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1119 Special Articles COLLEGE OF GENERAL PRACTITIONERS MORE than 300 members and associates of the college attended the second annual general meeting at B.M.A. House on Nov. 20. Dr. W. N. Pickles -was re-elected president of the college for 1954-55. A portrait of Dr. Pickles by Mr. Christopher Sanders, A.R.A., was presented to the college by Dr. R. A. Murray Scott, on behalf of the Yorkshire faculty. The chairman of the college council, Dr. G. F. ABER- cxoaBrE, after referring to the work of the undergraduate and postgraduate education committees, said that the college research register, which last year contained about 50 names, now stood at nearly 400, so a very considerable expansion of the research committee was required. The plan for the national morbidity survey was complete and there would be a rehearsal of the whole team- about 120-next year. " If this college never does any- thing else," Dr. Abercrombie declared, " it will still have contributed notably to British medicine by stimulat- ing the interest and coordinating the efforts of hundreds of general practitioners in the field of clinical ’research." Turning to the criteria for associateship and member- ship, Dr. Abercrombie said the question whether an examination should form part of the criteria for entry was the greatest immediate problem before the college. The first council had decided against an examination at present, but had authorised the formation of a com- mittee to study the technique and detail of such an examination if, in the future, it should be decided to introduce one. The financial report showed that the college had about 20,000 invested, and it was intended to preserve this sum untouched. The council recommended that associates should pay an annual subscription of one guinea but no entrance fee, and that members should pay an annual subscription of three guineas in addition to the entrance fee of ten guineas. If these recommenda- tions were accepted, Dr. Abercrombie said, the college’s finances would be on a firm basis. Paying tribute to the work of the honorary secretary, Dr. John Hunt, Dr. Abercrombie observed that in less than two years the college had grown to include more than 3000 members and associates, with 22 faculties in the British Isles and 5 overseas. CRITERIA FOR MEMBERSHIP The annual report, and the council’s recommendations it contained, were adopted unanimously. The following criteria for associateship and membership thus become by-laws of the college : Associateship A person shall be eligible for admission as an associate if he : (a) (i) Is a registered medical practitioner ; or (ii) Is a qualified medical practitioner during his period of provisional registration. Any person so admitted as an associate shall cease to be an associate if he fails to obtain registration within two years of qualification. (b) Gives an undertaking that he will continue approved post- graduate study if he enters and remains in active general practice, and that he will uphold and promote the aims of the college to the best of his ability. membership (a) A person shall be eligible to apply for admission as a member of the college if he : (i) Is a registered medical practitioner who has been q-ualifled " for not less than seven years. (ii) Is proposed and seconded by two members of the college, these sponsors not being in partnership with each other. w) Has been engaged in general practice either for a minimum period of five years or for a minimum period of three years as an associate of the college. (b) An applicant for membership must satisfy the council of the college of the high standard of his work in general practice by : (i) Evidence submitted by the applicant himself, on an applica- tion form, concerning his practice, experience, and academic and administrative achievements. (ii) Supporting evidence obtained by the council from the applicant’s sponsors, the board of his faculty and, if so required, from others whom he or his sponsors have chosen to appoint. (c) An applicant must also : (i) Submit himself to an interview with the censors, if required. (ii) Give an undertaking that he will continue approved post- graduate study while he remains in active general practice, and that he will uphold and promote the aims of the college to the best of his atn)itv. THE NEW COUNCIL The following were elected as council of the college for the coming year : At a meeting of the new council Dr. Abercrombie was re-elected chairman, Dr. Rose vice-chairman, Dr. H. L. Glyn Hughes hon. treasurer, and Dr. Hunt hon. secretary. 1. Central Health Services Council : Report by the Standing Nursing Advisory Committee on the Position of the Enrolled Assistant Nurse within the National Health Service. H.M. Stationery Office. Pp. 10. 6d. ENROLLED ASSISTANT NURSES THERE is a place for enrolled assistant nurses in most fields of nursing ; and their numbers may be increased by amending arrangements for their training and by improving their prospects of promotion. These are the broad conclusions of a report 1 by the Standing Nursing Advisory Committee of the Central Health Services Council, which has been commended by the Minister of Health to the attention of hospital and local health authorities. The committee observes that the enrolled assistant nurse’s duties should be clearly defined, and she should work under the supervision of a registered nurse. Her work should consist mainly, but by no means entirely, of basic nursing duties. The proportion of all nursing work that can suitably be done by enrolled assistant nurses will be greatest in the case of long-stay or con- valescent patients and smallest in the case of acutely ill patients. More careful selection of candidates would help to maintain a high standard of training and check wastage during training. The present arrangements for training and examination are generally satisfactory ; but it would seem advisable for the pupil assistant nurse to gain her necessary experience of the care of children with sick children, and not solely in nurseries with healthy children. It is essential that her training should be broadly based. The committee believes (like the Minister of Labour’s National Advisory Council on the Recruitment of Nurses and Midwives, but unlike the representative professional bodies that were consulted) that candidates who are lost because they cannot train full time might usefully be recruited for part-time training ; and it suggests that there is room for controlled experiments in such training, limited in the first instance to those pre- pared to work for at least 32 hours a week. This part- time training might be taken by some of those who have discontinued training for the Register after marrying in the second or third year. As regards status, the committee doubts whether it is wise to lay down hard-and-fast rules on the relative seniority of enrolled assistant nurses on the one hand, and of second and third year student nurses on the other.

