THE ROYAL COLLEGE OFGENERAL PRACTITIONERS

SPRING GENERAL MEETING

Friday 10th Sunday 12th April, 1981,Notre Dame College of Education, Glasgow.

Hosts:

West of Scotland Faculty

Approved by D.H.S.S. and S.H.H.D. for Section 63.

Applications to be received by Sunday 15th February, 1981.

The Willans,Brediland Road,PA1SLEY, Renfrewshire.

November, 1980

Dear Fellow Members,

Summer has passed and winter is approaching. We look back with some nostalgia to the gloriousweather provided for us at Windermere last spring. We, in the West of Scotland, ask you to look aheadnow to the spring of 1981, in particular to the weekend of 10th, 11th and 12th April, when the SpringMeeting ofthe Royal College of General Practitioners will be held in Glasgow, based at Notre DameCollege of Education in Bearsden. We may not be able to guarantee the same weather, although we shalldo our very best, but we can guarantee a very special welcome to all who care to come.

Our academic programme on the Saturday, entitled "Not Problems Challenges", features elementsof General Practice relevant to, but not entirely peculiar to the West of Scotland. This will be followedby some thoughts on how the challenges can be met in the years to come. The contributors are all eitherin General Practice in the region, or are dedicated to the progress of Practice, even including our visitorfrom the U.S.A. whom we are delighted to welcome back to Glasgow for this special occasion. Please donot feel that we are being parochial, because the West of Scotland Faculty area can reflect GeneralPractice as it is to be found almost anywhere in the British Isles.In addition, we invite you to participate in Computer Assisted Learning, on Friday afternoon and a

Reception at the University followed by a Civic Reception at the City Chambers on Friday evening, andof course, the Faculty Banquet in the Albany Hotel on Saturday evening. Your accompanying guestswill be well looked after and can enjoy some ofthe pleasures scenic, cultural or local that Glasgowand the West of Scotland have to offer.We as a Faculty look forward to meeting you.

Yours sincerely, cJlk^A&L*"*.D.A. HaldaneProvost, West of Scotland Faculty.

ACADEMIC PROGRAMMEFriday, 10th April, 1981 . Computer Assisted LearningVenue: Boyd-Orr Building, The University of Glasgow. Transport will be available to and from youraccommodation, and the Boyd-Orr Building. Arrangements have been made to accommodateapproximately 100 members for a one hour lecture and display on the use ofcomputer assisted learningfor General Practitioners. These meetings will commence at 2 p.m. and 3.15 p.m.The University of Glasgow has kindly arranged for the Hunterian Museumand Hunterian ArtGallery(Whistler Collection) to be open to Visitors.Sherry Reception to be held in the Randolpn Hall, at the University of Glasgow, at 4.45 p.m.Saturday, 11th April, 1981SYMPOSIUM: "Not Problems Challenges"Venue: Main Hall, Notre Dame College of Education, Bearsden.MORNING SESSION:Chairman: Dr. D.A. Haldane,

Provost, West of Scotland Faculty.09.00 Registration09.30 Welcome by the Provost.

Profiles of Practice09.40 I. Dr. D. Strang East Kilbride09.55 2. Dr. J. Toms Muasdale, Argyll10.10 3. Dr. H. McKenzie Easterhouse10.25 Discussion10.45 Coffee

Common Clinical Problems:11.15 Ischaemic Heart Disease Dr. N. Poole, Govanhill and Department of General Practice11.30 Comments and discussion11.45 Alcoholism An Historical & Social Perspective Dr. F. Wilson, Gorbals Health Centre12.00 Comments and discussion12.30 Sherry Reception by courtesy of Greater Glasgow Health Board followed by Lunch

Saturday, 11th April, 1981AFTERNOON SESSION:Venue: Notre Dame College of Education. Bearsden.Chairman: Prof. Victor M. Hawthorne, Professor and Chairman of School of Public Health andDepartment of Epidemiology, University of Michigan.14.00 Chairman's opening remarks14.15 Educational Responsibilities for General Practice: Prof. J.H. Barber, Department of

General Practice, University of Glasgow.14.35 Continuing Education: Dr. W. Roy, Associate Adviser in General Practice, Ayrshire &

