When I arrived in General Practice in rural Devon.... we ran a small hospital, a 24 h minor injury unit, our own on call .... at its best with 16 rural doctors sharing. We did our own intra partum midwifery, we were trained to fit coils etc, do smears, minor surgery.
When we appointed th partner after me we had 100 or so applicants.
Now the hospital is closed, we dont cover a minor injury 24 h unit. There is no midwifery. The partners almost never visit. There are no longer personal lists. The oncall is covered from 30 miles away ....
Much less responsibility, Having got rid of all the interesting stuff ...guess what ? Noone wants the job anymore.
When I was asked what I thought ...I said if I could do what I did ...I would do it all again. If I was asked to spend the next 28 years doing what now masquerades as General Practice I wouldn’t consider it.
The partnership model in my view was fantastic in riral areas and towns where men and women wanted a high degree of committement and the rewards it gave... which were rich indeed.
New Zealand may be your only hope!
Retirement .... aaah ! Come on in the water is lovely?
Entered medical school in London in 1971. Had the most wonderful 5 years. Early career doing a year of everything I could think of. Then in 1985 joined a rural practice in Devon. We ran two small hospitals, a 24 h cas unit and our own maternity unit. Hard work. Great partners. Heaven. New contract around 2003 turned us into hired hacks. Instead of high standards set by us and colleagues we are moderately well paid functionaries.
A career that was glorious became boring, Instead of doing what we thought was valuable we spent increasing time fulfilling other peoples requirements.
My medical school which was loved is now part of a huge conglomerate and the most unpopular in the UK. My practice which had 100 applicants for a partnership in 1985 is now lucky to find any applicants. This is true of most practices in Devon. Quelle catastrophe!
Left at 58 1/2 and thoroughly enjoyed 3 years assistantship 1-2 days a week. Retired at 62. Should have gone earlier. Personally I fear the wonderful Partnership model has been wilfully destroyed. What you sow ......
As I come to the end of my medical career stories such as these depress me more than I can possibly say! With a father, brother, brother in law etc in Medicine .... as we sit and review it all ...none of us would choose to work in the NHS any more. My father started at the commencement of the NHS , the rest of us qualifying in the seventies, by and large totally dedicted to the system. Increasingly it is an organisation that works against those who work in it, and have dedicated more than 25 years to it.
Medicine is a wonderful profession, but increasingly one which is very unattractive in this country. The money is fine ( when paid!) but the whole ethos feels it has lost completely the feel of a service. This has been replaced by the ethos of a poorly run business. The worst of all worlds. My son looked at working in medicine but is now following a science career. Time was when I would have been sad to see him missing the joys and thrills of medicine. Not any more. When he told me there was a sense of relief
It's all so mad. All I can suggest is that you retire immediately. I did so a year ago. Now what used to give me migraines makes me laugh and what irritated the sh*t out of me makes me laugh. What these morons say about General Practice makes me laugh ... but what has been done to the firm system in hospitals, what has been done to the relationships between consultants and GPs, what been done to break down a cohesive service where I used to work alongside midwives and health visitors on a weekly basis ... but where I now dont know their names. That makes me weep
As a retired Principal .... just left the ship last April. To tell the truth I suspect the Partnership model is doomed. I am so sorry to say that. Frankly once it is replaced the service certainly in rural areas will be greatly diminished.
I had no idea about Dr Gerada. So sad that we are led by people who have persuaded themselves that there is no conflict of interest in these quasi business models within the NHS. IMHO there is. Indeed in truth there is within the historic partnership model , but here it was tempered by the personel committment of partners to perform to a high standard. The more senior GP s are involved in running these mega practices the less hope I see for the model that I worked in and I feel has served the NHS so well.
It is the same within hospitals where the firm system was abandoned leaving juniors rudderless. It could have been adjusted to give them less hours but kept them within a framework ... but of course not.
Tragic beyond belief. Having been in an old fashioned rural practice the irony is extraordinary. We ran a 24 h MIU an 18 bedded hospital, a midwifery unit with an excellent record and a 50 bedded Geriatric Unit. 5 GP s also covering the on call between us.
Now the 50 bedded hospital has gone, the small cottage hospital due to close this year. The MIU gone. The extra ordinary thing is the remaining troops are not rested , on the contrary they are exhausted, fearful and totally dispirited. Where ee used to get 50 applicants for a partneship they are now happy to have sny..
I left 5 years early finding the job had gone from the best job in the world and turned into one I woulnt touch with a barge pole.
I remember Cary Cooper saying the vital thing was not salary etc but locus of control. When I started we worked extra ordinary hours ( wouldnt recommend that!) ....but we were in charge. Now as a Principal you are just there to put in place someone elses vision. Not empowering!