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1119

Special Articles

COLLEGE OF GENERAL PRACTITIONERS

MORE than 300 members and associates of the collegeattended the second annual general meeting at B.M.A.House on Nov. 20. Dr. W. N. Pickles -was re-elected

president of the college for 1954-55. A portrait ofDr. Pickles by Mr. Christopher Sanders, A.R.A., was

presented to the college by Dr. R. A. Murray Scott, onbehalf of the Yorkshire faculty.The chairman of the college council, Dr. G. F. ABER-

cxoaBrE, after referring to the work of the undergraduateand postgraduate education committees, said that thecollege research register, which last year contained about50 names, now stood at nearly 400, so a very considerableexpansion of the research committee was required.The plan for the national morbidity survey was completeand there would be a rehearsal of the whole team-about 120-next year. " If this college never does any-thing else," Dr. Abercrombie declared, " it will stillhave contributed notably to British medicine by stimulat-ing the interest and coordinating the efforts ofhundreds of general practitioners in the field of clinical’research."

Turning to the criteria for associateship and member-ship, Dr. Abercrombie said the question whether anexamination should form part of the criteria for entrywas the greatest immediate problem before the college.The first council had decided against an examinationat present, but had authorised the formation of a com-mittee to study the technique and detail of such anexamination if, in the future, it should be decided tointroduce one.The financial report showed that the college had

about 20,000 invested, and it was intended to preservethis sum untouched. The council recommended thatassociates should pay an annual subscription of one

guinea but no entrance fee, and that members shouldpay an annual subscription of three guineas in additionto the entrance fee of ten guineas. If these recommenda-tions were accepted, Dr. Abercrombie said, the college’sfinances would be on a firm basis.Paying tribute to the work of the honorary secretary,

Dr. John Hunt, Dr. Abercrombie observed that in lessthan two years the college had grown to include morethan 3000 members and associates, with 22 facultiesin the British Isles and 5 overseas.

CRITERIA FOR MEMBERSHIP

The annual report, and the council’s recommendationsit contained, were adopted unanimously. The followingcriteria for associateship and membership thus becomeby-laws of the college :AssociateshipA person shall be eligible for admission as an associate if he :(a) (i) Is a registered medical practitioner ; or

(ii) Is a qualified medical practitioner during his period ofprovisional registration. Any person so admitted asan associate shall cease to be an associate if he fails toobtain registration within two years of qualification.

(b) Gives an undertaking that he will continue approved post-graduate study if he enters and remains in active generalpractice, and that he will uphold and promote the aims ofthe college to the best of his ability.

membership(a) A person shall be eligible to apply for admission as a

member of the college if he :(i) Is a registered medical practitioner who has been q-ualifled"

for not less than seven years.(ii) Is proposed and seconded by two members of the college,

these sponsors not being in partnership with each other.w) Has been engaged in general practice either for a minimum

period of five years or for a minimum period of three yearsas an associate of the college.

(b) An applicant for membership must satisfy the councilof the college of the high standard of his work in generalpractice by :

(i) Evidence submitted by the applicant himself, on an applica-tion form, concerning his practice, experience, and academicand administrative achievements.

