To mark the 70th anniversary year of the NHS, a retired doctor looks at changes over the last century of general practice:
In 1918 my father, George, was a medical student at Queen’s University Belfast. He was the first doctor in his branch of the family, although his younger brothers Sam and Howard joined him later. There have been 20 more of us since then, mostly GPs.
With the 70th birthday of the NHS fast approaching, I’ve been thinking back across the decades, to what my parents told me about general practice and my own experiences as a GP in Cheltenham and then Castleford.
My father set up as a GP in Airedale, Castleford in about 1923 and a house was built for him by the local colliery where he was employed as its doctor. The 1920s and 30s were times of poverty and the great depression. He employed a collector to gather in his fees, although patients were often too poor to pay. His first home visits were made on a Douglas motor bike.
He undertook minor surgery and had an ether anaesthetic device: this was done on Sunday mornings and Joan, the cleaner, tidied up afterwards. My father gave her a packet of cigarettes each week as well as her wages. Back then, some people couldn’t afford to visit the dentist or the vet so my father would even extract teeth and put dogs down too.
My father’s second marriage, to my mother, was in 1944. He employed her as an assistant in the middle of the Second World War and she became his partner in more than one sense. I was born a year later.
In the Wakefield and Castleford area my parents were almost alone in voting in favour of the NHS. On the first day when people could register to become an NHS patient there was a queue out of the surgery and up the street. It was not long before the practice built to 10,000 patients and a third partner joined them. This huge practice operated with two consulting rooms, a waiting room, reception and a paper records area. There were open surgeries, with no appointment system, and patients sometimes had to queue outside in the rain.
My father died in 1967. On the day of his funeral the coal miners came out and doffed their caps as the cortege passed.
I studied medicine in London in the 1960s – with no mention of NHS finances in my undergraduate education. After a period undertaking research, I became part of what we called the ‘gold rush’. Training for general practice was to be mandatory: in 1973 I started as a GP partner in Cheltenham and so avoided mandatory training.
The four partners shared all out-of-hours duties. In hours we now had an appointments system, with two patients to be seen every 15 minutes. There were usually about five visits each after morning surgery, followed by a break at home until the 4pm surgery, all without mobile phones or computers.
In 1978, my wife and I bought the family house and surgery in Castleford from my mother, who had retired. Castleford was designated as an “open area”, which meant it did not have enough doctors to meet demand. After some form filling I could set up a practice, and I worked there until 2005. The Wakefield District Executive Council administered general practice, pharmacies, opticians etc. with a staff of about 20 (hospitals were managed by a separate body).
The practice grew from zero patients to over 5,000 and from two consulting rooms to 19 with a common room and education suite. I wonder what George, Sam and Howard would have thought?
So much has in changed in 100 years, and that gives us all much to be grateful for.
In my opinion the two most major advances in general practice enabled by the NHS are:
- The introduction of computers into general practice in the mid-1980s. Eventually, patients’ records were computerised and we became virtually paperless. Software became increasingly sophisticated, and computers enabled a huge paradigm shift in the way preventative, investigative and curative medicine was approached. Prescribing is also much safer using software that can warn about interactions and side effects.
- GPs in CCGs are now in control of how most general practice and hospital services are commissioned, with over 150 people working for my local CCG. They are facilitating radical new approaches: GP services in the evenings, weekends and holidays; appraisal and revalidation; integrating health and social care; patients consulting advanced nurse practitioners, pharmacists and other health and social care professionals; consulting by phone and the internet; urgent treatment centres.
So what are the next huge urgent tasks to be completed? In my opinion, education for social care service users on how to get the best for their particular medical or social situation is vital. And there needs to be more widespread compassionate care. Pressure of work or low pay is no excuse for a lack of compassion.
Find out more in our NHS70: primary care section.