Arran Health Board14.55 Discussion15.15 Tea15.45 Primary Care and Resource Allocation: Dr. J. Bryden, Chief Administrative Medical

Officer, Argyll & Clyde Health Board16.05 Prof. Victor M. Hawthorne16.30 Discussion closing remarks

Sunday, 12th april, 1981Venue: Main Hall, Notre Dame College of Education, Bearsden.10.00 SPRING GENERAL MEETING OF THE ROYAL COLLEGE OF GENERAL

PRACTITIONERS11.00 Coffee11.15 The William Pickles Lecture: Prof. I.M. Richardson, Professor of General Practice,

University of Aberdeen.13.00 Lunch

DisperseSOCIAL PROGRAMME

Friday, 10th April, 19812 p.m. 4.30 p.m.There will be a visit to James Buchanan & Company, Stepps, where the blending and bottling ofwhiskywill be shown (limited to 30).4.45 p.m. Sherry Reception, Randolph Hall, University of Glasgow.7.30 p.m.Civic Reception and Dinner at Glasgow City Chambers by courtesy of Glasgow Civic Authorities.Dress Informal.10.30 p.m. Return to residential accommodation, where Bar facilities will be available.

Saturday, 11th April, 19819 a.m. 12.30 p.m. City Bus Tour

Coaches will be equipped with public-address systems and will have official Tourist Guides. Tours willinclude: a visit to Glasgow Cathedral, and Glasgow Art Galleries, where morning coffee will be served.2 p.m. 4.30 p.m. Visit to Pollok HouseA notable house in the Adams style with important works in art in the Spanish School. AfternoonTea will be served.

Saturday, 11th April, 19819 a.m. 5.30 p.m. Whole Day Tour to Inverary Castle

All day tour to Inverary Castle, home of the Dukes of Argyll. Morning Coffee will be available at theCharles Rennie Mackintosh House in Helensburgh, orat the Arrochar Hotel, Loch Long. Lunch willbe provided at the Creggans Inn, Strachur.CH1LDREN: Notre Dame College of Education has a swimming pool, gymnasium and tennis courts.Members ofthe College staff will be available to care for children able to participate in these activities.

7.30 p.m.

Faculty Banquet: Albany Hotel, Glasgow. Dress: Dinner Jacket

The Faculty Banquet will be preceded by a Champagne Reception.

BOOKING NOTESPLEASE ENSURE THAT YOUR APPLICATION FORM IS CORRECTLY COMPLETED.Accommodation: will be either on the College Campus at Notre Dame College of Education, where thefacilities will be single. comfortable rooms with wash-hand basins etc. Bathrooms and showers on eachfloor.

:or at the Pond Hotel, a comfortable and modern hotel, less than 10 minutes drive by bus from theCampus site. Accommodation is in twin-bedded rooms with private bath or shower, and toilet.

APPLICATION FORM The Royal College of General PractitionersSpring General Meeting Glasgow, 1981

Please tick appropriate box

DelegateMale D Accompanying MaleOFemaleD person FemaleQCollege member a College member D

0

The Royal College of General PractitionersSpring General Meeting Glasgow, 1981

10th 12th April, 1981

1 wish to attend the Spring Meeting, 1981

Name.Address.

Tel. No:.

Accompanying persons.

Children's ages please.I enclose a chequefor £.made payable to the"R.C.G.P. SPRING MEETING 1981 ACCOUNT"

Please return this form by 15th FEBRUARY, 1981, to:Dr. G.P. Dolan, 27 Glasgow Road, Paisley, Renfrewshire, SCOTLAND.

The Journal ofThe Royal College of General Practitioners

The British Journal of General Practice

Editor

S. L. Barley, frccpGeneral Practitioner,Sheffield

Editorial Board

S. J. Carne, obe, frccp, dchGeneral Practitioner,London

A. G. Donald, ma, frccpGeneral Practitioner,EdinburghD.G.Garvie, frccpGeneral Practitioner,Newcastle, Staffordshire

D. J. Pereira Gray, ma, frccpGeneral Practitioner,Exeter

J. Tudor Hart, frccp, dchGeneral Practitioner,GlyncorrwgJ.C. Hasler, frccp,da,dchGeneral Practitioner,SonningCommonJ. G. R. Howie, md, ph.d,mrccpProfessor of General Practice,University of EdinburghD. H. I rvine, obe, md, frccp, drcocGeneral Practitioner,Ashington, Northumberland

