277

PANEL AND CONTRACT PRACTICE

Mortgaging the PracticeSEVERAL times recently public attention has been

drawn (see THE LANCET, 1933, ii., 1324) to the positionof practitioners tied hand and foot to money-lenderswho have made advances for the purchase of a practice.Some of these young doctors have signed a blankform of resignation from the medical list as a condi-tion of obtaining a loan, which means that they mayat any time be evicted upon completion of this formby the money-lenders. There are cases in which

panel practitioners have surrendered their practicesand the first intimation to reach the insurance com-mittee concerned has been a notification that the

mortgagees have appointed a locum tenens to carryon pending the sale of the practice. Such appoint-ments cannot be recognised, for in the event of

complaints arising it may be impossible to trace theoriginal practitioner who is of course responsible forthe conduct of the practice until his resignationhas been accepted by the committee and the patientsproperly transferred or given the option of beingtransferred to some other insurance practitioner onthe committee’s list. This trafficking in practices ison the increase-in London alone there are more than200 cases in which fees have been assigned-and theInsurance Acts Committee and the NationalAssociationof Insurance Committees are considering their action.It was decided in a recent case (O’Driscoll and Anotherv. Manchester Insurance Committee) that the remu-neration to which a practitioner who is on the medicallist of an insurance committee is entitled is a debtwhich is capable of attachment and, this being so,is a chose in action and capable of assignment. TheLondon Insurance Committee suggest an emendationof the National Health Insurance Act, 1924, some-what on the lines of Section 21 of the Act whichruns:

"Every assignment of or charge on, and every agree-ment to assign or charge, any benefits shall be void, and,on the bankruptcy of any person entitled to any benefit,the benefit shall not pass to any trustee or other personacting on behalf of his creditors."

This would not prevent a practitioner entering intoan agreement with a corporation or company toadvance money for the purchase of a practice andinstructing his banker to make appropriate periodicalrepayment. The committee say they have no desireto interfere with legitimate arrangements for the

purchase of practices, realising that in many instancespractitioners cannot buy at all without borrowing,but an insurance committee should not be forced intothe position of agent for either party. A resolutionin the sense of the emendation mentioned above is tobe tabled for the coming annual meeting of theNational Association of Insurance Committees. Thiswill make void every assignment of or charge on anysum payable by an insurance committee to a medicalpractitioner in respect of medical benefit except forsuch purposes as may be agreed between accreditedrepresentatives of the medical profession and theMinister of Health. The resolution if passed willestablish the broad principle, leaving the actualdrafting to specialists.

Health PropagandaWhile the main function of an insurance committee

is to administer medical benefit to insured personsliving within its area, it is also charged with the dutyof health propaganda. Many committees are not in

a sufficiently strong financial position to do much ofthis sort, others take it up in the form of lectures on" how to keep fit." When one remembers the amountof health literature sent out by M.O.H.’s, and publishedin newspapers, to say nothing of lectures by numberlesshealth societies, the question arises whether there isany need for set lectures by practitioners. Do notthe young people of to-day already tend to becomeneurotic over every little ache or pain ? And is notthis one of the contributing causes of so much sickpay amongst married women ? Birmingham doesnot think so. Last year its insurance committeedecided that a series of lectures on " How to KeepFit " should be delivered during the autumn andwinter by practitioners with over a thousand insuredpersons on their lists who had not lectured during thelast five years. Notice was to be given by an explana-tory letter addressed to the insured person enclosingan invitation card and a reply-paid postcard. Twentysuch lectures were given, 41,444 invitations beingsent out, and 4517 persons attended-an average of10.9 per cent. of those invited. The attendance ata particular lecture varied from 376 to 100, and thecost from :E18 14s. to 98 16s. The total cost of thelectures was :E274, or ls. 1. per person attending.Since 1925 when these lectures began, 250 have beengiven at a cost of E2913 ; the highest attendance was19 per cent. in the first year, and the lowest 6’5 percent. in 1930-31. Some people would doubt whetherthis expenditure produces results commensurate withthe money spent. It will be noted that last winterat best only one person attended out of five invited,while the cheapest lecture cost nearly jE9. It mightbe argued that if those who took the trouble to go tothe lecture really wanted to know how to keep fit

they could consult their own doctor.

THE SERVICES

ROYAL NAVAL MEDICAL SERVICE

Surg. Capts. C. V. Griffiths to Victory for R.N. Hospital,Haslar, and J. G. Danson to President for course.

Surg. Lts. S. R. G. Pimm to Victory for R.N.B., andH. de B. Kempthorne to Victory for R.N.B.

ROYAL NAVAL VOLUNTEER RESERVE

Surg. Sub-Lts. R. J. Carr and J. D. Spillane to beSurg. Lts.

ROYAL ARMY MEDICAL CORPS

Lt.-Col. L. G. Gibson retires on retd. pay.Maj. J. B. A. Wigmore to be Lt.-Col.

ARMY DENTAL CORPS

Capt. J. L. Craig to be Maj.Lt. F. J. McCarthy to be Capt.

TERRITORIAL ARMY

Lt.-Col. W. F. Denning resigns his commn. and retainshis rank, with permission to wear the prescribed uniform.

General List.-Lt. D. L. Cran resigns his coinmn.

INDIAN MEDICAL SERVICE

Lt.-Col. A. W. Overbeck-Wright retires.

ROYAL AIR FORCE

Squadron Leader A. J. 0. Wigmore is placed on theretired list on account of ill-health.