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Gold, incentives and meh

I can’t be the fall guy any more

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I have in front of me a letter from the A&E department. This is what it says:

‘This 15-year-old lad was playing football on Saturday, and lost his ball up a tree. He climbed the tree to recover it, but fell out from about eight feet and landed on his back. He did this four times. On the final occasion he fractured his clavicle.’

These letters give me the material for these articles. Human stories. The utter absurdity of the behaviour of homo sapiens. The basic material for 500-odd magazine columns, since I first started writing them 20 years ago.

The fascinating thing is the ambiguity. The obvious conclusion is that we are dealing with an utter moron, the type of dude Darwin predicted would be weeded out of the gene pool. But there is another interpretation worthy of serious contemplation.

Perhaps we are witnessing one aspect of the indomitable human spirit. The triumph of hope over experience. He kept climbing and he kept falling. It’s almost heroic. By definition, we only see the failures. Who knows how many teenagers keep climbing and get their ball back at the fifth or sixth attempt? There are probably many.

As I read the letter, I’m laughing and crying in equal measure. Because I now know this experience is nearly over for me. Because I can’t go on.

This article may be unique in the annals of Pulse because a decent proportion of it was written in a hospital bed, with 15 electrodes attached to my body and an IV drip limiting the use of my right arm.

The oxygen mask was hampering my vision and the pulse oximeter had to be transferred to a pinky, because I don’t type with those. But hey, a deadline is a deadline.

The fact that I was back in rapid AF and heart failure within an hour of getting back to work after a short holiday is not, I think, coincidental. The escalating workload, the tumbling income, the futility of trying to keep up with demand, the frustration of being the last port of call for so many problems that really are nothing to do with us; the sheer lack of time to practise medicine as it should be practised. It is insupportable that we are dumped on, taken for granted and held responsible for the failings of others. Above all, the total absence of interest in the vacancies at my practice makes the future as a GP partner unbearable to me.

My love affair with my profession is over. I hate this bloody job. I can’t stand going into work any more. It makes me depressed, unhappy and, latterly, literally sick.

I believe there is some currency in the Government’s ‘5,000 GPs’ idea, but I think they’ve got it the wrong way round. I predict 5,000 fewer GPs over the next five years, as people like me reach the end of their tether. I know of literally no one around my own age who is not thoroughly disillusioned. None of us will still be practising at retirement age. And there is no way we can be replaced, let alone the overall numbers of GPs be increased.

I have climbed my tree and fallen out too many times now. If I was stupid, I would get back up and start climbing again. But I realise that next time, I’m going to fall out and break something. In fact, I may already have done so.

Dr Phil Peverley is a GP in Sunderland.

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Readers' comments (156)

  • what an absolute f........ disgrace that we have allowed this noble profession to sink to such a level.
    its time to make some changes guys.
    Dont just agree at those meetings to eveything they say . Stand up and say something that will shake things up. We need to get together now and make some signif changes . we are capabale of this we just need t grow some.
    We were amonst the elite of the educational output of this country and we are being regularly shafted by a system that quite frankly does not care.
    Get well soon Dr Peverley. I am so sad that you and we are in this. Take care. 49 yo partner. In it for the longterm.

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  • bloody hell get out while you still can sell up and move to spain and chill out I say

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  • Vinci Ho

    Phil
    Please get well.
    End of the day , your own family is the most important. Life is only short...,,,,

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  • Phil, I have been reading and enjoying your articles and blogs since about the time you started them 20 years ago. Get well soon mate. Then get out. No-one will give you any medals for struggling on, not the NHS, not your patients, nobody. Make sure you live long enough to get your pension back and enjoy it. I manage a practice in a lovely genteel suburb of a lovely town in one of England's prettiest and most popular regions yet we can't get a single application from a GP after many months of advertising. The Titanic has been holed below the waterline and is going down, it is beyond saving, make sure you have swum away before it sucks you down with it.

    All the best Phil and thank you for the smiles and enjoyment your writing has given me over the last 2 decades.

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  • Una Coales. Retired NHS GP.

    Phil get well soon. Um and why is Pulse making you write to deadlines from a hospital bed? Surely we can have locum blog writers to fill in while you recuperate in hospital? When can you retire Phil? It has become a life-threatening profession. Get out now!

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  • Get out and get well soon, Phil! Best wishes for your future health and happiness.

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  • Understand completely - watch the trailer for Mad Max. It seems relaxed and sane compared with a day in primary care .