C. R. Kay, cbe, md, ph.d, frccpGeneral Practitioner,Manchester

I. G. Tait, MA, FRCCP, DCHGeneral Practitioner,AldeburghStatistical AdviserI. T. RuSSell, MA, MSC, PH.D, FSSLecturer in Medical Statistics,University of Newcastle-upon-Tyne

Founding EditorR. M. S. McConaghey,OBE, MD, FRCCP

Volume 31 Number 222 January 1981EditorialsWhy belong to the College? 3The nurturing of a medical journal 5

James Mackenzie Lecture 1980The compleat general practitioner Robin Steel 7

James MackenzieJames Mackenzie and coronary heart disease James S.McCormick 26

History of general practiceThe certifying surgeons D. U. Bloor 33

Clinical work in general practiceConstipation.a simple approach to treatment C C. Clarkand J. Codfrey 38

Domicilary careHome visiting by a geriatric department Jane Kimberand C P. Silver 41

International researchInternational sore throats F. M. Hull 45

Why not?Why not prescribe antibiotics for 'heavy colds'?J. A. McSherry 49

NewsCollege news 50Medical news 53

Letters to the Editor 55

Book reviews 58

ReportThe General Practitioner and Social Worker Workshop,Manchester/ 28-30 March 1979 61

COLLEGE NEWS

SUMMARY OF COUNCILMEETINGThe fifth meeting of the 1980/81 Coun¬cil was held at 14 Princes Gate on 27September 1980, with Dr A. G. Donaldin the chair.

Royal Commission on the NHSCouncil first debated a draft which theChairman and Honorary Secretary hadprepared as a further response to thereport of the Royal Commission on theNational Health Service. The report wasgenerally welcomed, and it was notedthat the Royal Commission had largelyaccepted the principles behind the Col¬lege's evidence. Two main themesemerged: whether general practitionersshould be allowed to prescribe onlyfrom a limited list of drugs, and whetherthe College could agree with the RoyalCommission's view, not put to it by theCollege in its evidence, that "possessionof the postgraduate qualification of therelevant Royal College should becomethe norm for appointment as a principalin general practice." It was felt thatthere was no evidence that an imposedlist of drugs would improve the qualityof prescribing; it was therefore decidedto withdraw support for the idea of alimited list of drugs. The second matterwas more difficult, and was debated atlength; Council eventually decided tosuspend judgement, since an immediatereply to the Royal Commission was notnecessary, and since members were

deeply divided on the issue. A point wasalso emphasized, but not debated be¬cause Council was at one on its im-portance: now that the new Act layingdown the legal requirements for vo¬cational training for general practicehas come into force, Council wishedparticularly to emphasize its belief thatthe time had come for the responsibilityfor allocation of Section 63 budgets tobe transferred from the postgraduatedeans to the regional advisers, acting onbehalf of the regional sub-committees ingeneral practice. Council was glad tohear from Dr S. E. Josse that the GMSCommittee had already adopted thesame policy, namely that any clinicaldiscipline should have responsibility forits own continuing education.

Clinical trialsCouncil was firm that it felt that ethicalapproval by a committee with generalpractitioner representation was always

necessary for any clinical trial, not leastthose large-scale ones which the CollegeResearch Units mounted, drawing theirobservers nationally. The BMA hasagreed with the College's views in prin-ciple, but further discussions were goingto be necessary in order to implementthe policy.

Medical educationCouncil approved the reply prepared byDr J. Lee and his colleagues to go to thecommittee on London medical edu¬cation (the Flowers Committee), whichmade three points only: that generalpractice should make a significant con-tribution to the teaching of medicalstudents, that medical schools should onthe whole be smaller rather than larger,and that the College welcomes therecognition that London medicalschools should play a more active partin graduate medical education in theirhealth regions.College prioritiesCouncil continued to think hard aboutwhat the College is doing and should bedoing, and especially about the Presi-dent's special theme of the College'spolicies in relation to medicine as awhole. It heard a short report from himabout a weekend-long meeting of theGeneral Purposes Committee which hadbeen devoted to the subject; it had itselfdivided into five small groups and hadheard the President report on thesegroups.

