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Tales from a country practice
At the time the NHS began 70 years ago, life in a rural practice could be beset by many difficulties – lack of transport, electricity and running water being just a few. Dr Ian Geddes, a retired Dorset GP from Sixpenny Handley in Dorset, and father of GP and NHS England’s Director of Primary Care Commissioning, Dr David Geddes, recalls the development of the GP practice there over the decades:
I took over the practice in Sixpenny Handley in 1975.
My predecessor had set up the scattered Dorset practice at the time the Health Service had just started. The husband and wife team described it as being a time of great goodwill; patients knew they could now afford to call a doctor.
For doctors, there was the satisfaction of being able to treat patients without money coming into the equation.
In 1948, Cranborne Chase was still recovering from wartime shortages, there were very few cars, which meant that most patients had to be visited at home – 49 calls in one day was the record – and there were many night calls too.
Sixpenny Handley had no electricity and evening surgery was done by lamplight. We did our own dispensing for the whole practice, making up large jars of stock medicines. Antibiotics were new and very precious.
To help outlying patients, medicines were left in Post Offices, village shops and friendly porches. None ever went astray.
The district nurse was also the midwife and normal confinements took place at home.
The older patients were still wary of hospitals. One old lady with a broken femur flatly refused to go, and was treated with traction provided by the weight of the doctors grandfather clock. She made a complete recovery.
My predecessors had to buy the goodwill in the practice for one and a half year’s income – £1,500. When I took over the practice, it was very much a cottage industry, but it was a very happy one, with undemanding goodwill on both sides.
My wife and I took over the large house in which the dining room was the waiting room, the billiard room the consulting room and the butler’s pantry the dispensary.
The kitchen was the scene of all practice meetings. We lived upstairs and were able to keep in close touch with local events from the talk in the dining room below – sometimes so intriguing that patients would not come through to be seen until the tale was ended or I would find that they had been taken to see our children’s pony!
A part-time dispenser did the filing, but there was no secretary and when there was no surgery, my wife was the hub of the practice day and night.
The house was over two miles from Sixpenny Handley so surgery was held twice a week in the vicarage dining room.
One patient, after having his back manipulated, said it was the first time he had been under the vicar’s dining table.
In 1978 the practice moved – by horse box – into a new surgery in Handley. The practice team increased to a district nurse/midwife, a shared health visitor, a secretary/receptionist as well as a new dispenser. My wife remained tied to the telephone out of hours.
Record keeping was revolutionised by changing to A4 folders and a fortnightly meeting of the medical team was attended by a social worker.
Still the medicines were routinely left in friendly porches and a ‘snow box’ was left in each village in November. My life was transformed by regularly swapping weekends with the doctor in Cranborne.
In 1984, I set up a partnership with another single-handed doctor practising with one part-time secretary/dispenser from two rooms in a converted garage in the neighbouring Chalke Valley and with Dr Hugh Pelly.
Another new surgery, including a room for the district nurses and health visitor, was built in Broadchalke and we were joined by two practice nurses.
The primary care team had arrived and our regular team meetings included, for part of the time, the local vicars and local volunteer group leaders. In 1991 it was agreed that one health visitor should cover the whole practice. A district nurse was seconded later on the same basis.
They thus formed a cross boundary integrated team, managing themselves and with flexibility to swap roles.
Later we were able to create a locality nursing team of nurses resident in the area, working when required and paid from savings in the nursing budget.
I retired from practice in 1995, but have seen the practice go from strength to strength. Care is delivered very differently now with computerised patient records creating opportunities for more proactive planned care, but practices now seem far more busy places, with a greater need for clinical staff to juggle competing demands.
As I have moved from giving care, to now in my 80’s receiving care, I see the benefit of having a relationship with my practice and the continuity of care that has made general practice for me such a rewarding place to work.
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Lovely account of a rural general practice. No quality targets, no audits, no CCG’s wanting data and achievement figures. Just doctors and nurses Providing medical care in the community.