Having run out of options, I handed the practice over to two doctors under ‘NHS rules’ which meant going into partnership with them for a short period and then resigning from the partnership.

As with all new brooms, changes would inevitably be made but I made it clear that no fundamental changes must occur until after Sue and I retired. In particular, I particularly wanted to retain the old fashioned ‘unbooked’ surgery to which patients who needed attention urgently could turn up before 10 am and we’d guarantee to see them.

I first set this up after ‘Which’ magazine conducted a survey many years ago on access to GPs and found there were divergent views on this. The GPs said that patients who needed urgent attention could always be fitted in whereas a majority of the patients disagreed. They were happy to wait for routine appointments but wanted to be seen urgently when the need arose and, when this didn’t happen, they felt they had to go to A&E. The magazine suggested that GPs should cater for both needs – an old fashioned ‘sit and wait’ surgery for the urgent cases and ‘booked in advance’ appointments for those whose Filofaxes (the forerunner of smart phones) were filled with numerous commitments and for those with chronic diseases (etc)

The problem of urgent same-day appointments remains highly topical – and the ‘sit-and-wait’ system worked well for us and for the patients. We still had the occasional grumble that “I couldn’t be seen for 10 days” (by which they meant “I couldn’t get an appointment with Dr Bloggs at 3.30 on a Thursday afternoon for 10 days”) but we could always answer these with: “Well actually you could have been seen this morning … or yesterday morning … or the day before that.” It also lessened the ‘no show’ numbers which are the bain of every GP’s life – and will remain so until a charge for missed appointments is introduced. The patients liked it because they could be seen quickly about problems which worried them a lot (such as a baby who had cried all night) by somebody with both clinical knowledge and experience of having a baby who cried all night … whereas this is the sort of problem that is difficult to ‘sell’ to a receptionist looking at a full appointments list and faced with getting an earful from the GPs if they are overbooked.

I liked it because old fashioned GPs (like me) still cling on to the belief that you miss a lot when you don’t at least clap eyes on a patient. And you miss more if you don’t examine them … as the old saying goes: “Those who don’t put their finger in it put their foot in it!” Sometimes you just get lucky … I’ve already mentioned the young lad whose mother rang the receptionist asking for a home visit because he seemed unwell and had a temperature – which wouldn’t have been considered urgent had the receptionist not told me: “While I was talking to her I could hear her son crying in the background and it sounded really weird.” This was before routine vaccinations for Hib, pneumococcus, and meningococcus (MenB, MenC, etc.) drastically reduced cases – so it was enough to alert me to the fact that this could well be meningitis – and, sure enough, it was … so, without that receptionist’s acumen, the story would not have had a happy ending!

One glance at the waiting room was enough to determine who should be dragged out and seen urgently and who could wait their turn. Needless to say there was usually a broad spectrum of conditions on show. At one end there were the occasional ‘nastie wastie coldie woldies’ but most genuinely needed to be seen. At the other end of the spectrum there were those who needed immediate attention … like babies with respiratory syncytial virus (aka RSV – given there wasn’t a vaccination available in the UK until recently), kids with severe asthma attacks and the occasional bloke with a heart attack who would rather sit and wait than “bother the doctor”.

We also offered ’email consultations’ (incl photos where necessary) which were appreciated by those who left home early to get to work in e.g. London and didn’t get home until late.

The patients were first seen by a nurse (we usually had two running the ‘unbooked’). Our wonderful team of nurses all had extensive hospital and general practice experience which meant they developed ‘clinical antennae’ – so they unfailingly sensed when a problem was serious enough to merit further input from a doctor. How different from the early ‘experimental’ reliance on ‘physician associates’ to make the workload manageable. By the way, I also had considerable experience of what we laughingly called “Knob diagnoses”. These involve unsatisfactory consultations in which you feel you are missing something until the patient gets up to leave, reaches for the doorknob and then says: “Oh, by the way, while I’m here …” or similar … at which point you start all over again with the real problem.

I digress. Sometimes we only had a dozen patients in the ‘unbooked’ … but it was unpredictable. There were times when it was ‘standing room only’. On these occasions, some patients would turn up, take one look at the seething mass of humanity spilling out of the waiting room, and decide that their need wasn’t quite as urgent as they’d first thought

We were encouraged to keep the ‘unbooked’ going by the reports of other systems that didn’t work as well. Chief amongst these was the (so called) ‘Advanced booking system’ where everyone had to ring at 8am. We’d had personal experience of these as my wife, Sue, was registered at a big practice in another village (as we weren’t supposed to be patients at our own practices). To get an appointment we had to use the method employed by the old ticket touts for major sporting fixtures. We had a bank of phones (mobiles and a land line) on ‘speed dial’ and at one minute before 8am we’d start repeatedly ringing the practice … and repeatedly getting the engaged tone. (There didn’t seem to be a queuing system) If it got to 8.40 before you got through there were times when you were told that all the appointments had gone. Quite how little old ladies who just had a landline got on, we never discovered … especially given that, at that time, there was no technology enabling a ‘callback’ facility.

That said, the ‘unbooked surgery’ was on borrowed time. It wouldn’t have survived the Covid pandemic, of course, as it would have been a hotbed of infection. But we managed to keep it going until, at long last, the big day came when Sue and I finally retired. There were fond farewells, generous gifts and sack-loads of cards. Being a hoarder I kept them all and Sue and I re-read them recently and were touched by the accounts from patients we’d known for 30 or 40 years, some of whom were very grateful for the help we’d given to departed loved ones and many of whom recounted incidents which meant a lot to them. Some even said they’d been with me since my time with Dr Ingold whom I later mentioned affectionately in my speech at the farewell do … for which we were starting to make arrangements – but more of that

Dr John Cormack