Finally it devoted nearly an hour to a

major debate, from which several ideasemerged. Council agreed with theHonorary Secretary that one of its nexttasks was to redefine the role of thegeneral practitioner and the aims ofprimary care; seeking these definitionsmight well combine with fresh ideasabout the MRCGP examination and a

possible replacement for the College'smost successful publication, the FutureGeneral Practitioner, a further reprintof which was agreed, bringing the totalprinted up to 9,500. Dr D. L. Crombiespoke about the College's priorities foritself.its collegiate function, as hecalled it.and its priorities for medicineas a whole; when these two kinds ofpriorities become confused (as in thedebate about the MRCGP examination)no action could result. Professor DavidMetcalfe suggested that the Collegeshould plan its future by constant refer¬ence to what the patient needs; he

pointed out that the British generalpractitioner has the huge advantage ofknowing how many patients he has, andthat these patients' needs can be de-fined. Dr Donald Irvine asked Councilto widen its view to include all the27,000 general practitioners in Britainand urged a still greater emphasis on thefaculties; he felt there was a danger thatthe faculties and their functions wouldget lost if a mechanism for defininggeneral practice and achieving con-sensus were to grow up around them.

The GMCAn important invitation was receivedfrom the General Medical Council tojoin in a series of conversations which itis having with various branches of theprofession, helping it to fulfil its role inco-ordinating graduate education.Council approved Dr Denis PereiraGray to be its representative at thismeeting, which would be a preliminaryto a big conference aiming to define theGMC's own policies.

The hospital serviceCouncil was unimpressed by theGovernment's recent paper on thefuture of the hospital services, which itsaw mainly as a political exercise. Itagreed with a response which theHonorary Secretary had drafted, em-

phasizing the need to retain smaller,more local hospitals; the need to involvegeneral practitioners more with the hos¬pital services, especially general prac¬titioner hospitals; the need to emphasizeyet again that most diagnostic servicesshould be open to all clinicians, whetherworking inside or outside hospitals; andfinally, the need to give general prac¬titioners the same access as hospitaldoctors to rehabilitation services. Coun¬cil agreed to send its response to theDHSS, with the paper on general prac¬titioner hospitals prepared by theHonorary Secretary in 1979. It alsoasked that the documents should go toArea Health Authorities (Teaching),where it felt its views needed especiallytobe noted.

DrugsurveillanceThe Chairman announced highly satis-factory progress on negotiations be¬tween the College and an independentcompany, Medical Monitoring and Re¬search Ltd. He sought approval forletters of intent to be exchanged between

50 Journal ofthe Royal College ofGeneral Practitioners, January 1981

CollegeNews

the two parties, the object being to setup a joint organization (the MedicinesSurveillance Centre) to provide a serviceto the profession, the pharmaceuticalindustry, the Department of Health andSocial Security and other appropriatebodies, by planning and organizingpost-marketing surveillance of new

drugs, and clinical trials in general prac¬tice. He pointed out that the Collegewas well placed to join this venture,since it alone had both the organization(in its Research Units) and the repu-tation to conduct this kind of large-scale, necessary and important research.Council approved, somewhat cau-

tiously, these first steps, after beingassured that:

1. The proposed surveillance and trialswould have nothing to do with drugpromotion.

2. The interests of all parties lay in thehighest ethical and academic standardsbeing applied; there would be no directcontact by the College with the pharma¬ceutical industry.

3. The College would have the right towithdraw from the investigation of anydrug.

4. College representatives on the MSCmanagement board would ensure highstandards of scientific investigation.

Public relationsCouncil debated a proposal that theCollege's present policy of dealing withthe press (normally through the Honor¬ary Public Relations Officer, Dr S. J.Carne, with special arrangements forspecial occasions) be changed to allow a

part-time press liaison officer with a

background in medical journalism to bebriefed on College policy and attendCouncil meetings. Although there waswide feeling that the College must re-

spond to all press requests for comment,it was nevertheless the opinion of almostevery speaker that a lay press officerwould be unable to do justice to Collegepolicy, and that the present arrange-ment should continue for the timebeing.