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  • " Wanna get through this.......Go ! "

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  • I love reading what you write. Please take care, your family need you

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  • You're a legend Phil

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  • There is alot of cynicism in your piece. May i suggest you join one of Dr Martin Brunet's Balint Groups.He is a VTS tutor in Guildford and writes some magnificant awe inspiring blogs on Pulse.

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  • You need to do the following,
    1] Retire on health grounds
    2] Have as much time doing nothing or whatever takes your fancy as you need
    3] And then if you can, continue to write your blog from the other side of the fence.
    Continuing to write from the other side of the fence would help others who need to make the break realise that life is wonderful without the NHS.

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  • OMG,
    I've just read your April blog.
    You need help with all of that.
    Keep letting us know what happens and especially what your CCG is doing to help.

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  • Flippinora Pev, foot-off-the-gas time. I do not want to read all the teary comments after your obit anytime soon, thanks. Yours is *just another* collapsing practice and it's time to stop. Time to look after you and your family, right now. Time for some staring into the middle distance watching the wind in the trees whilst listening to Bach, or something. Time for a trip to see Roseberry Topping, even if you park at the bottom and look up. Get well soon.

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  • I wish you all the best, and hope you have a speedy recovery. I have loved reading your blog over many years, and agree that this job has become unsustainable, overwhelming and harmful to our own health and well being. Please come back to Pulse and entertain us some more when you are well again.

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  • Best wishes Phil. As Practice Manager, your wit and insight has helped keep me sane. I've been in the job for five years now, and plan to get out asap. Get well soon, and then jump ship. The best thing we can all do is vote with our feet, and if they then put their money and their actions where their broken promises have been, maybe, just maybe, we'll think about it.

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  • Neil Bhatia

    Gel well soon Phil

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  • Neil Bhatia

    *get

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  • If you go back to work I'm coming up home to kick you up the A*rse mate. You've done more than enough, go now while you still can and your missus and kids get some quality time with you; this profession, leaders and government would happily see us all in an early grave. Don't give the b*uggers the satisfaction.

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  • Phil,please leave on health grounds ,without returning to the practice if possible,as it is time to consider your own health with at least the same level of attention you would give to your patients. The work of a GP is what you do,not who you are. Please don't be tempted to feel that you must keep going on. This sounds awfully like one of life's crossroads to me. I had a health problem after 25 years as a GP so retired 5 years ago. We can't afford to go on a world cruise, but I have walked 5 miles with my dog today and the bluebells are still out. Please - just for perhaps the first time- put your own health needs ( not wants,but needs) first. Good luck,and thank you for your column for all the years.

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  • You need to get over your disillusionment and soldier on.Your patients need you more than your family.For many of them you would have been their sole mentor,counsellor and friend through the years.The NHS pension will provide for your family but who will look after your patients.Remember why you became a doctor,to help mankind.Stress comes with the job but we're financially well compensated for that.You have no reason to complain.So chin up and march back to your surgery

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  • Phil - you can see how much people love you - it is just bonkers to think they cannot do without you though! What is going on that a person cannot be left to recuperate without being hounded with work?! Work is not the be all but it may be the end all of life -if you persist in playing the hero. Did you not realise how crazy it was to post right now? OK - get this...people love you enough to let you go..

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  • Phil - do as I did - get OUT NOW . Leave before it's too late for you and your family . I just left after 20 years and life on the other side is wonderful . I nearly lost everything in my life and only just got out in time . Please do the same .

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  • Russell Thorpe

    So many memorable articles. I await the novel lets face it the profession really needs a James Herriot!
    One of my favourites the old war hero not content with the effects of his antihypertensives and you quietly slowly, deliberately pushed the pile of pill boxes off your desk &...... into the bin.

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  • Phil, I would miss reading your articles very much but it sounds like -unfortunately - you have come to dislike your job- driven by all the politically driven changes that have changed our profession /vocation into a something very different from what it used to be.....so maybe getting out would be the best way forward or doing something different - maybe write a book ? Best wishes for a speedy recovery

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  • I've laughed out loud so many times on reading your articles, Phil. Get well soon and please look after yourself. Thank you.

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  • What more can be said other than get better soon and I hope what happens work wise is what is best for you.

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  • Phil mate, quit while your ahead
    Becoming a martyr for the NHS won't get you 72 virgins

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  • " You lucky,lucky bastard!" All joking aside- thanks Phil for all the laughs, wishing you all the best for the future.

