LETTERS
Medical cannibalism, strangury, and the spread of erratic hyphenitis B Lennox 236 Is there enough clinical time available in primary care? J Paris and K McKeon 236 Are postal urine specimens a feasible method for genital chlamydial infection screening? IGM van Valkengoed, AJP Boeke, SA Morré 236 The colorectal cancer jigsaw puzzle G Singh Kalsi 237 Health technology assessment in primary and community care G Curtis Jenkins 237 Supporting practice-based audit P Murphy 238 Needs assessment in primary care PH Fitton 238 Dermaclinic: preliminary triage by GP specialoids? M D’Souza, D Shah, B Johal, K Misch, L Ostlere 238 Note to authors of letters: Letters submitted for publication should not exceed 400 words. All letters are subject to editing and may be shortened. Letters may be sent either by post (please use double spacing and, if possible, include a Word for Windows or plain text version on an IBM PC-formatted disk), or by e-mail (addressed to journal@rcgp.org.uk; please include your postal address). All letters are acknowledged on receipt, but we regret that we cannot notify authors regarding publication.

Medical cannibalism, strangury, and the spread of erratic hyphenitis
Sir, The title of Beales’ and Dalton’s article, ‘Eating disordered patients…’ (January Journal),1 suggests an innovative solution to managing heartsink patients. However, even though we may be tempted to follow Dr Hannibal Lecter’s practice, it is generally accepted that Malcolm Bradbury was correct: ‘Eating people is wrong’.2 The cover of the same issue also mentions ‘good books with piss-poor titles’; I find this an unusually interesting expression for a medical journal. Perhaps there is a deliberate move towards a more tabloid style, but if you can manage to hyphenate ‘piss-poor’, at least try and do the same to ‘eating disordered’ so the title makes sense. Better still, read the recent editorial in the BMJ,3 ‘allow very, very few hyphens’ and rewrite ‘self-regulation, in-practice, wholeblood, practice-based, cross-sectional, outof-hours, doctor-staffed, and heroin-dependent’; all of which appear on the same cover. The style and content of the BJGP are evolving, and some of the changes are welcome, but you must be careful to avoid attracting the accusation of being ‘A pisspoor journal with a good title’.

Is there enough clinical time available in primary care?
Sir, Pereira Gray (December ’98 Journal) 1 stressed the importance of clinical time to general practice, calculating that 47 minutes of doctor time is available for each patient per year. Jarmen et al2 demonstrated that the number of GPs in an area is inversely proportionate to the local standardised mortality in hospital, a 1% increase in the number of GPs being associated with a 0.368% decrease in hospital standardised mortality ratios. The availability of clinical time is therefore an important quality and clinical governance issue. Clinical governance 3 makes fresh demands on GP time but can be put to good use. Doctors who prescribe antibiotics for inter-current infections may encourage patients to return with minor ailments. 4-6 Promoting good practice may allow redeployment of such clinical time; its availability and use therefore becoming important aspects of clinical governance. We examined the availability of clinical time in general practice in one health authority as part of the clinical governance baseline assessment. At the end of December 1998, North West Lancashire had 469 000 people served by 251 GPs working from 91 practices. Pereira Gray’s summary statistic of 47 minutes per patient per year1 was used as the ‘standard’ of the time necessary for a GP to provide patient care. Two measurements of doctor time were made: the number of minutes, excluding locums, available per patient per year by practice, assuming each doctor provided 30 hours of clinical contact time per week for 46 weeks per year; and the number of hours needed to provide 47 minutes of contact time