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THE Medical Practices Committee has completed its

survey of England and Wales and has assigned allexecutive-council areas or parts of them to one offour schedules, two of which are given below.

Schedule 1 contains the names of parts where, in theopinion of the committee, more doctors are needed. Partsnamed in schedule 2 are also completely open to anydoctor who wishes to start a practice. Admission tothe medical list of the executive council of places namedin both these schedules will be automatically granted,and intending practitioners can proceed to make all

arrangements acting on this assumption.Schedule 3 lists areas which are " doubtful." Appli-

cations to practise are likely to be granted, but informationin the hands of the committee may lead to the areabeing closed. The establishment of a successful practicein these areas is likely to be hazardous.

Schedule 4 gives the name of the " closed areas " inwhich the committee has decided that the number ofdoctors providing general medical services is for thetime being adequate. Such closure only gives thecommittee the power to refuse an application to go onthe medical list (subject to the right of the applicantto appeal to the .-Minister). To members of executivecouncils and local medical committees, and to doctors,it should convey no more than that the committee isunlikely to agree to an increase in the number of prac-titioners practising in the district and might agree withan executive council to refuse to allow replacement ofa practitioner who resigns. This does not mean, however,that a retiring practitioner could not be replaced.Where an executive council in agreement with the localmedical committee considered replacement desirable, the

. Medical Practices Committee would agree, and, further,it might suggest replacement in other instances where thisappeared desirable. Nor does closure mean that underno other circumstances would the committee admit a

practitioner to the list ; personal factors advanced bythe applicant, the executive council, the local medicalcommittee, or others interested might cause the applica-tion to be granted.


From the information furnished from the executivecouncils, it would appear that the number of practitionersavailable in the densely populated parts of the followingdistricts is insufficient for local needs. For more precisedetails application should be made to the local executivecouncil.

‘ .

COUNTIESBedfordshire.-Luton.Cheshire.--Crewe and Nantwich, Hyde, Dukinfieldand Stalybridge,

Runcorn and Stockton Heath, Newferry and Bebington.Cumberland.-Cockermouth, Maryport.- De&Att-e.—Chesterfield B. and R.D. ; Ilkeston B. ; Alfreton,

Bolsover, Claycross, Heanor, Long Eaton, Matlock, Ripley, Staveley,Swadlincote U.D.s ; Blackwell, Clowne R.D.s.Durham.-Felling U.D., Hebburn U.D., Jarrow B. and Boldon

LT.D., Houghton-le-Spring, Hetton and Washington U.D.s, Chester-le-Street U. and R.D., Stanley U.D., Consett U.D. and LanchesterR.D., Crook and Willington U.D. and Tow Law U.D., BishopAuckland, Shildon and Spennymoor U.D.s, Easington R.D.,Sedgefield R.D., Stockton U. and R.D.s and Billingham U.D.

Glou,cester.-Kingswood.Hampshire.-Aldershot, Eastleigh.Hertfordshire.-Ware U.D. and Cheshunt.Huntingdonshire.-Ramsey.Isle of Ely.-March, "BVisbech, Whittlesey.Kent and Canterbury.-Chatham, Dartford, Erith, Gravesend,

Rochester B.s; Crayford, Northfleet, Sittingbourne and Milton,Swanscombe U.D.s ; Dartford R.D.

Lancashire.-Aintree, Bacup, Barrowford, Coppull, Croston,Farnworth, Haydock, Heywood, Hindley, Huyton with Roby,Irlam, Kearsley, Leigh, Litherland, Middleton, Newton-le-Willows,Prescot, West Houghton, Widnes, Worsley.

Leicestershire and Rutland.-Ashby de la Zouch, Coalville, Hinck-ley, Melton Mowbray (excluding Somerby).

Lincolnshire (Holland).-Spalding U. and R.D.s.Lincolnshire (es<e!’eK).&mdash;Grantham.Lincolnshire (’tMe/).&mdash;Louth.London.-Battersea, Bethnal Green, Hammersmith B.s.

3jft<M!Mea;.&mdash;Edmonton, Heston and Isleworth, Southall. WoodGreen B.s ; Feltham, Hayes and Harlington, Staines U.D.s.