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  • Phil, I've never doubted your dedication to your hilarious column, but really this time you've gone too far. Flat on your back, wired to a heart monitor, breathless and exhausted, with a fair chance of more bad news to come. This is all just some giant metaphor for the state of the profession, isn't it? Clearly there are no depths you won't plumb.

    Seriously though, I want to thank you. In my 8 years since qualifying you have been a voice of sanity, of hope, and of reassurance that in silently shaking my head at the absurdity of it all a dozen times a day I am not alone. You were in my ear when the statin denouncer came in waiving the Daily Wail, or the snotty child was dragged along for the umpteenth time by a mother unable to comprehend what "self limiting" meant.

    And now, my friend, it's time to hang up the guessing tubes and put your feet up. Nothing is worth the stroke you lumber manfully towards. Chuck it in, smile sweetly as you toss the resignation grenade, and jet off for some sangria, safe in the knowledge that the system has failed you, not the other way around. It needs to be someone else's problem now, Phil.

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  • Una Coales. Retired NHS GP.

    WHY our dearest Pev can't just quit... From his April blog 'Meanwhile, in the real world, my own practice is fragmenting at a rate I wouldn’t have thought possible only two years ago. Several departures have left me as the last partner standing in a practice that has two full-time equivalents, but needs five. Personally, I am drifting in and out of atrial fibrillation, and recently learned the true meaning of ‘panic attack’. It’s not nice.

    I’m supposed to buy my partners out of their share of a £1m building and then become personally liable for the redundancy packages of 15 employees, should it come to that. An advert in the BMJ produced precisely no applicants for the partnership post; after all, who would voluntarily take this shit on?'

    He is caught between a financial rock and hard place. Let's say there were 4 partners originally (list size 8,000) who own £250k each of a £1m bldg. They have left the surgery one by one and the partnership contract gets rewritten each time. Which means Pev has had to pay them £250k each out of his own pocket as they leave or £750k in hopes that he can recoup the money when he sells off the commercial building, that is if anyone wants to buy a nhs gp surgery.

    As he is the last partner standing, If he quits and hands back the NHS GP contract to NHS England, he has to pay 15 employee redundancy packages or say £150,000-£300,000 out of his personal savings. He is financially screwed.

    This is what it means to be a NHS GP partner delivering an unworkable NHS contract and not allowed to be a limited liability company like private companies can who are now delivering many NHS services. I blame the BMA trade union and LMC who charge each practice a levy to negotiate for them. No fair deal!

    This NHS GP contract is set to drive many a GP partner in their late 40s (not the older lot with a gold plated up to £1.8 million pension cap protected for 10 years from 2012 or the wealthy managing director GPs buying up 25-60 surgeries) to an early grave or financial destitution, especially if they are the last GP left in the surgery to pay off staff redundancies and debt liabilities.

    I wish I had an easy answer for Pev's predicament. He faces financial destitution and life if he quits or working to an early grave if he remains.

    And our BMA refused to allow my emergency ballot on action! Mass undated resignation from a financially crippling and unworkable GP contract that is literally killing our GP partners! Shame on the BMA leadership!

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  • You need to quit now not only for your own sake but also for your patients.

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  • Indeed, it's clearly time to put your own needs before those of you patients; like most GPs you' ve clearly done far more than your 'bit' for them over the years as the job has become increasingly difficult not helped by a full-on political assault upon the welfare state and our own once proud profession's role within it. So go easy Phil in the knowledge that you've made a real difference to the lives of thousands of your patients and very many of your peers. Take care.

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  • Una Coales. Retired NHS GP.

    Pulse editor and Pev, clearly what is holding Pev back is the enormous financial liability he faces when he hands the surgery back to NHS England.

    Can we not help him? Can Pulse or a close friend of Pev or even the Sunderland LMC set up a Just Giving donatiom page so that we may all donate what we can to help cover his staff redundancies and any remaining practice debts? The BMA and LMC must have a charity pot for members in dire financial situations?

    This is what Pev needs right now to then be able to walk. Remember we GPs practice holistic medicine. The root cause of his panic attacks, atrial fib and heart failure is stress over his practice financial debts and his personal liabilities if he takes out advice and hands back the surgery.

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  • you cannot go back full time.full stop.very soon you will make up your own mind what to do,and i know what that will be.

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  • I feel only GPs themselves understand our job and whilst everybody around us pays lip-service to the idea that we are tested to destruction they cannot embrace the idea of actually being in our situation. I salute you as a kindred spirit and fear for others who call themselves a GP.

