Læknablaðið - 01.06.1972, Blaðsíða 59

LÆKNABLAÐIÐ
39
much and sometimes all of the costs of running the centres. Where
hospital authorities do this, the facilities are none the less available
to all doctors outside the hospitals. There are few district hospitals
left without at least improvised provision of this kind and not many
without the specially designed premises such a service needs. I sup-
pose I speak at up to ten a year and I am always astonished at the
number of people who give up an evening to attend.
Most of this work has been done for little or no remuneration
by hospital specialists or general practitioners or both. Nearly always
there are one or two moving spirits in any centre and whatever
outside help in terms of money and advice may have been available,
the movement has depended primarily upon the personal enthusiasm
of a relatively small proportion of the profession, and especially those
who are clinical tutors. Many clinical tutors tum over their small
honoraria to the centre’s funds. Yet that would have been of no avail
if the profession as a whole had not been behind the programme, and
the test of its effectiveness is the extent of its use. Last year some
45,000 postgraduate courses were attended by general practitioners
in England and Wales. Their number is only 20,000 individuals and
3 out of 4 attended at least one course. That is five times the frequency
of attendance of roughly the same number of general practitioners 10
years ago. It is more than 10 times the frequency of 20 years ago.
Nor is that the whole of the story, even for general practice. The
other side of this programme, the organised vocational training, has
also been greatly improved, but is not yet sufficient. There are regions
in which virtually all of the doctors in the grade we call registrar,
roughly equivalent to the resident of North America, are engaged
in day release schemes of training for higher diplomas in one or
other specialty. Many are given paid study leave for special courses.
In the last two or three years there has been a rapid increase
in the number of training programmes for young graduates, consist-
ing of linked selected posts in hospital along with trainee assistant-
ships in group practices and a certain amount of academic prepara-
tion intended to give three years vocational training for general
practice, all of it of course salaried. There are not enough of these
places. Probably not 10% of the immediately required recruitment
from general practice could come from them, but the number of
such projects is rapidly increasing and given better organisation, it
should soon be possible to ensure that every intending general prac-
titioner can be better prepared for that form of practice. Many general
practitioners still enter practice, after rather haphazard preparation
in hospital posts, less than five years after qualification and usually
as assistants to established practitioners with the expectation of be-
coming partners as principals within a year. There are financial ad-
vantages to continuing education in general practice. Under the present
system of remuneration allowances are paid for seniority in general
practice, but only provided a minimum of sessions have been given
to postgraduate education over the years. The minimum requirement
is at present far less than the average time given to such work by