Computers in general practiceFollowing the report of the College'sworking party on computers (publishedby the Journal as Occasional PaperNumber 13), the Chairman proposedthe establishment of a new standingjoint committee to be set up with theGeneral Medical Services Committee,with whom extremely cordial relation-ships had been established on this topic.The committee would advise the DHSS

and other interested bodies on the appli¬cation of computers in general practice;it would be advisory only, and wouldmake recommendations through itsparent bodies. Council agreed to thisproposal and nominated Drs Kay andSmail and Professor Metcalfe to thecommittee. It recommended that theCentral Information Service should pro¬vide the secretarial and administrativeresources.

1980AppealThe Appeal Secretary, Mr James Wood,announced that the Appeal had reached£550,000. He confessed his disappoint-ment at the recent slow growth of thefund, but not his surprise, consideringthe proportions of the industrial re-

cession and its effects on the small busi-nesses to which the College had mainlyturned. He pointed out that 100 mem¬bers had raised £45,000 through theirown efforts, and hoped that morewould follow their example; the effortsof a further 1,000 members would suf-fice to reach the Appeal target.

Siege costs

Council heard that the total cost to theCollege of the damage sustained duringthe siege at the Iranian embassy at num¬ber 16 Princes Gate was £27,370. Muchof this was to be met by the insurers,and all other specific losses should becovered by a claim on the MetropolitanPolice.

SubscriptionThe Honorary Treasurer reported a pro¬posal to bring the subscription year for¬ward from 1 July to 1 April in 1981, andCouncil agreed to put this forward as a

special resolution to the AGM inNovember.

MRCGP examinationThe Chairman of the Board of Censors,Dr Donald Irvine, announced that arecord number of 730 candidates hadpresented themselves for the MRCGPexamination in May. Council recordedits gratitude to the College staff fordealing with the administration, and tothe examiners for their part in this ever-

increasing work load.

Preventive medicineThe first two of the reports from theCollege's Preventive Medicine WorkingParty were presented and approved; en-titled Health and Prevention in PrimaryCare, and The Prevention of ArterialDisease in General Practice, they will bepublished by the Journal as ReportNumbers 18 and 19 from General Prac¬

tice, that is, they will be statements ofCollege policy.

LibraryThe establishment of a Library Foun-dation Board was agreed by Council.Designed on similar lines to the Scien¬tific Foundation Board, the new Boardwould, in effect, give the library more

money and more flexibility in using it.Council gave only a cautious welcometo FAMLI (Family Medicine LiteratureIndex), which is a selected and amplifiedquarterly list from Index Medicus ofpapers relevant to general practice. Boththe editor and the deputy editor of theCollege Journal commented on somedeficiencies of FAMLI, and advisedthat course organizers would so far beunwise, on the evidence of the firstissue, to use it in preference to theCollege library's own New Reading.Council asked the treasurer to exploreways of making a contribution to sup¬port the development of FAMLI.

Research fellowshipDr Kay reported that the research div¬ision executive had approved the estab¬lishment of a research training fellow¬ship; he hoped that a recent graduatefrom vocational training would be at-tracted to this post.

Honorary fellowsCouncil received with acclamation therecommendation that Mr James Wood,Administrative Secretary of the Collegesince 1970, was, along with LordRichardson, Mr J. A. S. Cleminson(Chairman of the Appeal Committee),Mrs Enid Balint-Edmunds and DrGavin Shaw, to receive an HonoraryFellowship.

Editor's note

Many other items of business, some

likely to be important in the future,were discussed briefly, but their noticehere would take up too much space.Any member may inspect the minutes ofCouncil meetings in person at the Col¬lege. Apply to the administrative sec¬

retary, or contact your faculty rep¬resentative (A full list of members ofCouncil will be published in our nextissue.).

MR JAMES WOODMr James Wood, dsc, AdministrativeSecretary of the College since 1971, re-tired on 31 December. As an officer inthe Royal Navy he rose to the rank ofcommander, specializing in radio and

Journal ofthe Royal College ofGeneral Practitioners, January 1981 51

CollegeNews

communications; he spent several yearsas naval attache in Madrid, and afterleaving the service was secretary of theBritish Productivity Council. His 10years have seen a strengthening of theCollege's financial position, culmi-nating in the great achievement of the1980 Appeal; to raise £600,000 duringthe worst economic recession for over30 years is something which could onlyhave been done after the most meticu-lous planning, which has come to beseen as the hallmark of the man.Another of his gifts has been to under-stand, to a degree unusual in someonewho is not himself a general prac¬titioner, just what general practice is allabout. His grasp of how the Collegeshould relate to other bodies was vital tolaying the administrative basis for thesuccessful launch of the Joint Com¬mittee for Postgraduate Training inGeneral Practice, the Central Infor¬mation Service, and the Scientific andLibrary Foundation Boards.