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  • My heart goes out to you, and is really hope you find a sensible way out soon. Ultimately the situation may well not be as bad as Una says. I doubt that the redundancy payments would be as high as she says...... Effectively about a year's pay for each member of staff sound excessive to me, assuming that they have not all been employed full time for 30 years. You would also be unlikely to have to find all the money to buy out your ex partners' entire shares as there is likely to be a partnership mortgage in place which can be taken over until the property is sold ( either to a new provider or on the open market). There will be some capital which can be used.
    However, the situation is terrible and others should not belittle the incredible commitment and risk that partners make.
    A Facebook page is a nice idea, and I would contribute. However, we just don't know how many partners are in this position and might need our help. Do the GMC know? If not, why not? Are they actually asking practices and partners if they are in trouble? Do the BBC know? Would Phil be prepared to talk to the press and explain what is happening?
    Above all, why in God's name would anyone take on a partnership? Sadly this can only get worse and anyone currently holding the risk could get burnt. I don't see why Una thinks this does not include those in their 50s and 60s who want to retire.
    Good luck Phil.

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  • To anonymous at 29 May 7.35pm....
    "your patients need you more than your family"
    "the NHS pension will provide for your family"
    Yeah, that's right, soldier on, die early, doesn't matter does it???....as you pension will give your bereaved a pot of money!!!! You're a f**king disgrace.

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  • This comment has been moderated

  • Thought this was another spoof to start with - then the horror struck....any post which puts income over Phil's health as Una initially did just misses the point. And it is unlikely that his problems would be served by charitable giving.

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  • Around us NHSE takes over the practice and TUPEs the staff, so redundancy costs may be avoidable.

    You cant pay people unrealistic valuations for a surgery which is worth far less than most partners think it is. I hope the practice contract was not rewritten each time with fairy dust valuations in it.

    I got out at the start of April. I think I avoided a similar situation by the skin of my teeth. I akready new it was get out our die soon. The stress was terrible, I had panic attacks, nightmares, waking in the middle of the night wrrying about the practice and now it is lifted.

    I still wake up with nightmares about being unable to admit patients due to bed shortages but at least that is not real and in my life now.

    The public, our "leaders", the politicians seem to have no idea (or they don't care) about how being a GP now damages, and destroys your relationships, your social life, your will to live and your soul.

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  • I've found that it isn't usually the outside forces that cause the physical and mental harm, it's how we react to those influences. A full course of CBT might be a great help and comfort. It really does help if you engage fully.

    Get well soon and look after yourself, Phil, and thanks for your brilliant articles over the years.

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  • I am so very sorry for you Phil and for all the amazing GPs that do a job most wouldn't. I am grateful every day of my life for the amazing doctors I have met and been treated by. I can't believe what has happened to you all because I met so many idealistic and lovely people and I owe them my life. (I have severe asthma and I have been ventilated 10 times - I read this journal because I've seen all you talk about but from the other side and I need an outlet like this too!) I thank you and wish I could help make the world a better place.for you all. You should look after yourselves because it sounds like nobody else well. Thank you

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  • Farah Jameel

    I am sorry to see a fellow colleague in this way and feel awful for how the profession has left you feeling.

    Look after yourself, a big hug and lots of good wishes.

    Get well soon.

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  • Hussain Gandhi

    Pev as many comments state look after yourself.
    Most important thing in life is you and yours. Everything else is just gravy.
    To anonymous 29.5 7.35pm- your comments are disgraceful and offensive. You clearly do not have the courage or responsibility to comment as yourself and hide behind anonymity as a troll. I am assuming your belief is that GPs should not simply work for the health of our patients but give so much as to risk our own sanity, health and possibly lives in the process?

    Your comments are both insensitive and offensive and I call on the moderators to be responsible and act appropriately.

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  • Deepest sympathy - get well soon - you've served your time (I've been enjoying your column for a very long time!).
    Like others, I can only deplore the effects successive governments have had on general practice and GPs.
    In 1990 there was an outcry when Kenneth Clarke forced GPs to retire at 70: what has been done to general practice since to make even 60 a late retirement age for GPs?

