Number Of General Practitioners Research Articles

BMA calls for lower blood alcohollevel for drivers Number of GPs increases Public health doctors forecast required manpower New health minister appointed Government promises extra pounds sterling50m for mentally ill patients GPs clarify their role in childbirth

# BMA calls for lower blood alcohollevel for drivers {#article-title-2} The BMA and the Parliamentary Advisory Council for Transport Safety (PACTS) are calling for the legal blood alcohol limit for driving to be reduced to 10.9 mmol/l (50mg/100ml) from the current level of 17.4 mmol/l (80mg/100ml). Research has shown that the risk of becoming involved in a traffic accident greatly increases at blood alcohol levels over 50mg/100ml and the two organisations want legislation to be introduced to reflect this evidence. Some other European countries have switched to the lower level; France is the latest country to do this. In a letter to the transport secretary, Sir George Young, the BMA and PACTS say that legislation needs to be enforced if it is to be effective and that they would support measures to enhance current levels of enforcement, in particular the introduction of random breath testing. The possibility of being tested randomly is considered more likely to act as a deterrent as there is a higher chance of drivers being caught. # Number of GPs increases {#article-title-3} The number of general practitioners in England and Wales increased by 0.7% from 30416 to 30615 during the past year, with women accounting for the majority of the increase. In April 1995, 29.9% of all general practitioners were women. The average patient list size fell to 1869, compared with 2059 in 1985. The number of general practitioner registrars decreased by 3.6% between April 1994 and April 1995 (from 1611 to 1503), but the number of women registrars increased by 1.6% so that more than half of all registrars …

Deprivation and hospital use in a non-metropolitan region of England

ObjectiveTo investigate influences on hospital use in a non-metropolitan region ofEngland (Wessex). DesignLeast-squares regression analysis was used to identify area predictors, at localauthority level, of number of consultant episodes and (separately) of bed use. Variables were assigned for deprivation, strength of primary care, private sector provision, and local levels of ill health. Short-stay (less than 30 days) episodes and bed use were examined separately from long stays. ResultsThere were substantial differences between the regression models for numberof episodes and bed use, and between those for short stays and long stays. Significant predictors of the number of short-stay episodes were: number of general practitioners, standardised mortality ratio and proportion of residents with limiting long-term illness; these variables did not predict bed use in short-stay episodes. None of the variables was significantly associated with long-stay episodes or bed use. ConclusionsAnalysis of geographic variation in hospital use should distinguishbetween short-stay and long-stay use, and should defend the choice of number of admissions versus bed use as the dependent variable. Deprivation was not shown to be a factor influencing bed use in Wessex. This finding argues against the use of a single funding formula across the whole of the country.

Child health surveillance: development of a multicentre course and its evaluation.

With increasing numbers of general practitioners wishing to provide child health surveillance during the 1980s and the expected further increase with the 1990 General Practice Contract, a course in child health surveillance was developed. The content of the course was determined by a needs assessment of Welsh general practitioners in combination with the expectations of paediatricians already involved in educating doctors in community child health. A multicentre course with prepared materials was developed. Teaching methods reflected adult learning needs, included practical clinical competencies and was centred in small groups each led by local tutors. The course was held annually on three occasions, with 220 participants in total. The materials and teaching methods were highly acceptable to the participants, and evaluation demonstrated a significant increase in knowledge and confidence. All participants reached the required clinical competence, six after further teaching. The content, teaching methods, and evaluation methods were altered in the light of feedback, resulting in a 'stand alone' course with built-in evaluation, which is now being provided by local tutors. This study has demonstrated the feasibility of providing a course for large numbers of doctors, using predominantly small-group teaching and discussion with local tutors. We are grateful to all the participants and especially the tutors.

Current and possible screening practices for diabetic retinopathy by general practitioners: new evidence from a pilot survey of Oxfordshire general practitioners.

