387

PANEL AND CONTRACT PRACTICE

Sickness Claims

- THE sickness experience of the Hearts of OakBenefit Society, as reported in the daily press, bringsto light some interesting facts. During the last

eight years, that is during the period of the mostacute depression from unemployment, there has beena continuous yearly rise of sickness claims. Whenwork was abundant claims were light, but in industrial(especially mining) areas there is now an immenseincrease in sickness. Apparently the actuarial calcu-lation for the sickness of young people is not inaccordance with the society’s experience. Youngpeople are claiming much more than they did ; theyhave no jobs and nothing to do except to think aboutthemselves, and there is a consequent increase inclaims for mental and nervous depression. In thefirst week of January there was an increase of100 per cent. in new claims, in the second week of110 per cent., in the third of 130 per cent., and inthe fourth of 200 per cent. It is suggested thatthese claims, approximately 10,000 a’ week, werealmost entirely a result of influenza, and this mademore serious by a low standard of physique and anexaggeration of under-nourishment, both backed upby mental depression. Even in happy times influenzais apt to .leave depression behind, and an increaseof nervous and mental breakdown is to be expected,brought on partly by influenza and partly by theabsence of happiness and of employment, especiallyamong young people who have failed to obtainemployment since they left school. While certifiableinsanity may show little variation, it is worthy ofnote that the number of out-patients attending theMaudsley Hospital jumped from 1608 in 1930 to1993 in 1931. Figures for 1932 are not yet available.The effect of the prevalence of the influenza epidemicis evident from the number of prescriptions receivedby the pricing bureaux of insurance committees.

Effect of Removal from the Panel

The Minister of Health can only remove a doctor’sname from the panel after an inquiry which hassatisfied him that the continuance of the practitioneron the panel would be prejudicial to the efficiency ofthe service. His action is administrative after an

inquiry committee has reported its findings, and fromhis decision there is no appeal to the courts. This

procedure is apt to be confused in the lay mindwith that of the General Medical Council which haspower to erase a doctor’s name from the Registerif it is proved to the satisfaction of the Council thathe has been guilty of infamous conduct in a profes-sional sense. This is a far greater penalty thanremoval from the panel, for it prevents a doctorfrom acting as a medical practitioner at all. It doesnot, of course, take away his medical knowledge-he could diagnose and treat a case just as well beforeas after the decision-but he cannot give a medicalcertificate which would have any value legally, hecannot give a death certificate, and he cannot suefor his fees. If an insurance committee or a localmedical committee or a panel committee reports tothe Minister that the continuance of a practitioneron the panel would, in their opinion, be prejudicialto the service, he must (but if the report comesfrom other sources, he may) set up an inquiry com-mittee consisting of a lawyer and two doctors whomay go into anything in connexion with this doctor’spractice. Due notice is given to the doctor of all

points of inquiry, evidence is given on oath, barristersor solicitors are employed, and the rules of evidenceare strictly adhered to. The committee reports tothe Minister who decides on that report the penaltyto be imposed-after consultation with the advisorycommittee. It may be a fine, in which case thedoctor has the right to be heard on the question ofits amount. It may be suspension of decision for aperiod, to give the doctor time to furnish evidenceof subsequent good conduct. It may be permissionto retire from the panel, on the written undertakingthat he will not rejoin elsewhere without the Minister’sconsent. Or it may be immediate removal from the

panel list. This decision does not prevent the doctorfrom carrying on with private work in practice, butthe regulations definitively prevent him acting eitheras an assistant or as a deputy (including locumtenency) to another doctor’s practice. It might ’bethought that, as the principal is responsible for theacts of his assistant or deputy, he could employwhomsoever he wished to do the work he could notdo himself, but the regulation is quite clear on thismatter. A doctor removed from the panel cannotact as locum tenens, assistant, or deputy to anotherpanel doctor. He could, of course, have a partnerwho is on the panel, but he would not himself beable to treat any panel patients for or on behalf ofthat partner.

Inspection of SurgeriesGloucester insurance committee has decided to

revert to the practice of inspecting the surgeries andwaiting-room accommodation of its insurance prac-titioners. There had, it seems, been a few complaints.The regulation is brief but important :A practitioner is required to provide proper and sufficient

surgery and waiting-room accommodation, having regardto the circumstances of his practice.

No standard is laid down, but obviously such things asheating and seating must be taken into consideration,for it is not to the advantage of the service nor ofthe practitioner for insured persons to be overcrowdedwhen attending for treatment nor that they shouldbe expected to sit in badly ventilated and insufficientlyheated rooms. On the other hand, it is not suggestedthey should have the use of the doctor’s best roomwhen they come in, as they often do, wearing theirworking clothes and muddy boots. Some time agoa discussion took place whether a couch should beprovided in the consulting room. Was a couchaccommodation or was it apparatus ? The insurancecommittee has no authority over apparatus, but ithas over accommodation; hence the matter was

important. The doctor in this case said he neverused a couch in his consulting room ; any examinationin the recumbent position was done at home in thepatient’s bedroom, which, he said, was more suitablefor the purpose, especially in the case of women

patients. In view, however, of emergency treatmentthat may at any time be required it can hardlynowadays be contended that a couch is not a necessityin the consulting room.

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TINFOIL FOR HOSPITALS.-The tinfoil fund ofthe Ancient Order of Druids last year received over

100 tons of tinfoil, lead capsules, tooth-paste tubes,and other waste metals averaging JE20 per ton invalue which were sold for the benefit of hospitals. Sincethe fund was started in 1912 more than 20,000 has thusbeen realised.