We’d had the public meeting at which representative GPs from each practice were quizzed by the public about the new medical centre.
The decision makers (who were needed to answer the majority of the questions) were nowhere to be seen. One example – I’ve mentioned that Patients in SWF were promised that transport would be provided in order to cater for those who were potentially disadvantaged by the closure of ALL healthcare facilities within the town – a plan the residents weren’t at all happy about. We were in the dark about this.
The meeting raised more questions than we had answers for so an online list of promised services was issued by ‘the powers that be. Here’s an example of what was said in answer to a list of ‘frequently asked questions’…
Q: “Will all current medical services on offer by the three current surgeries be offered at the new surgery?
A: “Yes, services will remain the same. Opportunities for improvements through closer cooperation and through other medical and community services also being based in the building should arise, however.“
What’s more: “Services currently based in the SWF Clinic have all been invited to move to Crouch Vale Medical Centre as noted in the answer to question 23 to offer more joined-up care for local patients.” This appears to have been somewhat of an exaggeration. Minor surgery, seemingly, is an example. This used to be readily available in the town but is no longer. Similarly, cryotherapy seems to have disappeared and, rather worryingly, beauticians have filled the vacuum and are now offering to remove pigmented lesions. Let’s hope they can distinguish between seborrheic keratoses and melanomas!
The SWFH & SCG also issued a list of services to be based at Crouch Vale Medical Centre – https://swfhealthsocial.co.uk/2019/11/01/gp-surgeries-and-other-nhs-at-crouch-vale-medical-centre-from-11-nov/
I’ve mentioned that the local NHS managers wanted to keep a tight control on any publicity – but at the same time they were keen to give the impression that the local GPs were the movers and shakers. This gave rise to an amusing press release which was presumably put out by a junior member of staff at NHS headquarters who didn’t have much idea about local geography and, when writing an article which was supposed to appear to emanate from the local GPs, had confused SWF with Kelvedon. Accordingly, I sent a ‘tongue in cheek’ letter to the doctors at the Kelvedon & Feering Health Centre thanking them for their interest in the plans for healthcare in SWF.
One theme that I’ve flogged to death throughout this saga has been the incompetence of local management and the consequential harm done to both clinicians and patients. From talking to those in other walks of life I’ve been reassured that management issues are common. The difference is that, if, for example, you work for a company that makes Whoopee cushions, poor management is irritating and counterproductive … but a few less Whoopee cushions (or an unacceptable percentage that don’t make a sufficiently farty sound when Granny sits on them) is not the end of the world. In the NHS, however, patients’ lives and health are at stake – and those who are not up to the job or who find it amusing to play games that put patients at risk can do great harm. Competent managers can do great good – whereas poor managers can make Harold Shipman look like a rank amateur.
The consequences of poor management are not only seen in General Practice, however. ‘I am fond of quoting consultant psychiatrist ‘Theodore Dalrymple’ who retired at the earliest opportunity, as did his wife (also a consultant), because they were treated so shabbily. As for the woes of junior hospital doctors, Adam Kay chronicles these brilliantly in his best-seller, ‘This Is Going to Hurt’. If there is anyone in the country who still hasn’t read it, do so immediately – it’s available from all good bookshops – and most bad ones too.
I had toyed with the idea of a ‘hospital career’. I qualified as a dentist initially at ‘The London Hospital’ and was lucky enough to get the professorial house job. This was against the odds as two of the four maxillo-facial surgeons were Catholics and, not knowing this, I’d answered the question on the application form “Which job(s) would you not accept were it/they to be offered to you” by writing ‘Pope’. Then at Cambridge I got the opportunity to work for Prof Roy Calne, the pioneering transplant surgeon … not because of academic merit but because – in a previous role (at the ‘geriatric’ unit) – I’d looked after his father. He’d had a stroke and the family were concerned that, despite making a good recovery, he’d subsequently changed personality – going from ‘the life and soul of the party’ to being somewhat sullen and uncommunicative. I changed the batteries in his hearing aids and he immediately perked up and started chatting animatedly to all and sundry. That was enough to endear me to the esteemed Professor.
With that background I was poised for a career in maxillo-facial surgery but was put off by the stress of the ‘see one, do one, teach one’ ethos that existed in hospitals at that time and the poor way that junior doctors were treated (as described so elegantly by the aforementioned Adam Kay). I remember being up all night to ‘pump’ blood into a patient who was bleeding like a stuck pig intra-abdominally after a cholecystectomy. This involved putting in a central venous line – something I’d never done before. The reason was that the on-call registrar, who should have opened himup and dealt with the source of the bleeding, was at a dinner and didn’t want to be disturbed.
We were expected to work 100+ hours a week for a pittance (this was before the EU’s Working Time Directive) and there was zero ‘pastoral care’.
The other problem with working as a surgeon is that you tend to have fleeting contact with patients – whereas the joy of general practice is that the tendency is to develop a relationship that lasts for years. So, all in all, I was very glad that I’d chosen general practices as a career – but now it was getting close to the time I’d have to hang up my stethoscope. I’d been putting it off for years and had written about my misgivings but Anno Domini had taken its toll … and I needed to spend more time with the grandchildren.
Dr John Cormack