To investigate the relationship between the number of general practitioners in a GP practice and screening for diabetic retinopathy in order to evaluate the viability of increased GP involvement in screening for blinding diabetic eye disease. A ten point questionnaire was developed and sent to 50 randomly selected general practitioner practices throughout Oxfordshire. 41 (82%) of the general practitioner practices returned completed questionnaires. The mean number of GP's per GP practice was 4, with a standard deviation of 4 GP's while GP practice sizes ranged from 1 to 9 GP's per practice. Overall, 66% (n = 27) of GP practices indicated that they referred their diabetic patients for screening, even though 83% (n = 34) of GP practices performed funduscopy. 76% (n = 31) of GP practices ran diabetic clinics, and 66% (n = 27) of GP practices indicated that they wanted more training in the use of the ophthalmoscope and detecting diabetic retinopathy, despite the fact that 78% (n = 32) of this same group had received some form of postgraduate medical training in diabetes in the last five years. Lastly, only 27% (n = 11) of GP practices would alter their attitude to screening for diabetic retinopathy if they were paid substantially more to do so. Most GP practices referred their diabetic patients for screening, even though the majority of GP practices performed some form of funduscopy and that amongst the largest GP practice sizes all performed dilated funduscopy and did not refer for screening. Given sufficient remedial training in the use of the ophthalmoscope and practical sessions on detecting diabetic retinopathy, it is likely that smaller GP practice sizes would be encouraged to screen for sight-threatening diabetic retinopathy.

The Dutch Advanced Training Programme for General Practitioners; An International Initiative

The aim of the Dutch Advanced Training Programme for General Practitioners is to provide a limited number of general practitioners with a training which will enable them to play a leading role in professional organisations as well as at universities, in helping to shape the future development of general practice. The objective of the training is the acquisition of clinical and medico-scientific expertise. This Dutch programme implemented by the Department of General Practice at the University of Limburg was officially launched in 1991, for a total of 10 participants. The present paper outlines the background, objectives, organisational structure, curriculum profile, assessment and evaluation of the programme.

Research in general practice

EDITOR, - Heather A Waldron and Ronald F Cookson correctly state that increasing numbers of general practitioners are participating in clinical trials sponsored by drug companies.1 I am concerned about their …

The decline in popularity of the intrauterine device

To assess the attitudes and practices of general practitioners (GPs) in New South Wales in regard to intrauterine device (IUD) use. Randomised group comparison of 100 rural and 100 urban GPs by questionnaire. Sixty-five rural and 66 urban general practitioners took part in the study. Almost 50% of GPs who responded to the questionnaire always discussed the IUD when counselling about contraception, whereas 6% never discussed IUDs. Rural GPs were more likely to discuss IUD use than urban GPs. In the past, 68.7% of GPs had inserted IUDs but only 20.6% still inserted them. Fifty per cent of GPs who did not currently insert IUDs felt they lacked expertise due to less demand for IUDs from women or inadequate training. Prevailing community attitudes towards intrauterine devices have resulted in fewer requests to general practitioners for IUDs, resulting in a lack of expertise in IUD insertion. Increased litigation associated with IUD use, and subsequent publicity, has increased the cost of medical indemnity insurance. All these factors have contributed to fewer GPs being prepared to insert IUDs. Australian women are being deprived of balanced information about the benefits and risks of IUD use and of the possibility of using this very effective, low-cost, low-maintenance method of contraception.

A statistical study of factors influencing outpatient service in health districts.

This paper describes a statistical study within NHS health districts, using routinely available data, of the supply of outpatient services, the demands made on these services and the resulting balance of supply and demand. Indicators of supply have been investigated which aim to reflect the resources available within a district for outpatient services and indicators of demand have been studied which link to the number of general practitioners who are considered likely to make use of the services provided. Some preliminary analysis is attempted of relationships between the observed balance of supply and demand and the predictions based on the statistical models developed.

General practitioners' practice expenses.

General practitioners are unlikely to receive the exact level of remuneration recommended in the 16th report of the doctors' and dentists' review body1 even if the level was accepted in full by the government and implemented from 1 April. This alarming sounding position is so because general practitioners' remuneration is a series of fees and allowances designed to produce an average income across all unrestricted principals and would be realised in gross terms only if changes in volume (including increases in the number of general practitioners) were as expected by the review body. It will be achieved in net terms only if the amounts set aside for turn out to be an accurate forecast of actual expenditure. The term practice expenses is used here to refer only to those which fall to be met from gross fees and allowances and excludes those reimbursed directly to general practitioners by family prac? titioner committees?for example, it excludes the 70% of staff salaries which qualifies for direct reimbursement but includes the 30% which does not. For both gross income and to combine to yield the desired average level of net income would therefore be unlikely if not im? possible. The possibility of compensating errors occurring in the two variables such as being higher than expected while gross income is overachieved may result in a misleading level of accuracy, and nobody should underestimate the difficulty of the review body's task in setting fees and allowances to achieve its stated intention. Practice element