’or/o7&.&mdash;Mitford and Laimditch.A’<M-<&a7K,p<OM.&mdash;.Kettering.VofMM&er!6[m<Z.&mdash;Ashmgton, Bedlington, Haltwhistle. Wallsend.Nottingham County and City.-Arnold. Bawtry, Beeston, Carlton

and Netherfield, Clipstone, Eastwood, Hucknall. Kimberley,Langold, Stapleford, Warsop, Worksop, City of Nottingham.

Soke of Peterborough.-Peterborough, Whittlesey, Market.Deeping.o?Me!*se<.&mdash;Chew Magna, Street.Staffordshire.-Newcastle-under-Lyme B. and R.D. ; Wednes-

bury, Bilston, Rowley Regis, Tipton B.s ; Kidsgrove, Biddulph,Aldridge, Brownhills, Rugeley, Darlaston, Willenhall, Wednesfield,Sedgley, Brierley Hill, Amblecote UD.s ; Lichfield R.D.Surrey.-Mitcham B. ; Chertsey, Walton and Weybridge U.D.s.Sussex (West).-Lancing.tf?-M?tc&s7nt-e.&mdash;Bedworth, Nuneaton, Warwick U.D.s ; Ather-

stone R.D.HtMs/ne.&mdash;Swindon.Worcestershire.-Bromsgrove, Halesowen, Oldbury, Stourbridge.Yorkshire (East Riding).-Haltemprice district, Hedon district,

Howden and Goole.Yorkshire (North Riding).--Carlin How, Dormanstown, Grange-

town, Guisborough.Yorkshire (West Riding).---Castleford and Normanton U.D.s,

Featherstone U.D., Knottingley U.D., Pontefract B., OsgoldcrossR.D., Horbury U.D., Ossett B., Wakefield R.D., Batley B., Heck-mondwike U.D., Hoyland Nether U.D., Stocksbridge U.D.,Wortley R.D., Penistone U. and R.D.s, Hemsworth U. and R. D.s,Cudworth U.D., Darton U.D., Royston U.D., Darfield, Wombwell,Worsborough, Dodworth U.D.s ; Swinton, Rawmarsh, Wath-on-Dearne U.D.s ; Adwick-le-Street U.D., Bentley with Arksey U.D.s,Rotherham R.D., Doncaster R.D., Tickhill U.D., Thorne R.D.,Conisborough, Mexborough, Dearne U.D.s ; Maltby U.D., KivetonPark R.D.

Denbighshire and Flintshire.-Buckley, Caergwrle, Connah’s Quay,Hawarden, Holywell and Wrexham R.D. -

Glamorganshire.&mdash;Aberdare, Bridgend, Caerphilly, Gelligaer,Llwchwr, Maesteg, Mountain Ash, Neath, Penybont, PontypriddPort Talbot, Rhondda.

,I-Ionnwuthshire and Newport.-Abercarn, Bedwas and Machen,Bedwellty, Cwmbran, Ebbw Vale, Pontypool, Risca and Tredegar.


All of the larger cities in the country have densely populateddistricts, where the services of additional doctors are required.In addition more doctors are required in the following countyborough areas:

Barnsley Great Yarmouth Stoke-on-TrentBirkenhead Leicester SunderlandBootle Middlesbrough TynemouthBurton-on-Trent Northampton WakefieldCarlisle Norwich WalsallCoventry Rotherham WarringtonDerby St. Helens West BromwichDudley Smethwick West HartlepoolEast Ham South Shields WolverhamptonGateshead


The committee declares the number of doctors includedin medical lists and practising in the following areas tobe adequate :


Berkshire.-Lambourn (Hungerford R.D.), Brightwalton (WantageU. and R.D.s).

Buckinghamshire.&mdash;Great Missenden, Prestwood, Chalfont St.Peters, Chalfont St. Giles, Gerrards Cross, Beaconsfield, Seer Green,Stokenchurch, Brill, Long Crendon, Haddenham.

Cheshire.&mdash;Hoylake and West Kirby district, Knutsford andWilmslow (with the -exception of Lymm), Bollington (Macclesfielddistrict), Helsby (Runcorn district).

Cornwall.&mdash;St. Agnes, St. Ives and Carbis Bay, Hayle, Townshendand Fowey, Tywardreath and Marazion, Mullion, Lizard, St.Keverns, Falmouth, Perranarworthal, St. Mawes, Ruanhighlanes,Bude, Widemouth Bay, Rock, Wadebridge, Tintagel, Boscastle,St. Germans, Downderry, Millbrook, Cawsand, Upton Cross andPensilva, Constantine, Padstow, Torpoint, Mevagissey.