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  • Vinci Ho

    Phil, sincerely dedicate this song to you
    "Let It Be"

    When I find myself in times of trouble
    Mother Mary comes to me
    Speaking words of wisdom, let it be
    And in my hour of darkness
    She is standing right in front of me
    Speaking words of wisdom, let it be

    Let it be, let it be
    Let it be, let it be
    Whisper words of wisdom, let it be

    And when the broken-hearted people
    Living in the world agree
    There will be an answer, let it be
    For though they may be parted
    There is still a chance that they will see
    There will be an answer, let it be

    Let it be, let it be
    Let it be, let it be
    Yeah, there will be an answer, let it be
    Let it be, let it be
    Let it be, let it be
    Whisper words of wisdom, let it be

    Let it be, let it be
    Ah, let it be, yeah, let it be
    Whisper words of wisdom, let it be

    And when the night is cloudy
    There is still a light that shines on me
    Shine on until tomorrow, let it be
    I wake up to the sound of music,
    Mother Mary comes to me
    Speaking words of wisdom, let it be

    Let it be, let it be
    Let it be, yeah, let it be
    Oh, there will be an answer, let it be
    Let it be, let it be
    Let it be, yeah, let it be
    Whisper words of wisdom, let it be

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  • Vinci Ho

    I was going through a really difficult time around the autumn of 1968. It was late in the Beatles’ career and we had begun making a new album, a follow-up to the “White Album.” As a group we were starting to have problems. I think I was sensing the Beatles were breaking up, so I was staying up late at night, drinking, doing drugs, clubbing, the way a lot of people were at the time. I was really living and playing hard.

    The other guys were all living out in the country with their partners, but I was still a bachelor in London with my own house in St. John’s Wood. And that was kind of at the back of my mind also, that maybe it was about time I found someone, because it was before I got together with Linda.

    So, I was exhausted! Some nights I’d go to bed and my head would just flop on the pillow; and when I’d wake up I’d have difficulty pulling it off, thinking, “Good job I woke up just then or I might have suffocated.”

    Then one night, somewhere between deep sleep and insomnia, I had the most comforting dream about my mother, who died when I was only 14. She had been a nurse, my mum, and very hardworking, because she wanted the best for us. We weren’t a well-off family- we didn’t have a car, we just about had a television – so both of my parents went out to work, and Mum contributed a good half to the family income. At night when she came home, she would cook, so we didn’t have a lot of time with each other. But she was just a very comforting presence in my life. And when she died, one of the difficulties I had, as the years went by, was that I couldn’t recall her face so easily. That’s how it is for everyone, I think. As each day goes by, you just can’t bring their face into your mind, you have to use photographs and reminders like that.

    So in this dream twelve years later, my mother appeared, and there was her face, completely clear, particularly her eyes, and she said to me very gently, very reassuringly: “Let it be.”

    It was lovely. I woke up with a great feeling. It was really like she had visited me at this very difficult point in my life and gave me this message: Be gentle, don’t fight things, just try and go with the flow and it will all work out.

    So, being a musician, I went right over to the piano and started writing a song: “When I find myself in times of trouble, Mother Mary comes to me”… Mary was my mother’s name… “Speaking words of wisdom, let it be.” There will be an answer, let it be.” It didn’t take long. I wrote the main body of it in one go, and then the subsequent verses developed from there: “When all the broken-hearted people living in the world agree, there will be an answer, let it be.”

    I thought it was special, so I played it to the guys and ’round a lot of people, and later it also became the title of the album, because it had so much value to me, and because it just seemed definitive, those three little syllables. Plus, when something happens like that, as if by magic, I think it has a resonance that other people notice too.

    Not very long after the dream, I got together with Linda, which was the saving of me. And it was as if my mum had sent her, you could say.

    The song is also one of the first things Linda and I ever did together musically. We went over to Abbey Road Studios one day, where the recording sessions were in place. I lived nearby and often used to just drop in when I knew an engineer would be there and do little bits on my own. And I just thought, “Oh it would be good to try harmony in mind, and although Linda wasn’t a professional singer, I’d heard her sing around the house, and knew she could hold a note and sing that high.

    So she tried it, and it worked and it stayed on the record. You can hear it to this day.

    These days, the song has become almost like a hymn. We sang it at Linda’s memorial service. And after September 11 the radio played it a lot, which made it the obvious choice for me to sing when I did the benefit concert in New York City. Even before September 11th, people used to lean out of cars and trucks and say, “Yo, Paul, let it be.”

    So those words are really very special to me, because not only did my mum come to me in a dream and reassure me with them at a very difficult time in my life – and sure enough, things did get better after that – but also, in putting them into a song, and recording it with the Beatles, it became a comforting, healing statement for other people too.

    – Paul McCartney

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  • T Roscoe

    Time to go Phil, you know you have to.. Make it NHSE's problem and get your pension fully paid up as you are retiring through ill health.

    Tref

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  • Legend

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  • Hope you are soon feeling better Phil but don't forget - many of our patients are feeling exactly the same.

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