His unfailing dignity and courtesywere typified by his role in the siege ofthe Iranian Embassy in May 1980;neither of these qualities could in anysense be diminished by the sight of himleaving the College by means of a ladderover an eight foot wall, dressed in hisbest suit and carrying a briefcase.guarded by a posse of heavily armedpolice.The College has always been proud to

have him as its ambassador, and our

good wishes go to him and his wife Sueduring his retirement in Petersfield,Hampshire. The award to him of anHonorary Fellowship at the AnnualGeneral Meeting in November 1980 wasonly part of the way in which the Col¬lege can thank him for all his work onour behalf.

EAST ANGLIAN FACULTYThe latest Newsletter of the EastAnglian Faculty has a note from theirJournal representative, Dr NigelOswald, of 124 Newmarket Road, Cam¬bridge. He lists what he feels should bethe aims of a Journal representative.These include:

1. Presenting constructive criticismdirect to the editor and passing on theviews of individuals or groups.2. Improving the circulation of theJournal3. Trying, together with the ResearchCommittee of the Faculty Board, tostimulate research in the region. DrOswald favours fairly short researcharticles, but ones with a high degree ofrelevance to the ordirfary general prac¬titioner. He hopes that if this work is ofan adequate standard, some of it will bepublished.We hope that other faculties will ap-point their Journal representatives, andthat they will show equal energy andpersistence.

EAST SCOTLAND FACULTY

Video equipmentThe Department of General Practice atDundee University has received a do-nation of £300 from the East ScotlandFaculty. The money will be used to buyvideo equipment for the teaching ofcommunication skills. It is hoped thatthis equipment will be used in helpingthe faculty devise a way of introducing aclinical component into assessment.

Audit groups and educationThis faculty's education committee setup audit groups in 1974 and has recentlysent us a report on their work. Sixgroups looked into how long it took forthe various stages of diagnosis in lungcancer to be dealt with.first symptomto first general practitioner consultation(average four and a half weeks), firstsymptom to firm diagnosis (average sixand a half weeks).and so on. Thirty-nine doctors (members and non-mem-bers of the College) took part, many ofthem without experience of small groupwork and of reviewing their recordssystematically. A consultant chest phys-ician and a community physician helpedthe groups by giving information onlocal and national statistical trends, byarranging access to hospital records,and by their general interest. The auditgroups' reports make no claim to stat-istically perfect results, but the interestaroused among the doctors is plain, andmany of the principles of effective adultlearning were met: involvement of thelearners, rapid feedback and relevance.We look forward to hearing more fromthese and other audit groups.

Retirement of Dr A. C. ReidDr Arthur Reid of Auchterarder isshortly to retire from active generalpractice. Dr Reid qualified in 1938 andmoved to Auchterarder with Mrs Reidin 1940. Dr Reid volunteered for servicein the RAMC and saw active servicethroughout the remainder of the war.He joined the College of General Prac¬titioners in 1955 and was elected to theFaculty Board of the East ScotlandFaculty. He was responsible for facultyresearch, helped launch the first faculty

in bronchitissustained release tetracycline hydrochloride

.-> Organon Laboratories Ltd 3ySM4 5DZ

52 Journal ofthe Royal College ofGeneral Practitioners, January 1981

CollegeNews

project.the infant feeding study.andwas appointed the first clinical assistantof the Scottish General Practitioner Re¬search Support Unit when it wasfoundedinl970.Dr Reid was elected to the Fellowship

of the College in 1970 and was theFaculty representative from 1971 to1974. His award of the MBE came as no

surprise to those who knew about hislong record of public service.Although Dr Reid is shortly to retire,

the indications are that he will not beleft to do his beloved gardening inpeace. He has been nominated to serveon the Tayside Health Board and hisfriends and colleagues wish him everysuccess in this.