Cumberland.-Alston, Bootle and Millom, Ravenglass and Gosforth,Caldbeck and Dalston, High Hesketh district, Keswick, Kirkoswald,Rowrab.

Derbyshire.&mdash;Buxton B., Bakewell U. and R.D.s, WhalevbridgeU.D.Devon and Exeter.-Yelverton, Lifton, Ottery St. Mary, Hols-

worthy, Lynton and Lynmouth, Pinhoe, Bradworthy, Hartland,Churchinford, Clayhidon, Culmstock, Shebbear, Beer, Seaton,Colyton, Braunton, Woolacombe, Croyde Bay, Georgeham, Ilfra-combe, Shaldon, Chulmleigh, Hatherleigh, Winkleigh, Dunsford andUmberleigh, North Tawton, Sticklepath and Witheridge, Sidmouthand Sidbury, Hope Cove, Lustleigh and Bovey Tracey, Moreton-hampstead, Newton Ferrers, Yealmpton, Modbury, South Brent,Buckfastleigh, Salcombe, Brixham, Paignton, Totnes, Ashburton,Kingskerswell, Teignmouth, Dawlish. Starcross, Chudleigh andExmouth, Lympstone, Woodbury, Morchard Bishop, CharitonFitzpaine, Bishopsteignton, Black Torrington, Bow, Brandninch,Budleigh Salterton, Tipton St. John, Chillington, Uffculme.

Dorset.&mdash;Abbotsbury and district, Bourton and Gillingham,Branksome, Broadstone, Buckland Newton and Cerne Abbas,Canford Cliffs, Charmouth and Lyme Regis, Child Okeford, CorfeCastle and district, Cranborne, Dorchester, Evershot, Ferndown,West Moors and Kinson, Handley and district, Maiden Newton,Marnhull and district, Milton Abbas, Winterbourne Stickland anddistricts, Puddletown, Shaftesbury and district, Stalbridge,Sturminster Newton, Swanage, Yetminster.

Durham.-Stillington.Gloucestershire county and city.&mdash;Bishops Cleeve, Blockley,

Moreton-in-Marsh, Chipping Campden, Mickleton, Charlton Kings,



Cheltenham, Cleeve Hill, Prestbury, Fairford, Lechlade, Minchin-hampton, Nailsworth.

Hampshire.&mdash;Lymington, Fleet.Herefordshire.&mdash;Eardisley, Kington, Hay-on-Wye, Staunton-on-

Wye, Pembridge, Weobley.Hertfordshire.&mdash;Braughing R.D.Huntingdonshire.&mdash;Alconbury Weston, Buckden.Isle of Ely.&mdash;Manea.Jsks of Scilly.Kent and Canterbury.-Lydd, Tunbridge Wells, Sandwich B.s ;

Broadstairs and St. Peters, Herne Bay, Sevenoaks, SouthboroughD.D.s; Ashford (East), Ashford (West), Cranbrook and Tenterden,Romney Marsh and Sevenoaks R.D.s. ,

Lancashire.&mdash;Allithwaite and Grange-over-Sands, BroughtonWest and Kirkby Ireleth, Coniston, Hambleton, Preesal, Pillingand Stalmine with Stainhall, Haverthwaite, Hawkshead, LythamSt. Annes.

Leicestershire and Rutland.-Peatling Magna, Hallaton, Somerby,Uppinghani. Market Overton.


Lincolnshire (Kesteven).&mdash;Bassingham, Billinghay, Castle Bytham,Colsterworth, Corby, Dunston, Folkingham, Martin, Metheringham,North Hykeham, Ropsley.

Lincolnshire (Lindsey).-Bardney, Chapel St. Leonards, Coningsby,Covenham (St. Bartholomew), Covenham (St. Mary), Fulstow,Hogsthorpe, Immingham, Keelby, Mablethorpe, Mareham-le-Fen,Market Rasen, Newton-on-Trent, North Thoresby, Revesby Bridge,Saltfleetby (All Saints), Sutton-on-Sea, Tetford, Tetney, Theddle-thorpe (All Saints), Toft Newton, Woodhall Spa.

