789

He also pleaded for an early conference between themedical officers of the reception areas on the onehand and of the evacuation areas on the other. Dr.Brewer, endorsing Dr. Glegg’s appeal for consultation

with the medical officers, said that the Governmenthad arranged for amateurs to make a house-to-houseinvestigation to find out what the public-healthdepartments knew already.

PANEL AND CONTRACT PRACTICE

Not Temporary ResidentsA medical-service subcommittee has been dealing

with a case in which a practitioner accepted a

considerable number of persons as temporary resi-dents, and received the appropriate remunerationbut did not fully understand what the term meant. Ithad been noticed in the committee’s office that thispractitioner was accepting more temporary residentsthan his neighbours, and it was also observed thatof 54 thus treated he later accepted no fewer than35 on his permanent list. Inquiries showed that14 out of 16 more recently accepted " temporaryresidents " could not properly be regarded as such.The terms of service contain no definition of what

constitutes a temporary resident, and reference mustbe made to regulation 17, which says that the removalof an insured person shall be considered temporaryif when he removes he intends to remain less thanthree months. In the area of the committee concernedin this case the ratio for payment is 6 to 1 , that is,if a practitioner accepts an insured person as a

temporary resident and submits a continuation cardshowing that he has in fact provided treatment, hereceives the equivalent of eighteen months’ remun-eration-say 13s. 6d. This provision is made, of course,because these patients are not treated on an insurancebasis ; broadly speaking, it is only those who requireimmediate treatment that seek the help of a temporarydoctor. It is clear therefore that for an insured personto be accepted as a temporary resident he or shemust definitely intend or expect not to remain morethan three months in the neighbourhood, and infact he has to sign a declaration to that effect.The respondent practitioner told the subcommittee

that his district has a notoriously floating population ;but he admitted that he had entirely misconstruedthe definition of a temporary resident. He was underthe impression for instance that a domestic servantwho was not sure whether she would remain in hersituation could be regarded as a temporary residentfor the first three months. The subcommittee foundsome difficulty in appreciating this point of view, forit is well known that domestic servants are apt tochange their situations and those who framed theregulations were not likely to have arranged thatsuch persons should attract the equivalent of eighteenmonths’ remuneration to a practitioner merely becauseit is uncertain whether they and their employerswill get on well together for as long as three months.The doctor’s frank admission made it unnecessary

for the subcommittee to prove the facts. He askedthat the amount irregularly obtained from thePractitioners’ Fund should be repaid in full and heaccepted as a basis of his offer that he should repaythe difference between the amount paid him in respectof temporary residents over the past three yearsand that which he would have received if his propor-tion of temporary residents had been the averagefor all practitioners in the county. This amount wascomputed at S79 6s. 3d. ; but the committee wishedto give full credit to the arguments adduced by thedoctor as to the peculiarities of the insured populationin his district, and they therefore decided that thesum to be repaid should be assessed at E70. It is tobe recovered in three instalments.

The Practitioners’ Fund

The Central Practitioners’ Fund for 1938 has beenfinally determined at :f:7,514,903 compared with:f:7,200,125 for 1937. Insurance committees are nowproceeding to distribute the balance available to

practitioners, and the result in London is to makethe value of a unit of credit for 1938 approximately9s. 3-6d. The balance for distribution in London is;E44,573 as compared with 1:68,958 for 1937.The Central Practitioners’ Fund for 1939 has been

provisionally determined at 7,252,000, and in noti-fying insurance committees of this the Minister hasuttered his usual warning that the final determinationof the fund will not necessarily enable any additionalpayment to be made to practitioners at a later date.

Costly MedicinesCritics of national health insurance have from

time to time alleged that insurance practitioners aredebarred by their conditions of service from prescrib-ing for their insured patients any medicines, howevereffective, if they are costly. Panel doctors, suchcritics contend, have to do the best they can withcheap medicines. A case reported to the Derbyshireinsurance committee at their meeting on Feb. 21shows that this allegation rests on a misapprehension.In this case the patient, who was suffering fromparalysis, had prescribed for him by his insurancedoctor a drug (Prostigmin) which during 1938 costno less than 308. The total sum spent by the com-mittee in supplying the patient with medicine fromthe beginning of his illness was j6470. No memberof the committee raised any objection to the expendi-ture, which was regarded as necessary to keep thepatient alive.An insured person is entitled under the National

Health Insurance Act to such " proper and sufficientmedicines " as his insurance doctor prescribes forhim, and a doctor is not debarred from prescribingany medicine, however costly, if he can show, shouldthe question be raised, that it was necessary for theproper treatment of the patient.

ST. MARK’S HOSPITAL, LONDON.-The number ofpatients treated at this hospital during 1938 was

the highest recorded; 1027 were admitted as against997 in 1937 and 662 in 1924. The number of

patient awaiting admission exceeds 250 and is rapidlyincreasing. The space set free by the erection of thenurses’ home is to be used to improve the operating-theatre unit and increase the accommodation in publicand private wards. Work on the second operating-theatrewill be completed this year. About 33,000 is stillrequired to cover the cost of the nurses’ home and thereconstruction work and extensions. Steps are beingtaken to enlarge the accommodation of the X-ray depart-ment and to install modern equipment. The follow-upscheme for cancer cases now provides a systematic recordof all cases admitted to the hospital from 1910 onwards.Tumour cases have been grouped into three classes :group A, or early operable ; group B, in which the musclewall of the bowel has been penetrated by the growth ;and group C, or late operable, in which extension outsidethe rectum has occurred, with invasion of the regionallymph-nodes by the growth. Results indicate that abouta fifth of the cases fall into group A, a third into group B,and a half into group C.