(ii) Supporting evidence obtained by the council from theapplicant’s sponsors, the board of his faculty and, if so

required, from others whom he or his sponsors have chosento appoint.

(c) An applicant must also :(i) Submit himself to an interview with the censors, if required.

(ii) Give an undertaking that he will continue approved post-graduate study while he remains in active general practice,and that he will uphold and promote the aims of the collegeto the best of his atn)itv.

THE NEW COUNCIL

The following were elected as council of the college for thecoming year :

At a meeting of the new council Dr. Abercrombie was re-electedchairman, Dr. Rose vice-chairman, Dr. H. L. Glyn Hugheshon. treasurer, and Dr. Hunt hon. secretary.

1. Central Health Services Council : Report by the StandingNursing Advisory Committee on the Position of the EnrolledAssistant Nurse within the National Health Service. H.M.Stationery Office. Pp. 10. 6d.

ENROLLED ASSISTANT NURSESTHERE is a place for enrolled assistant nurses in most

fields of nursing ; and their numbers may be increased

by amending arrangements for their training and byimproving their prospects of promotion. These are thebroad conclusions of a report 1 by the StandingNursing Advisory Committee of the Central HealthServices Council, which has been commended by theMinister of Health to the attention of hospital and localhealth authorities.The committee observes that the enrolled assistant

nurse’s duties should be clearly defined, and she shouldwork under the supervision of a registered nurse. Herwork should consist mainly, but by no means entirely,of basic nursing duties. The proportion of all nursingwork that can suitably be done by enrolled assistantnurses will be greatest in the case of long-stay or con-valescent patients and smallest in the case of acutely illpatients. ’

More careful selection of candidates would help tomaintain a high standard of training and check wastageduring training. The present arrangements for trainingand examination are generally satisfactory ; but it wouldseem advisable for the pupil assistant nurse to gain hernecessary experience of the care of children with sickchildren, and not solely in nurseries with healthychildren. It is essential that her training should be broadlybased.

The committee believes (like the Minister of Labour’sNational Advisory Council on the Recruitment ofNurses and Midwives, but unlike the representativeprofessional bodies that were consulted) that candidateswho are lost because they cannot train full time mightusefully be recruited for part-time training ; and it

suggests that there is room for controlled experiments insuch training, limited in the first instance to those pre-pared to work for at least 32 hours a week. This part-time training might be taken by some of those who havediscontinued training for the Register after marryingin the second or third year.As regards status, the committee doubts whether it is

wise to lay down hard-and-fast rules on the relativeseniority of enrolled assistant nurses on the one hand, andof second and third year student nurses on the other.

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Organisation of wards on the basis of nursing units, andfully advising the ward staff as to which qualified nursethey should consult in the absence of their own wardsister or staff nurse, should help to avert difficulties.

In some hospitals, and particularly in chronic-sickwards, the enrolled assistant nurse acts as ward sister orstaff nurse. If regularly employed in this way, she shouldhave the chance of promotion to a more senior grade,perhaps with the title of " senior assistant nurse."The main considerations that prevent some enrolledassistant nurses from taking general training are domesticand financial; and the enrolled assistant nurse whowishes to be non-resident throughout such trainingshould be given every facility to live out. _

The report deplores the tendency of assistant-nursetraining-schools to seek approval to become generaltraining-schools as soon as they can provide enoughvariety and quality of experience. This " retards =

the expansion of assistant nurse training facilitieswhich must be achieved if the number of practisingenrolled assistant nurses is to be maintained, let aloneincreased."

The report does not include the committee’s findings onmental and mental-deficiency nursing, which the CentralHealth Services Council has referred to the Standing MentalHealth and Nursing Advisory Committees for furtherconsideration.

GENERAL MEDICAL COUNCILOPENING the 189th session on Nov. 23, Sir DAVID

CAMPBELL, the president, said that at their last meetingthe council had approved the first report submitted by theSpecial Committee on Public Health, charged with thetask of revising the rules adopted in 1945 as to courses ofstudy and examinations for the diploma, and of con-

sidering applications by Commonwealth universities forthe recognition of diplomas granted by them in publichealth. The power to recognise such diplomas wasconferred on the council for the first time by the MedicalAct of 1950. Any general revision of the rules wouldtake some time ; but it was already clear that thecouncil would need to consider carefully whether a