A COMPARATIVE EXAMINATION OF THE AUSTRALIAN AND NEW ZEALAND HEALTH SYSTEMS

AbstractIn both New Zealand and Australia the 1970s was a period of rapid escalation in health costs, and modest increases in utilisation, set against a background, particularly in the later years, of economic downturn and restrictions in government spending. As a consequence total expenditure on health care, as a proportion of gross domestic product, continued to rise throughout the decade, reaching 6.7 percent in New Zealand and 7.9 per cent in Australia by 1979. Much of this difference can be explained, statistically, by the higher level of national income per capita in Australia ‐ the contrasting systems of financing and provision appear to be less significant. Other related explanatory factors include differences in the proportion of the labour force employed in the health sector; in the number of general practitioners per head of population; and in the rates of utilisation of both personal and hospital services.

The Psychiatrist's Family—A Comparative Study

The results of a questionnaire survey of the partners of psychiatrists and general practitioners are presented. The questionnaire was designed to elicit feelings about the respective professions. Methodological issues are discussed, and the wisdom of comparing different medical groups is questioned. Although significantly fewer psychiatrists' partners initially had positive feelings towards their spouse's career, the majority of both groups reported currently positive feelings. Only a minority, and in equal proportions in the two groups, reported that their spouse's profession had interfered with their relationships with friends or had influenced their marital relationship. A significantly greater number of general practitioners' partners reported that their spouse's profession was more stressful than that of other professionals. The results also indicated that a significantly greater number of psychiatrists than general practitioners as perceived by their partners as using psychiatric interpretation and jargon in the family setting. Furthermore, the comments provided, although representative of only a minority of respondents, demonstrated that this could provide a unique stress for the families of some psychiatrists.

The clinical psychologist in primary care.

Abstract This paper presents some aspects of the potential contribution of clinical psychologists to the work of general practitioners and reviews the recent reporting on this. It further surveys 42 consecutive referrals to a clinical psychologist by a number of general practitioners in the North of Scotland which are thought to be representative of a general trend throughout the UK as a whole, both in terms of the nature of the referrals and of the clinical psychological services given in response to these. The lack of overlap of these services with others, such as psychiatric, paediatric, and educational psychological is noted. The interaction between primary care and clinical psychological services here reported is one which has implications for other social agencies like social work and community health services, and is perhaps setting a pattern for longer term developments nationally. Some of the implications of such a development are discussed.

General practitioners in the Western Metropolitan Health Region of Sydney.

A comprehensive survey of the number of general practitioners in the Western Metropolitan Health Region of Sydney identified 753 general practitioners with one or more practice locations in the region; this was the equivalent of 711 full-time general practitioners, and represented a general practitioner-population ratio of 1:1533.

The economics of general practice in England.

The number of general practitioners in the NHS has risen slowly since 1948. Believed to have been about 18,000 (in England and Wales) in 1948, there were 20,600 in 1971. The movement was not always upwards year by year?there was a slight fall in the mid-60s?but in general the tendency has been for the numbers to increase. As a proportion of all doctors in the NHS, however, general practitioners have fallen from 60% to 46%. The normal practice, in discussing the supply of family doctors, is to talk in terms of list size, that is, the ratio of NHS patients to general practitioners. The average list size for England and Wales fell slowly from 2,400 to under 2,300 in the fifties and early sixties and then rose again to nearly 2,500 in 1969. It has begun to fall again in recent years. The distribution of general practitioners around the country has always been a matter of policy concern, although it is probably true to say that in the early years of the NHS the distribution of hospital specialists was of more immediate interest. List sizes have ranged from 3,000 or more in parts of the East Midlands, Lancashire, and Durham to about 2,000 in the south-west and other largely rural areas, and this sort of spread has been a fairly constant feature of the NHS (DHSS). So much for the statistics?but have these numbers any more significance? What do they tell us about the type of care which the general practitioner provides? There has been a general tendency, when discussing general practice, to adopt the slogan 'Short lists good?Long lists bad'. This, of course, is to commit the elementary error of confusing inputs with outputs. General practitioners are 'inputs'. Improved medical care (or, perhaps, better health or something vaguer than that) is what we want. Unless it can be shown that more general practitioners per 1,000 of the population are conducive to better medical care then more inputs may not mean more output. The evidence concerning the relationship between list size and the care provided by general practitioners is surprisingly limited and difficult to interpret (Clarke, 1971). It is notorious that the rate at which patients consult their family doctors varies widely. Nevertheless it is clear from the work of Wright (1968) and Cartwright (1967) that there is a relationship between list size and rate of consulta tion. This is illustrated by a table taken from Present State and Future Needs of General Practice (Council of the RCGP, 1973).