When we started on call for the local Doc I trued to fill it and do it with local doctors. While that lasted it worked well. As we found ourselves increasingly stretched we all left. I would strongly advise against working in this unsafe system. One complaint can have devastating consequences on your ability to function.
I know this is terrible but I had a Great Grandfather, Grandfather, father, brother and father in law as Doctors. I was extremely relieved when my son turned down the possibilty of going into medicine.
I really find it difficult to think of a way forward for primary care or Primary Emergency Care. The only solution is for 5% to be taken from secondary care and invested in primary care. Must stop I just saw a pig flying past
Seems that retiring at sixty IS a good idea. Yet more screening done "because its there" rather than for logical reasons backed up by firm data.
Can somebody give me an inkling about what Julie Srhive said ... just intrigued!!
As I wander off into retirement ... I am afraid TC you are just going to have to keep working just to humour me !
DEP1 .... I cant bear it!!
I did a lot of work especially in New Zealand in the 1970-80s ... and thoroughly enjoyed it.
Here as I say when i started we ran two small hospitals, took Xrays, developed them, ran a 24h casualty, and were involved in intra partum obstetrics. Now we do almost none of this. Actually before I finished obstetrics I delivered a young woman who seventeen years earlier I had delivered. I may be one of the last GPs to ever do that!! So I like Timothy loved the active general practice that now feels like a distant echo.
Well I am in a similar situation to Dr Harris. I have been in a partnership for nearly thirty years. I still have children of school age and had always intended to work until I was 63-65. This was not because I needed to but because I for many years enjoyed the job so much. On top of this I felt a strong belief in the NHS that I felt it was my duty to work until I was 65 to contribute to Bevan's and Beveridge's great edifice.
As a practice we have always been very busy. We were not part of a OOH group for the first fifteen years of my practice so did all our own on call covering 900 square miles. We ran two hospitals between the five partners. One a fifty bedded Geriatric Hospital and another sixteen bedded acute GP hospital. We also had and ran a 24 hour casualty and our own midwifery unit. We were on call for our own patients deliveries all year round whether or not we were on call. In other words we ran pretty well everything and I LOVED it. Knackering but fulfilling would cover it!
We of course in a great position to start new disease prevention and monitoring clinics and employ more specialist nurses etc etc. For fifteen years we never stopped thinking of ways to try and improve the care of our patients.
Then starting with Ken Clarke's reforms slowly but surely our independance has been whittled away. I estimate that new partners coming in from around 2000 have never thought of an original idea because we have spent the entire last decade putting in place other people's ideas of primary health care. Some good, some bad , some unspeakable, none envisaged by us.
There has been a never ending move towards ""prevention" to the extent that we have have less and less time to deal with patients that are actually ill or dying. These and other ill patients are now looked after by others. Whilst of course some of this is good and inevitable; it to my mind has happened to too great an extent. Our availability to have the time to nurture and care for patients as they go through their crises and illnesses has become less.
To cover the guidelines of people deemed to be at risk a quite staggering percentage of the apparently well are now on an extraordinary concoction of polypharmacy. Often these guidelines which seem to be applied to everyone are extrapolated from specific groups and the outcomes may well not be the same for all those who are being treated. Increasingly in conversation I find GPs saying that they wouldn't take all this medication themselves!!
I am saddened that the GPs, who at their best were among the most innovative of doctors, have become through pressure the workhorse of a centralised medical system that is in danger of treating everyone as if they were the same. Saddened that our wider role of seeing the person with the disease as the centre of our concerns is being relegated behind targets. Doing the job we feel we should do is being relegated behind being seen to do the job others percieve we should do.
An example of this thinking is considering risk factors such as Cholesterol levels and high blood pressure as diseases. We then treat these diseases to a target rather than discussing when mediction is potentially indicated what the benefits and risks of such treatment are. For instance how many people you would need to treat for 10 years to prevent a stroke or heart attack and then encouraging our patients to make an informed decision. This rather than a target based approach would be an intelligent way to proceed.
So I am a little further down the road than Dr Harris. I went part time earlier this year and now have decided to retire next year just before my sixtieth birthday.
It must seem odd to the non doctors that when running two hospitals, a casualty and doing large numbers of out of hours I LOVED this job. Now working 8-6.30 I find it unrewarding for me and I dont believe that patients feel more cared for.
My son is fourteen. If he were to try to become a physician I would be quietly delighted. He has poor sod a father, two uncles, two grandfather, a great grandfather and even a great great grandfather who are physicians! But what would I say to him if he had expressed a wish to become a general practitioner in England. Ten years ago I would have encouraged him now I would not. It no longer strikes me as a job for an independent thinking man or woman. Of course he might choose to disagree!