"The ABKC should be directly responsible for clubs and take more of a leading role as to how those clubs are run."
The ABKC should have no official role whatsoever. It is the Association of British Kart Clubs and as such is an entirely voluntary association of karting clubs, like the association of scottish karting clubs, not some official body responsible for anything. If there's an advantage to the club from being a member, fine. If not, the club won't be a member.
It will still be an MSA associated club, it will still run MSA meetings and still be eligible to participate in any championship events that are either organised by the club or wish to visit the club.
I agree with you on the issue of kart medicals. It is absurd that I can fly an aircraft on the basis of a self assessed medical (NPPL) but cannot drive a kart....though I suspect that karting is much more highly stressed physically, somewhat like squash. Squash, as a sport, has a number of people who die every year on the court, but they don't crash into the rest of the grid doing it.
Do we trust drivers to take 'normal' care of their health and see a doctor once a year for an MoT, as the NHS guides recommend?
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