Training of the internist as a primary physician.

The internist in the United States has traditionally served as a primary physician for his patients. The rapid and continuing decline in the number of general practitioners has made it imperative that this function be continued. Many training programs in internal medicine are based in hospitals devoted to the highly specialized care of seriously ill patients: consequently, there is a growing trend toward subspecialization and less interest in primary medical care. A remedy is suggested.

RECRUITING TO GENERAL PRACTICE IN ENGLAND AND WALES, 1961-69

The number of general practitioners and the annual number of recruits to general practice both fell during the middle 1960s with a recovery towards the end of the decade. The proportion of recruits with U.K. or Irish qualifications has fallen from 96% to 80% while that of recruits with Asian medical degrees has risen 4% to 18%. The main loss of U.K. qualified recruits to general practice has been among English and Welsh graduates, especially those with Oxford, Cambridge, or London degrees.

THE DISAPPEARANCE OF THE GENERAL PRACTITIONER: TWO SIMILAR VIEWS—1872 and 1968

In 1968 Doctor Helen M. Wallace in writing about the decrease in the number of general practitioners cites the following facts: It is clear from the existing data on medical manpower that although the total number of all physicians and of all pediatricians is increasing, the ratio of general practitioners to population is decreasing markedly. . . . For example, the ratio of general practitioners to the childhood population under fifteen years of age fell from 345 pen 100,000 in 1940 to a ratio of 135 in 1961.1 About a hundred years earlier Doctor J. B. Fonssagrives was similarly bothered by the disappearance of the family (general) practitioner. In a book widely read by mothers in the 1870's he wrote: In former times there was such a person as the family physician; he exists no longer, except in a few small towns where old-time customs are still kept up, and in which free thus far from the cosmopolitan mania, the various generations of a family quietly succeed each other under the same roof. But how vastly different (1872) is the ordinary course of events! The placid home life is becoming the exception; the house is giving place to the tent; we are born in one town reared in another, married in a third, and we shall die, God knows where. Thus situated–encamped as it were–we do not dream of providing ourselves with a physician. There comes an emergency, and we go from door to door in quest of the first one we may meet.

STATEMENTS OF THE EXECUTIVE BOARD OF THE AMERICAN ACADEMY OF PEDIATRICS

THE Executive Board of the American Academy of Pediatrics has given intensive consideration to the many problems that face the practicing pediatrician in this era of rapid scientific progress, population expansion, and socioeconomic change. Rapid growth in the child population without parallel increase in numbers of pediatricians makes the delivery of quality pediatric care at the private practice level progressively more difficult. To an even greater degree, affording proper health services for the nation's underprivileged children is a tremendous challenge. Marked decrease in numbers of general practitioners reduces still further the medical manpower for child health needs. All of the problems cited above will intensify during at least the next 15 years, for it is predicted that by 1980 more than half the population in the United States will be less than 21 years old.

Training Physicians for Family Medicine

THE DECLINING RATIO of physicians to population and the accompanying decrease in the number of general practitioners or family doctors present a serious problem demanding urgent attention. <h3>Some Factors in Physician Shortages</h3> Demographers predict that the population of the United States will reach 215 million by 1970. At the present rate of medical training, it will be impossible to maintain the present ratio of 133 physicians per 100,000 population. Several recent publications,^1-4have considered this ratio and have emphasized its crudeness as an index of the supply of physicians relative to the needs for medical service. The ratio does not reflect that the number of physicians engaged in activities such as teaching and research has almost quadrupled in the past 30 years. Furthermore, 40% of all physicians are listed as specialists.⁵Alvey⁶recently pointed out that data in the<i>New England Journal of Medicine</i>showed that 95%