I was a House Surgeon at Nelson Hospital in 1960. Amongst the general practitioners in the town were a few old doctors who showed up from time to time. One of them was J.P.S. Jamieson, by that time a man in his eighties. (It was from him, over a cup of tea, that I would hear about the treatment of diphtheria in children ninety years ago.) He had been the President of the New Zealand Branch of the British Medical Association, and he was one of the few proper leaders we have ever had.Each of these men provided succour and support to a handful of mainly elderly patients. Their activities, so far as one could judge, were absolutely harmless. No cases of mismanagement or neglect found their way into the wards.Some years later, a retired Auckland obstetrician wrote to the New Zealand Medical Journal to complain about the cost of the annual registration with the Medical Council, which he said was too dear. If he gave it up because of the cost, he complained, he would be unable to write prescriptions. This got him a firm put-down from the Chairman of the Medical Council, who, if my memory serves me correctly, was Dr W.S. Alexander. He made it clear that the Council was opposed to this business of an old doctor treating family members. Dr Alexander had a valid point in respect of an obstetrician. Now the Council has set its sights on all older GPs.A few days ago, I spotted a red flag. I was talking to my own GP. He has the view that the demands of the Royal College of General Practitioners make it a worse proposition than bpac, so he has gone with them, and he is already embarked on his tick-a-box higher education, at a cost of $1200 p.a. plus GST.Ominously, my doctor says that the questions are "easy". Ah, "easy," are they? So why does bpac want to dish up to experienced GPs easy questions at considerable expense? What's the point? Why did the Medical Council not think that existing safeguards were good enough? There have been no published complaints about general practitioners perceived to be deficient in knowledge. The big boss is taking a hammer to a peanut, turning up the heat on the oldies by requiring them to pay for things that they don't need. We cannot expect that either the cost of the annual ticket, nor the "easy" questions coming out of bpac, will stay as they are for long. Costs will rise.Younger doctors should heed the warning. At the age of sixty, you will be ‘on yer bike', unwilling or unable to manage either the Medical Council dues, or the bpac questions about the drugs with the unpredictable side-effects and the unpronounceable names. Save hard, and don't think that you will be allowed to supply remedies to your grandchildren.It is taking longer than ever to get into independent general practice, you'll be paying lavish sums to locums, and in no time at all you'll be looking down a slippery slope marked "exit". At the end of the day, it is the patient who pays for all this over-scrupulous "improvement".Doctors cannot provide economical primary care when they have to meet the demands of the Royal College and the Medical Council. The GPs need leadership. Where is it? Roger M Ridley-Smith Retired GP Wellington, New Zealand