in touch with a Collegethat I had been involved continuously withsince joining in 1953. So I paid the extrasubscription to remain a life fellow of theRCGP. This means I receive the CollegeJournal, news from my faculty, and an in-vitation to attend the faculty's AGM.

I have at times contributed to the cor-respondence columns of the Journal, and Iwas asked to write this article by thehonorary editor of the News section, so itmust be presumed that the College continuesto show interest in ideas put forward by doc-tors who are no longer working. I still repre-sent the College on Age Concern and TheParkinson's Disease Society, and I have beeninvited on to the Medical Advisory Commit-tee of the latter organization. But whyshould I continue? Perhaps because I nowhave more time to serve on these bodies thanI had when I was in practice.What about the faculty? To find how I

should now relate to the faculty I attendedthe AGM. At least I made up a quorum asit seems there were more apologies than at-tenders, due perhaps to it being held in thefirst week of July rather than in November.Although I had not attended for two yearsI did not feel a stranger, having been aformer provost during a period of rapiddevelopment. At least I felt among friendsuntil I found myself filling my glass next toa senior fellow I have known for many yearsand with whom I have lectured. Since he isa sage, able and willing to offer opinions onanything, I put my question to him aboutwhat place a retired member might havewithin the College and the faculty.

His answer was forthright: "No place, ifhe is not working". I then asked aboutfellowship and keeping in touch with one'scolleagues. "Fellowship is not for the facul-ty" came the brusque answer. It was nowthat I felt an intruder, regretting that I hadaccepted the invitation to attend. I could seethat he was right, and usually respected hisopinions which are rarely given so plainly.When the AGM began my old friend the

provost welcomed me as his predecessor.This failed to console me, so that when avote was taken on a proposed change I abs-tained feeling that I had no right to influencematters for others. However, later in themeeting I put forward the following pro-posal which I had prepared:

"I was disturbed to see it stated recentlythat 70 per cent of the major officeswithin the College are held by academicsor regional advisers who account for lessthan 1 per cent of College members. Thisis because of increasing commitment in-volving time, travelling and effect on part-ners and patients. May I suggest an ideathat may reconcile the problem. Retire-ment at age 60 and even 55 is considered

increasingly, while some Council membersare well over 60. How does this Facultyview the idea of one or two recently retireddoctors with a suitable record of involve-ment in the Faculty being asked to serveon Council for a limited term, free as theymight be of other commitments. Such anopportunity might be an inducement toretire early."Does the College owe any obligation to

long serving members beyond the use of clubfacilities at Princes Gate, or information andlibrary services for those who, like myself,consider continuing in medical journalism.Increasingly educational and administrativefunctions are being delegated to the facultiesand it seems clear to me that it would be dif-ficult for retired doctors to be useful unlessthey are working. On the other hand the ex-perience of such men as advisers could beinvaluable. I have little doubt that youngpractitioner groups could benefit from oldermen with experience on LMCs, FPCs, andwith experience on other matters such aspractice management, research andpublication.

Dr Keith Thompson at his retirement home inSitio de Calahonda, Spain, where he nowspends half the year.

In some ways we are faced with somethinglike an old boy's association, although inother fields these are often more concernedwith sport and socializing than academicfunctions. It might be argued that a doctorwho wants to remain active in the Collegeshould not retire. Indeed, successful retire-ment is based on continuing developmentand cultivating new interests. While doctorsmay want to give up consulting, they never-theless retain an interest in general practiceand medicine, the advancement of whichmay owe something to their individual con-tributions. It is often thought that fertilityof ideas is lost with advancing age, and whilethis is true of creativity, old spectators cangive useful tactical advice. No one can yetsay if successful retirement might not depend

on further development of an old interestsince we find patients occasionally wholoved travel but never had time to indulgeuntil retirement when they became greattravellers, photographers and sometimesauthors.

There is little doubt that this is a new ques-tion. There must be many who joined theCollege in the early 1950's when generalpractice existed at a very low ebb and whofought to establish the structure of ourspeciality, and feel justly proud at the wayit stands now. Some of them may considertheir work has been done; others envisagefurther objectives.As I drove home from our AGM, one

thing dominated my thoughts and that wasthe variable view members had of the roleof the GP. Our new provost had pointed outthat central College agreed that we shouldfocus in future on clinical work. Someyounger members disagreed with this view,and a senior member declared that theirbusiness was that of health promotion. Iheard others say that we were in the businessof caring, and leaders of the primary healthcare team. Anything, it appeared, other thanclinicians.

Yet in the latter part of my professionalcareer, having developed an interest in ex-amining crystals aspirated from knee joints,I should have liked to have asked some ofthese colleagues to name the conditionswhich can be associated with pseudo-gout.Years ago this would have been seen as aspecialist problem, but I have seen generalpractice evolve until it is now within ourremit. The reason I believe we should focuson clinical work is because, unless we do, wecould be replaced by counsellors dealingwith anxiety, opticians screening eyes, nursepractitioners treating a large amount oftrivial illness still brought to doctors, socialworkers, health visitors, and midwives.Unless we can clearly define our role the costof training and maintaining doctors in ourspeciality may lead to great reductions in ournumbers.

