Stage 1 of a GP career: we start our VTS and watch how our trainers flit from ears to rash to gynae and back again without batting an eyelid, and hope that one day we can too.
Stage 2: we learn the RCGP curriculum by heart and carry out our consultations using the patented ‘McTilt’ (head to one side, concerned look on face, while asking about the patients’ ideas, concerns and expectations without a hint of irony). We focus on getting through the exam.
Stage 3: the guideline stage. We are out there on our own, and guidelines are like having a complete medical encyclopedia at our fingertips. We can’t understand why everyone isn’t following them and religiously reference the relevant guideline in our notes: ‘Diagnosis – viral URTI. Manage patient as per NICE CG69 with directions to appropriate self-help resources via NHS Choices website and advice on over the counter remedies.’
Stage 4: enlightenment. Suddenly a patient doesn’t fit in the guideline box – or refuses to. We realise the world doesn’t end if we go off-guideline and the GMC won’t come knocking on the door. Even better, the patient seems better off for not doing something that comes with level 1a evidence. This is a revelation. We begin to see the light and cross off medications left, right and centre.
Many of us stick at Stage 4, but what we should all be aspiring to is Stage 5: the Real Life GP. I met a prime example this week and he left me feeling rather like I should have called him Sir. It wasn’t a department of health or NHS England bigwig. It wasn’t an esteemed member of the BMA great and good. It was a GP in Hull.
I was so impressed that I asked if I could stick him in my next column; so here you go Dr Gabriel Hendow – your name in print. Among all the hardworking staff from Hull (we are the City of Culture don’t you know!), Dr Hendow stood out. Not because he’s been a GP for 45 years, while I’m already struggling after 10. Not because he takes great pride in having objected to the many ridiculous schemes that have come the way of general practice during that time. But because he is the epitome of a Real Life GP.
He runs his singlehanded practice, in the face of the move to merging and working ‘at scale’. His patients love him, so do his colleagues. What’s more, he is one of the only singlehanded GPs in the UK to be rated ‘outstanding’ by the CQC. You can argue inspection is a pointless tick-box exercise and it means nothing, but judging from the twinkle in Dr Hendow’s eye, he views the rating like I do. It’s a middle finger up to the mess being made of general practice, and especially to the singlehander-hating CQC. It’s a point scored for all those GPs just trying to do their job, and a big fat zero for those who sit interfering in their ivory towers.
So, Dr Hendow, I salute you for what you represent; for being the resilient, Stage 5 GP that I aspire to be some day. Until then, I will continue to upset the apple cart in my own little way, while thinking of you and your outstanding practice.
Dr Zoe Norris is a GP in Hull