number of changes should be made in the existing rules,which provided among other things for the grant of acertificate as well as a diploma in public health.The Pharmacopoeia Commission expected to submit

an Addendum to the 1953 Pkarmacopaeia with a view toits publication in the autumn of 1955. This procedurewould conform with the plan proposed by the council in1947, under which complete new editions of the Pharma-copccia would be published at intervals of five years withan Addendum half-way between the publication ofeditions.The second edition of the list of approved hospitals and

of recognised house-officer posts in Great Britain andIreland, published in October, gave particulars of 727approved hospitals, compared with 634 in the originallist. Of the 727 hospitals, 531 were in England andWales (compared with 456 in the first list), 1 was in theIsle of Man, 115 were in Scotland, 26 in NorthernIreland, and 54 in the Republic of Ireland. The totalnumber of recognised posts had risen from 3048 in theoriginal list to 3368 in the new list. 3069 of these postswere in the United Kingdom : 1208 posts in medicine(including its specialties), 1492 in surgery (including itsspecialties), and 352 in midwifery ; 17 provided mixedexperience. While the number of posts in surgery thusexceeded those in medicine by 284, time spent in the 352posts in midwifery might of course be counted, for thepurpose of obtaining a certificate of experience, either astime spent in medicine or as time spent in surgery.The council had also issued last month a second editionof a list containing particulars of approved hospitals and

recognised posts in Colonial territories. This list, whichsuperseded that issued a year ago, contained 36 hospitalsapproved for an indefinite period by one or more of threeuniversities-namely, those of London, Oxford, andWales. The council had also been informed that certainoverseas hospitals, not situated in Colonial territories,had been approved by some licensing bodies, either

indefinitely or for a purpose limited to the employmentin them of specified individuals. The council understandthat 8 hospitals in the U.S.A., 4 in Canada, 3 in theUnion of South Africa, and 1 in France had been so

approved.At their last session the council had considered a

suggestion that, in order to eliminate any brief periodwhich might in some cases elapse between the date onwhich a provisionally registered person completed hissecond post and the date on which he could obtain full

c registration, the council should encourage hospitalauthorities to issue certificates of satisfactory service aweek or two in advance of the date on which the personwould actually complete six months’ service in his secondpost. The council were unable to accede to this suggestion.At least one licensing body had been in doubt as to theirproper course on being presented with a number of suchcertificates which had- been given before the end of theperiod of service mentioned in the certificates. The

legal position of a licensing body in this matter had nowbeen clearly stated by the legal assessor. " It appearsto me that the upshot of his advice is that it is not legallyopen to a licensing body to grant a certificate of experi.ence to an applicant until, among others, the two followingconditions have been satisfied : first, twelve monthsmust have passed since the date when the applicant,having previously passed his qualifying examination,first became engaged in employment as a house-officerin an approved hospital ; secondly, six months musthave passed since the applicant began to be engaged onhis second period of employment. This, I think, shouldremove any uncertainty which may have been felt in thematter."

1. Daily Telegraph, Nov. 17, 1954 ; Manchester Guardian, Nov. 17.1954.

Medicine and the Law

Ambulance DrivingTHE driver of an ambulance, said to have been carrying

a dying man, was charged with dangerous driving.l The

police evidence was that the ambulance was driven alongJesmond Road, Newcastle, at such a speed that it hadto swerve to avoid a car coming out of a side turningand crashed into a trolley-bus standard. On discoveringthat the ambulance contained a seriously injured patient,the police allowed the driver to proceed. The magistratesdismissed the charge without calling on the defence andawarded costs of .S10 5s. against the police.The law with regard to the driving of ambulances is

clear enough. They are not subject to the speed limit:the Road Traffic Act, 1934, provides that " the pro-visions of any enactment ... imposing a speed limiton motor vehicles shall not apply to any vehicle on anoccasion when it is being used for fire brigade, ambulanceor police purposes if the observance of those pro-visions would be likely to hinder the use of the vehiclefor the purpose for which it was being used on thatoccasion."But such vehicles must obey traffic signals and give

priority to pedestrians on what are called " uncontrolled *’

pedestrian crossings. Breach of the law may lead to uaction for civil damages as well as to criminal prosecution.In Ward v L.C.C. (1938) a fire engine came to trafficlights ; the driver, who had been ringing his bell.seeing no vehicle in the way crossed against the lights.