Younger GPs don’t know how good we used to have it

Dr David Turner turns the clock back 25 years to see what younger GPs are missing out on

Being a GP is a lonely job most of the time. Yes, we have patients coming in every ten minutes or so, but in between that, most of us spend the time alone in our consulting rooms.

Conferences are one of the few opportunities we get to meet and chat with colleagues of all ages from different parts of the country. At last month’s LMC conference, discussion on the ‘future of general practice’ was (unsurprisingly) rife. How will we survive the relentless demands from patients and secondary care with increasing costs/ever squeezed funding/shoddy premises etc.

But I also found it an interesting opportunity to reflect on the past and compare the work and problems that general practice faces today to what being a GP was like 25 years ago.

Many younger GPs do not realise that family doctors used to be on call for their own patients 24/7. That the GP co-operatives, when set up by neighbouring practices, did alleviate some of this on call burden but a cost. We had to pay money out of our own pockets to run the co-ops and in addition work in them for free to keep them viable. A quarter of a century ago, doing home visits for women who had had normal births was routine, as was visiting the recently bereaved.

In my first practice, most GPs would do three or four visits each every day. That was on top of regular ward rounds to nursing homes, all squeezed into the middle of the working day. We opened every Saturday morning and even when co-operatives existed, we took our own calls from 7pm and would often end up doing a home visit or two on the way into work in the morning.

Most of us still used paper notes, so the back seats of our cars were often strewn with Lloyd George files as we did home visits and took patient records home to dictate referral letters. The concept of ‘phone consultations’ did not exist. I think we GPs rarely phoned patients, unless it was about an urgent blood test result.

With no QOF, CQC, or annual appraisal to worry about though, we did seem to have more time to meet with colleagues over coffee, lunch or at post-grad centre meetings with our secondary care colleagues. We knew many consultants by first name and would dictate referral letters to them personally – and usually receive personal responses. This is something our younger colleagues may find hard to believe, but I cannot recall a single referral being rejected in the first two decades of my career. Nor do I remember any job lists for us to do at the end of hospital letters.

Look, I’m not wearing rose tinted glasses. I’m not suggesting that things in the past were better than they are now. Indeed, many changes have improved the lives of GPs over the last 25 years. But equally, there are lessons and experiences we can take from the past to try and improve our current situation.

You want my take on it? Less admin, less bureaucracy, less micromanagement, and more time spent face to face with our patients/fellow GPs/secondary care colleagues might improve our lot.

Dr David Turner is a GP in Hertfordshire