NORTH AND WEST LONDONFACULTY

Election of OfficersThe following have been elected officersfor 1980-81: Provost, Dr EdwardShaoul; Chairman, Dr Conrad Harris;Secretary, Dr William Styles (01-7437153); Journal representative Dr B. A.Qureshi (01-570 4008). The faculty'splans include a meeting in January onthe primary care team, one in March tomeet the new editor of the Journal, anda wine and cheese party in June. Theeducation committee is planning a studyday for overseas trained doctors. Detailsof all these meetings can be obtainedfrom the secretary.

NewsletterThe editor of Faculty News, this fac¬ulty's newsletter, invites general prac-

titioners and any other doctors to sendcontributions which would be of interestto members. Contributions should besent to Dr B. A. Qureshi, 32 LegraceAvenue, Hounslow West, MiddlesexTW47RS.

ANNEHAMILTONPRIZEThe Anne Hamilton Prize will beawarded by the College, in alternateyears, for an essay on 'Caritas'. Theessay should demonstrate an under-standing of the importance of sym-pathetic communication betweenpatient and carer and should be basedon original work. The competition willbe open to anyone involved in patientcare and will be judged by three as-sessors appointed by the Awards andEthical Committee. The prize will be£150.The first competition will be held in

1981. The application procedure will beadvertized in the Journal, which shallhave a prior claim to publication of anyessay submitted.

BMAAPPOINTMENTSDr Derek Buchanan, who has been amember of the College since 1958, hasbeen appointed Scottish Secretary. DrMichael Hardman Lea, who is to be-come Provincial Medical Secretary forthe North-West and Merseyside regions,is also a College member and is Honor-ary Secretary of the north-west Englandfaculty.

MRCGP EXAMINATIONThe dates for the next MRCGP exam-inations are as follows:

May/July1981Written papers: Thursday 14 May 1981.Orals: In Edinburgh during the weekending 27 June 1981 and in Londonduring the week ending 4 July 1981.Closing date: 12 March 1981.

October/December 1981Written papers: Thursday 29 October1981.Orals: In Edinburgh and London duringthe week ending 12 December 1981.Closing date: 3 September 1981.The written papers will be held inLondon, Birmingham, Leeds, Man¬chester, Exeter, Newcastle, Edinburgh,Aberdeen, Cardiff, Belfast and Dublin.These and other centres may be used as

required, subject to a minimum (and insome centres maximum) number ofcandidates.

It may be necessary to limit the totalnumbers, and candidates are thereforeadvised to apply well in advance of theclosing dates. The application fee* forexamination in 1981 is £100-00 and there-application fee is £75 00. Candidateswithdrawing from the examination afterthe closing date for applications forfeit40 per cent of the full fee. Applicationforms may be obtained from the Exam¬ination Administrator at the College.*The 1981 rates for the application feehave been approved by Council andratified by the Annual General Meetingofthe College.

MEDICAL NEWS

OUT-OF-HOURS CARE FORCHILDRENThe Children's Committee, an advisorybody to the Department of Health andSocial Security, has produced a reporton emergency care for children. It de-scribes the most common arrangementsmade by the health and welfare servicesto cover out-of-hours calls, and high-lights some of the difficulties of organ-izing a system which guarantees speedyhelp and advice.

One section of the report concentrateson general practice and the ways generalpractitioners provide cover for week-end, night and other out-of-hours calls.It pinpoints some of the problems whichan efficient system must overcome.children who are not registered with anygeneral practitioner in the district inwhich they live, and parents who maynot know that their general practitioneris obliged to provide emergency cover.

Deputizing systems present special

problems. Patients often find it difficultto contact the service and the Com¬mittee feels that liaison between theservice and general practitioners is poor.For instance, it is possible for a child tobe seen on a number of occasions out ofhours without the practice doctor know-ing anything about it beyond the ap-pearance of the visits in his account.Nor is there any easy or reliable way ofthe deputizing doctors (even if they arein the same practice) having access to

Journal of the RoyalCollege ofGeneral Practitioners, January 1981 53

EDITORIAL NOTICE

ManuscriptsArticles submitted for publication must be original andshould not have been published before or be currentlysubmitted to any other journal. They should be typed withdouble or triple spacing, on one side of the paper only,with at least 25mm margins. A4 paper is preferred and thepages should be numbered on the right and fastenedsecurely on the left. The first page should contain the title,which should be as brief as possible, the name(s) ofauthor(s), initials, degrees, title, town of residence, theapproximate number of words in the article, and the nameand address of the author to whom proofs should be sent.

