the Doctors' and Dentists' Review Body and not simply that of the DHSS. In its debate on the subject the Central. Committee for Hospital Medical Services.
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in addition to their consultant salaries in recognition of their special responsibilities. They are also eligible for merit awards, but the amount of any award which is paid to them is abated by the amount of the supplement they are receiving. The Central Committee for Community Medicine (CCCM) has for some time been seeking to end this arrangement, a change which would require the authority of the Doctors' and Dentists' Review Body and not simply that of the DHSS. In its debate on the subject the Central Committee for Hospital Medical Services (CCHMS) felt that, while prepared to support this change for RMOs, it could not do so in connection with AMOs, particularly at a time when areas are about to disappear and the future responsibilities of district medical officers and their possible entitlement to salary supplements has not been clarified. CCHMS has, of course, no right to interfere with the activities of other craft committees and merely decided that it could only support part of the proposed change, further action by CCCM on the matter being for that committee to decide. However, as far as the question of DHSS requiring agreement from other crafts before accepting a proposal in negotiation is concerned, your correspondent may be interested to know that all matters negotiated by either CCHMS or the Hospital Junior Staff Committee require the agreement of the other committee before the DHSS will implement them, so that CCCM is certainly not being dis-
criminated against. Current problems with regard to the remuneration of community physicians arise in the main from their consultant status, which imposes upon them a system of remuneration inappropriate to their role in the NHS. The concept of salary supplements for special responsibility is entirely foreign to the pattern of consultant remuneration, this kind of need being met by awards for distinction and meritorious service. Retention of merit award and salary supplement in full would give the recipients the potential of earning in total more than the most distinguished clinician. It is evidence of the respect for RMOs felt by CCHMS that this situation was accepted for them, but clearly widespread dissemination of such an arrangement could hardly be defended. D E BOLT Chairman, Central Committee for Hospital Medical Services BMA House, London WClH 9JP
1289
8 NOVEMBER 1980
full-time staff, with a collective experience and memory as long as any elephant's, took up the running whenever this was expedient. In other words, the BMA's forays were those of a balanced force of all arms, with great effectiveness. The only drawback-as the Secretary remarks-is that those whom the negotiators serve, for reasons of professional ethics and independence, severely limit the type of weapons and ammunition which their representatives may employ. I would not wish it otherwise, but it is a fact of life. DAVID GULLICK Welwyn, Herts AL6 OQH
The hospital practitioner grade
SIR,-I am impelled to write on behalf of clinical assistants who because they are not principals in general practice are excluded from the hospital practitioner grade. Correspondents such as Mr G S McCune (30 August, p 623) clearly do not appreciate the deep sense of grievance they feel, and it is iniquitous that because of a "skillfully negotiated" closed-shop arrangement they should continue to do work similar to that of hospital practitioners but under very different and inferior terms and conditions of service. The provision of part-time training and consultant posts might suit some but not necessarily all of these doctors, but this is an entirely separate issue and not relevant to their exclusion from the hospital practitioner grade. Other considerations such as domestic commitments (and surely practice commitments should cause equal concern) and fears about creating a sub-consultant grade are all red herrings which deliberately divert attention from the central principle involvednamely, equal pay for equal work. This issue has been debated for almost ten years without a fair and just settlement. There is no valid reason why posts similar in every respect to the hospital practitioner grade should not be established for other suitably qualified doctors. The main stumbling block has been the strength of the lobby within the BMA which is determined to create posts "tailor made for principals in general practice" to the exclusion of all other doctors whose interests, in this context, the Association cannot claim to represent. MARGARET SHAMY
Full-time negotiators for the medical profession? SIR,-Abroad on holiday I missed the letter of Dr D H Fox (4 October, p 946), but have just read that of his colleague, Dr B W Hill (25 October, p 1145), and the comment of the Secretary. May I add a word, from past experience; I do not think this view is com'placent or prejudiced, but your readers must judge. The BMA's negotiators-a blended team of doctors daily in clinical practice, with staff members (both medical and lay-all of them "full-time negotiators")-was, and is, far and away the optimum arrangement. Speaking from their first-hand experience, the BMA's clinicians could shoot down any excursions into this field by departmental doctors, who necessarily had left it years before. The BMA
York District Hospital, York Y03 7HE
***The Secretary writes: "It is the policy of the BMA that a mark II hospital practitioner grade should be established for doctors not in general practice as principals. Progress on this grade has been slow, primarily because of the great difficulties in finding solutions to the problems of the career structure in the hospital service." Women in hospital medicine
SIR,-There has been a certain amount of correspondence recently concerning the arrangements for part-time training for married women doctors. A lot of this has been very critical of the feasibility and usefulness of the new arrangements, and it has been stated that
regions are not implementing the manpower approvals which were given to 88 of the 200 applicants for senior registrar training posts last year. For the scheme which is currently operating, the commitment of the profession-that is hospital consultants-will be necessary; at the present time their commitment is less than 100%'. When consultants do, as I am sure they ultimately will, accept fully the idea of opportunities for part-time training, then the time taken to plan a training programme and make arrangements for a supernumerary doctor to be accommodated in a clinical department will be much shorter than it is at present. In this region there is considerable enthusiasm for the concept of part-time training, but it does take a long time to make the necessary arrangements. Furthermore, the Royal Colleges' educational approval is not too speedily forthcoming in all cases-again, the increase of commitment of hospital staff to the idea will undoubtedly help to speed things up. Notwithstanding the above, all the arrangements for all but one of the doctors with manpower approval in this region, including the necessary interview at local level, had been completed within eight months of the approvals being known. Two of the doctors with manpower approval are being unavoidably delayed in taking up their posts by new arrivals in their families, one of whom would otherwise be in post by now; we are still struggling with a training programme for the other doctor. One woman had undertaken some outside commitments, but will start her appointment on 1 December. Another doctor who had a manpower approval has left the region. Judging from our experience, therefore, it would appear that the region's response has been enthusiastic, but the time taken to arrange the posts had obviously been underestimated. The struggle over the one training programme is at least in part due to apprehension on the part of the profession. VERA M HOLLYHOCK Winchester S022 5DH
SIR,-Your leading article "Women in hospital medicine" (13 September, p 693) asks what arrangements society can make to enable women, who form an increasing proportion of the medical profession, to stay in medicine, obtain postgraduate training, and enter the hospital specialties. At the same time it casts light on another crucial problem: the reasonable and natural need of each woman (or man) for a harmonious life and the opportunity to work and study within her (or his) profession. I believe that the solution proposed, entailing special arrangements for the postgraduate education of women doctors, is unfortunate. This would only augment the existing inequality of professional opportunities and perpetuate the one-sided division of domestic duties which exists in many families. Progress will be made only if the work load of all doctors is reduced. This would allow men and women to share the responsibility for the family with no loss of professional standards. Fathers would spend more time with their children and find, perhaps, not only greater happiness, but also an insight and emotional maturity which would help them to be better doctors. VIBEKE BINDER Herlev Hospital, 2730 Herlev, Denmark