Perhaps these ideas will encourage retiredmembers to enlarge on my thoughts. Doesthe College still need us? Can we still be ofservice? Or are we an embarrassment as wor-thless 'has beens'? We cannot all be Macken-zies and Pickles, honoured and glorified.Perhaps we are just in limbo. What do youthink and want? That is what matters. Writein with your views, honest and unsentimen-tal please. This is not a minor question sincethere were 1,072 retired life members inJanuary this year, and a further 240 retireddoctors contributing annually at one quarterrate. This will increase quite considerably bySeptember, so we are talking about 9 per centof a total membership of 15,198. D

Keith Thompson

Journal of the Royal College of General Practitioners, September 1987

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Meeting the CandidatesI KNOW if I see a large animal with

big ears and a trunk that it is anelephant. And, however many statisticsthe zoo keeper might produce to prove itwas a giraffe, I would still be left with thefeeling he was wrong. I have seen anelephant before, even if I cannot prove itwith accurate figures.

In the recent election I had the samefeeling about the health service. Every dayI see how it works. And watching all thepoliticians debating the finer points Ibegan to wonder whether this was thesame organization.

But I was in a position to voice mydoubts. Using my regular medical columnin the local paper I decided to interviewthe candidates. As a local paper I knewthat I must not show political bias ifI supported one party I would alienatetwo thirds of my readership.On the day the election was announc-

ed I wrote to the three candidates askingfor an interview for the paper.

I received two immediate phone callsand one letter by return of post. Althoughour receptionist recognized the name ofthe Conservative candidate she mistookhim for a fellow GP.The next step was to ring the chairman

of the LMC to make sure that I was notgoing to upset his plans. He was delighted.The GMSC had asked all LMCs to meettheir candidates. Suddenly I was also theLMC representative. But I was cautious.My role as a reporter was to gain infor-mation and not to provide propaganda forthe candidates. However I was lent theGMSC booklet 'Who Cares' which gaveuseful advice.

L

I taped each of the interviews. You didnot have to look at the rosettes to seewhich party each candidate was from.The Labour man was a pleasant

postgraduate student probably gainingexperience in a 'no hope' seat before be-ing offered a more realistic chance. Buthe was interesting. We had a long discus-sion about the role of the Labour move-ment in the social history of the earlytwentieth century. Fascinating, but not amajor vote winner in the Torquay of the1980s.The Liberal was a keen, young, local

man. He knew the community well, butI did wonder whether he had ever travell-ed beyond Exeter.

I was met by the Conservative at hisdoor with a huge glass of wine. We hada superficial chat with the phone ringingevery few minutes and his wife and agentreminding him about a dinnerengagement.My aim was to ask about primary care.

Only one of the candidates claimed tohave heard of the green paper althoughhe hadn't heard of any of its contents -and none of them had heard ofCumberledge.

I found that I could achieve. most byavoiding 'Robin Day' tactics. In surgeryI try to help patients relax and open upand the same techniques seem to work forpolitical interviews. Only once did I trapa candidate into a 'banana skin' situationand I decided not to use this in the arti-cle. The Conservative was explaining thesuccess of his policies: "And we havemanaged to bring down GP list sizes'"So you don't agree with the green

paper when it suggests that there is noevidence that lower list sizes improve pa-tient care?"

"Are we talking locally or nationally?"I am still not sure quite how that isrelevant.The other aspect I found-disconcerting

was the way they had to look up their opi-nions in the manifestoes. I felt that if Ihad offered them a cup of coffee theywould have had to consult about whetherthey took sugar.

I liked them all as people and could notunderstand why they wanted such a dread-ful job. When the tape recorder was offthey all talked in a much more relaxedway. If I was really mean I would have hada second hidden recorder.With the help of the sub editor I pro-

duced a full page headlined 'Doctor con-

sults candidates'

After the debate and the detailedanalysis in the media a patient came intothe surgery. She has two Down's Syn-drome children, both of whom are nowover 18. "Please could you sign the formso that they can have a postal vote?"They certainly met the criteria on the

form. And it was not up to me to decidewho should be entitled to vote. They aredelightful children but I felt that I mustexpress my reservations.

"Isn't that a bit irresponsible. How dothey know who to vote for?"

"Oh, they know who looks the nicest"she said.

I suppose they can recognize anelephant as well as any other voter. fZ

PL Moore

Continued from page 430

Gleneagles '87an educationalinitiative provingits worthfacilities of the hotel, no GP needed to feelguilty about leaving his/her spouse andchildren for yet another weekend. This isan important factor in the continuing suc-cess of the Gleneagles Workshops.When the idea of a workshop was first

suggested, it was hoped that it might bepossible to constructively discuss tradi-tional and modern techniques for resear-ching problems in general practice.We further hoped that individual GPs

might see ways of adapting some of theideas and techniques presented, to theirown practice.

It is, as yet, too early to say whether wehave succeeded. However, the signs are en-couraging. It appears that holding suchan event every two years is acting as astimulus to continuing faculty researchand education, as well as establishing animportant focus for faculty identity whichcan only benefit future faculty activities.

It would have been premature to havemade any such claims after Gleneagles '85but the success of a further workshop thisyear leads us to believe that what has beencreated in the East Scotland faculty is sus-tainable and a continuing source of educa-tional potential for the future. z

James A Grant

Journal of the Royal College of General Practitioners, September 1987

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432