Original articles should be arranged in the usual orderof: summary, introduction, aims, method, results, dis¬cussion, references, and acknowledgements.

Illustrations of all kinds are welcomed. Graphs andother line drawings need not be submitted as finishedartwork . rough drawings are sufficient, provided theyare clear and adequately annotated. The publisher's Illus-tration Unit will be pleased to assist and advise authorswith their figures. All illustrations should be accompaniedby typewritten legends, giving corresponding numbers.

Metric units, SI units, and the 24-hour clock are pre¬ferred. Numerals up to ten should be spelt, those over tentyped as figures, except at the beginning of a sentence,where they should be spelt. Scientific names giving genusand species should be underlined, and generic names ofdrugs used wherever possible, though brand names mayfollow in brackets. Initials may be used for well knownorganizations such as the NHS, with no stops betweenletters.

References must conform to the style of the Journal.The College librarian is glad to give authors help withchecking details.The title page, figures, tables, legends, and references

should all be on separate sheets of paper.

ProcedureTwo copies of each article should be submitted with astamped addressed envelope, and the author should keep acopy. All articles are acknowledged immediately. They areread first by the editor and then sent to two or moregeneral-practitioner assessors, as well as other experts inthe subject.The assessors are asked to consider each article for: the

ethical basis of any research, scientific accuracy, orig-inality of content, style, and relevance to general practice.When publication of an article in its initial form is notrecommended, the assessors' comments may be passedanonymously to authors and revision encouraged. Revisedarticles are welcomed and treated as new submissions.Authors are usually given a decision within six weeks; itthen takes an average of five months before the publi¬cation of accepted articles. In 1979 the acceptance rate ofarticles submitted to the Journal was 29 per cent.

All articles and letters are accepted subject to editing,which may be considerable and which is based on theprinciples outlined in Gowers's (1954) The Complete Plain

Words and Fowler's (1965) Modern English Usage. Thecopyright of all material appearing in the Journal is vestedwith the Journal.

Letters to the EditorThe editor welcomes letters for publication; they should beas short as possible, and in any case not longer than 400words. Correspondents are asked to state their qualifi-cations.

ProofsGalley proofs are sent to authors, who are asked to checkthem for printers' errors and return them promptly. Alter-ations cannot normally be accepted when they deviatefrom the original typescript.

Proofs are not normally sent to correspondents exceptwhen the text has been heavily edited. Reprint order formsare sent to authors with the proofs.

CirculationThe Journal is published monthly and is circulated to allfellows, members, and associates of the Royal College ofGeneral Practitioners, and to a growing number of privatesubscribers including universities, medical schools, hos¬pitals, postgraduate medical centres and individuals inover 40 different countries of the world. The number ofprivate subscribers has more than doubled in the last fouryears.

SubscriptionsThe annual subscription is £30 post free (£35 or $80overseas), including the Reports from General Practiceand Journal Supplements when published.

Journal PublicationsThe Reports from General Practice and Journal Supple¬ments are distributed with the Journal to all collegemembers, and associates, and subscribers. A list of thosestill available is published regularly in the Journal. Thesepublications deal in depth with many different aspects ofgeneral practice and can be obtained, while still in print,from the Royal College of General Practitioners, 14Princes Gate, London SW7 1PU. Occasional Papers arealso published periodically; these are not posted to readersbut can be ordered from 14 Princes Gate, London SW71PU.

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Correspondence and Enquiries to the EditorAll correspondence to the editor should be addressed to:The Journal of the Royal College of General Practitioners,30 Endcliffe Crescent, Sheffield S10 3ED. Telephone(office hours only) 0742-681836.

Published on behalf ofThe Royal College of General Practitioners by Update Publications Ltd., 33/34 Alfred Place, London WC1E 7DP.Printed by Cradley Printing Co. Ltd., West Midlands, England.