Middlesex.&mdash;Finchley B.Norfolk.&mdash;Freebridge Lynn, Diss, New Hunstanton, Wells.Northamptonshire.&mdash;Brixworth, Byfield, Cold Ashby, Crick, Flore,

Guilsborough, Kings Cliffe, Long Buckby, Moulton, Raunds, Weedon,Welford, Vest Haddon, Woodford Halse, Yardley Hastings.Northumberland.-Rothbury.Nottinghamshire county and city.-Carlton-on-Trent, North and

South Collingham, Colston Bassett, North Leverton, Tuxford.Oxfordshire county and city.-Bampton, Bloxham, Burford,

Chinnor, Clifton Hampden, Cropredy and Thame.Shropshire.&mdash;Clun.Somersetshire.-Chard, Churchinfold, Combe Down, Dulverton,

Dunster, Ilminster, Keinton Mandeville, Langport, Milborne Port,Minehead and Porlock, Nailsea, Stogumber, Wellington, WestonZoyland, Williton, Wraxall, Yatton.

Staffordshire.&mdash;Uttoxeter R.D., Pattingham (Seisdon R.D.).Suffolk (East).&mdash;Aldeburgh, Alderton, Earl Soham, Peasenhall

and Yoxford, Orford, Kessingland, Southwold, Wangford, WrenthamFressingfield and Stradbroke.

Suffolk (West).-Melford.Surrey.-Guildford B. and R.D.s ; Banstead, Coulsdon and

Purley, Dorking, Haslemere. Leatherhead U.D.s.Sussex (East).-Newick, Chailey, Cuckfield LT. and R.D.s, Bexhill,

Haywards Heath, Rye U.D.s; Battle, Hailsham, Uckfield R.D.s.Sussex (West).-Barnham, Eastergate and Yapton, Cowfold,

Haslemere (area adjoining Surrey border), Selsey, Storrington,Worthing district.

Warwickshire.&mdash;Bideford-on-Avon, Hampton-in-Arden, MeridenR.D., Marton, Southam R.D. (with the exception of Southam andadjacent parishes), Stratford on Avon R.D.

Westmorland.&mdash;Ambleside, Milnthorpe, Burton, Arnside andKirkby Lonsdale, Bowness, Windermere and Staveley, Grasmere,Glenridding, Kirkby Stephen, Kendal.

TViltshire.-Aldbourne, Bradford-on-Avon, Broadchalke, CastleCombe, Great Bedwyn, Littleton Panell, Mere, Sherston, SuttonBenger, Whiteparish, Burbage, Codford St. Mary, Fovant, Hindon,Market Lavington, Pewsey, Shrewton, Tisbury.

Worcestershire.&mdash;Hundred House district, Malvern district.Yorkshire (East Riding).-Hornsea, Bubwith, Elvington, Escrick,

Holme-on-Spaiding Moor, Leven, Middleton-on-the-Wolds, Rilling-ton, Roos, Stamford Bridge.

Yorkshire (WartTt Riding).-Aldbro St. John, Ampleforth, Ays-garth, Coxwold, Danby, Easingwold, Tollerton, Hawes, Helmsley,Grosmont, Hutton Rudry, Stokesley and Great Ayton, KirbyMoorside, Kirklington, Knayton, Leyburn, Newsham, Reetb,Thornton-le-Dale, Topcliffe, Welburn.

Yorkshire (West Riding).-Harrogate.Anglesey.&mdash;Beaumaris B., Llangefni and Menai Bridge U.D.s,

Llanfairpwll and Bodorgan (Aethwy R.D.), Twrcelyn R.D.s(with the exception of Cemaes Bay) and Valley R.D.

