My letter related to motion 104 of the HJS Conference which proposed that the HJSC, which now has sole negotiating rights for junior doctors, should incorporate representatives from the Junior Hospital Doctors Association and Medical Practitioners Union to give these organisations an input into the negotiating machinery in return for their abandoning their claims to separate negotiating rights. He sees this as an attempt to "constrain the doctor's choice of representative organisation," though how arranging for the JHDA to have a share in the negotiating process can impair a doctor's choice of representative organisation escapes me. If the argument is that the organisations representing junior doctors should not come together to confront the Health Departments as to do so would infringe the right of the individual doctor to have his uncompromised views pressed upon the Departments, then he advocates a political Tower of Babel. The alternative to co-operation within the HJSC would be the creation of a new structure in which representatives from the HJSC, JHDA, and MPU would thrash out a common negotiating position. This will not come about unless ACAS awards negotiating rights to the latter two (and this is far from certain), as the BMA will require good reasons to forgo its present monopoly position. In my letter I said that such a structure would be less efficient than that now existing, as it would mean much "coming and going" between it and the BMA, JHDA, and MPU to produce agreement. Mr Rawlins makes two interesting points: that he knows of no evidence to support the view that it would be less efficient, and that no "coming and going" would be needed for the JHDA, as its negotiating committee has "full . .. authority" to act on behalf of the JHDA. I do not know why he should have sought evidence when none could exist (as no such structure has previously existed in junior politics) or indeed why he should seek evidence to support the selfevident. The second point suggests that the JHDA affords such autonomy to its negotiating committee as to smack of oligarchy and accords little with his enthusiasm for democratic principles. Perhaps it would have been better if he had simply said that the JHDA was averse to involvement in the HJSC and would prefer to sit it out, waiting hopefully for ACAS to report. TOM MCFARLANE Manchester
Distribution of registrars
SIR,-Professor L P Le Quesne (2 September, p 697) questions the calculations on which the redistribution of senior registrars and registrars was based. Since there has been a good deal of misunderstanding about these your readers may find an explanation helpful. Professor Le Quesne's first point is that the calculations were based on 1976 figures, which might change. But the figures used for senior registrars were the establishments in the various specialties, and since these are controlled centrally they will change only as a result of the redistribution itself. Professor Le Quesne cites the particular case of senior registrars in general surgery in the Trent region. The actual position is as follows. In 1976 Trent had an establishment of seven
BRITISH MEDICAL JOURNAL
posts, which was six less than their "fair share" (13) on the formula adopted by the Central Manpower Committee. During 197677 four posts were redeployed to Trent, making their establishment 11 in 1977. They are still two posts below their "fair share" and it is proposed that they will gain one of these posts during the current round of redistribution. In brief, the changes in Trent's staffing between 1976 and 1977 do not, as Professor Le Quesne suggests, convert them into a region to surrender posts but merely reflect their progress towards a fairer share of available posts. As regards staff with honorary NHS contracts, the Department has never claimed that these figures would be difficult to obtainas Professor Le Quesne points out, we collect them annually. The reason that the Central Manpower Committee agreed that these staff should be excluded for the time being is that honorary contracts are issued in a wide variety of circumstances on a basis which differs widely from place to place, so that two doctors having honorary contracts with the same national whole-time commitment to the NHS may, in fact, make substantially different contributions. The Department has undertaken to study these problems further to decide how staff with honorary contracts may be included in as fair a manner as possible. It is clear none the less that including them would not make a substantial difference. If the original calculations had been based on all staff contracted to the NHS Trent's "deficiency" in senior registrars in general surgery would still have been six posts. Professor Le Quesne's own region would have had 11 more than their "fair share" rather than 10. Since they have only been asked to give up seven of these posts in all (including the three already given up) it seems extremely unlikely that any later changes in the figures would mean that they had given up more than their share. In conclusion, may I put on record that the Department would be happy to answer any further queries on these figures that anyone wished to raise with us. V M DEMMERY
23 SEPTEMBER 1978
campaign for renewed growth in this part of the NHS. Capitulation will get us nowhere. J TUDOR HART Glyncorrwg,
nr Port Talbot, W Glamorgan
United Kingdom Packaging Review Annual Survey for 1977, updated June 1978.
SIR,-Dr Ian Tait (26 August, p 641) refers to the advantages of a gradual introduction of A4 records into general practice. A more practical mechanism, which would remove the need to dismantle A4 folders when returning records to the family practitioner committee and spread capital costs over a number of years, would be for each FPC to issue an A4 record for every patient newly registered in the NHS.' The existence of two sizes of record, though possibly inconvenient, would not present an insuperable obstacle. H W K ACHESON Department of General Practice, University of Manchester Acheson, H W K, Journal of the Royal College of General Practitioners, 1976, 26, 277.
Related ancillary staff
SIR,-In a column entitled "Doctors' wives get equal rights with mistresses" the Daily Telegraph Health Services correspondent (29 July 1978) described how Dr Michael Glanvill, of Chard, Somerset, received a favourable judgment in the High Court against Mr David Ennals and the DHSS concerning reimbursement of salaries paid to wives working in their general practitioner husbands' practices. The BMA was quoted as saying that Dr Glanvill was to be congratulated. That is absolutely right, but the BMA should also give an abject apology for not taking this case and others to court years ago. Perhaps the Association can now follow the lead and "have a go" when there is a fair possibility of humiliating the Department. The end result could well be a softening in the arrogance that civil servants sometimes display Assistant Secretary, when negotiating with the profession.
Eileen House, 80-94 Newington Causeway, London SE1
Department of Health and Social Security
HARVEY GORDON Mid-Surrey District, Surrey Area Health Authority, Epsom, Surrey
General practice records
Priorities in planning
SIR,-Dr Ian Tait (26 August, p 641) says that the reform of general practice records is now bogged down over the question of the financial consequences of conversion to A4 and asks us to "accept what we have a chance of getting." The wealth devoted to packaging materials of all kinds in Britain rose from C937m in 1971 to C2716m in 1977,1 with consequences to be seen on every beach and roadside; most of that expansion represents more selling, not better protection of goods. If as a nation we can squander resources in this way and at the same time accept a records system unchanged since it was introduced in 1912 because we can afford nothing better we have indeed walked into a bog. I still think the first step is to rally the present A4 users to pool their experience of both the difficulties and the new opportunities involved in using an adequate record and to
SIR,-It is a great relief to hear from Mr David Ennals (9 September, p 776) that the report I quoted (26 August, p 631) of the priorities of the Department of Health and Social Security was utter nonsense. It came from a widely circulated trade union newspaper, but I have not kept the copy. I am sorry if I have used a report which misrepresents the views of such important people, but the source seemed impeccable and the quotation evidently had the reporter's approval. May I express the sincere hope that all the measures taken by Mr Ennals and his colleagues may in fact improve the Health Service ? If they have even the wholehearted intention of doing so then it is indeed time for "all good men to come to the aid of the party."
RICHARD HARDY General Hospital, Hereford