We are familiar with the idea that the distribution of consultants should be guided by ‘norms' supported by the College. Current norms have been derived from what is (or rather was at the time), not from knowledge of how consultants spend their time, still less on the basis of estimates of morbidity or demand. As Russell noted, a norm of one consultant for 70,000 people was developed using simple arithmetic when there were 700 consultants available to forty-nine million people. From this starting point, one consultant to 60,000 or 40,000 or 25,000 people suggests the possibility of an improved service, but it cannot be assumed that the service is better simply because more people are providing it. Evaluation of the consultant's contribution to a service requires, among other things, knowledge of what the consultant actually does with his time.
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