Breconshire.&mdash;Llanwrtyd.Cardiganshire.&mdash;Aberayron, Cardigan, Crosswood, Henllan,

Lampeter, New Quay, Pontrhydgroes.Carmarthenshire.&mdash;Caio, Llandovery, Llangadock, Llanybyther,

Ferryside, Nantgaredig.Caernarvonshire.&mdash;Abersoch, Bettwsycoed, Conway, Criccieth,

Llanaelhaiarn, Llanfairfechan, Nevin, Penmachno, Penmaenmawr.Denbighshire and Flintshire.&mdash;Abergele (and adjacent areas of

Kinmel Bay and Towyn), Colwyn Bay (and adjacent areas ofLlanelian-yn-Rhos), Old Colwyn and Rhos-on-Sea, Glynceirog (withadjacent areas of Pontfadog and Llanarmon D.C.), Hanmer (withadjacent areas of Ty Broughton, Iscoyd, Horseman’s Green,Bronington, Bettisfield and Ellesmere), Llanfair (with adjacentareas of Llansannan, Llangerniew and Bettws-yn-Rhos), Llangollen(and adjacent areas of Rhewl, Llantysilio, Pentredwr, Glyn Dyfrdwy,Garth), Llanrhaiadr-ym-Mochnant (with adjacent areas of Llansilin,Moelfre and Llangedwyn Rhydycroesau), Cerrigydruidion, (withadjacent areas of Hiraethog, Llanfihangel, Llangwm, Tir-Ifan andBettws, G.G.).

Glamorgan.&mdash;Creigiau (Cardiff R.D.), Cowbridge Municipal andR.D.s, Loanmorlais and Penclawdd (Gower R.D.), Porthcawl U.D.

Merionethshire.&mdash;Corwen, Barmouth, Corris, Towyn and Aber-dovey, Harlech.

Monmouthshire and -7Vewport.-Caerleoii, Tintern (Chepstow R.D.),Raglan (Monmouth R.D.).

Pembrokeshire.&mdash;Boncath, Maenclochog, Newport, St. David’s,Solva, Trecwn, Tenby.


Bournemouth Hastings Southport

B., borough. U.D., urban district. R.D., rural district.



J. E. STONEC.B.E., M.C., F.S.A.A.


THE Select Committee on Estimates 1 recommendsthat " A uniform system of costing should be devisedas soon as practicable for the Hospital Services in

England and Wales." What is meant by costing? ‘?What are the objects and advantages of costing inrelation to hospital finance and accounting ? ’?

It is difficult to give an accurate and comprehensivedefinition of costing. It may, for want of a better, bedescribed as a systematic record of the detailed transac-tions relating to the various activities of a hospitalwith a view to arriving at the total expenditure andunit cost in respect of each ward, department, activity,&c. Contrasted with financial accounts, cost accountsendeavour to arrive at these figures by a process ofdetailed analysis, showing as it were a series of smallincome and expenditure accounts. The financial accountsendeavour to arrive at the same total by the method ofgrouping the items of income and expenditure.


The objects of cost accounts for hospitals may be statedbriefly as follows :

1. To provide the managing authority with knowledge- ofthe working or running expenses and costs of wards, depart-ments, functions, and activities, with a view to (a) obtainingand maintaining control over financial transactions, and(b) increasing the efficiency of the administration.

2. To find out the elements of the working expenses witha view to detecting waste of material, loss of time, and soon, and to securing, where necessary, a planned reduction ofexpenditure.

3. To ascertain that the proper relationship exists between .the expenses incurred and the services obtained in respectof each activity.

4. To serve as a guide in the preparation of annual andother budgets on a unit or departmental basis, and to enablefuture policies to be founded on reliable information of thework and the cost of each unit or department.

5. To record promptly the facts and tendencies of all theactivities with a view to enabling the maximum number ofpatients to be treated for-the least expenditure of material,labour, and time. ’

6. To show the cost of the staff as distinct from the costof patients. -

7. To show the cost of special services as distinct, fromgeneral services.

Among the particular advantages are these:(a) With complete and accurate costs of maintaining each

activity, the apportionment of expenditure between thevarious classes of patients treated, and more particularlybetween inpatients and outpatients, may be made on morereliable data than are available under existing arrangements.

(b) Cost accounts will show the nature and extent of thespecialised treatments available. A wide range of differencesexist in this connexion, but under the existing arrangementsthese cannot be allowed for in calculating the cost per bed.

Cost accounts combine the advantages of both thesubjective and objective methods of accounting, the

expenditure first being allocated to objects (wards,departments, or activities) and then to subjects (natureof expenditure) within the objects. They show also theextent to which each ward or department has beencalled upon by others, and the cost of the servicesrendered to these latter denartments. Each denartment

1. Seventh Report from the Select Committee on Estimates:Session 1948-49. The Administration of the National HealthService. H.M. Stationery Office. 1949. See Lancet, 1949,i, 1065.