We made rapid progress with the preparations for the farewell party. The village hall seemed to be the best venue and it was also appropriate in that it was where the ‘standing room only’ meetings to discuss the fact that Essex County Council hadn’t made any plans for health care facilities in the new town were held when I first arrived in SWF.

It repeatedly denied any responsibility. In similar situations elsewhere, the County Council is generally considered responsible for ensuring adequate healthcare infrastructure is planned and delivered, typically in collaboration with health service partners. While the NHS is responsible for commissioning services, the Local Authority IS responsible for ensuring the development is sustainable and meets the health needs of the new community. Following these meetings a group (Medac) was set up to put pressure on the powers that be to provide a health clinic.

When the day of the party arrived there was tea and cakes and jam (and slices of delicious ham) plus the very best that Phoebe’s Pantry could offer. Nurse Katrina made us a wonderfully decorated cake. When our patients started arriving, we decided we would greet them all at the door because otherwise some would get lost in the mêlée and we wouldn’t have a chance talk to them. There was an amazing turnout – which meant that the downside of this plan was that a huge queue built up so we had to get a move on.

As ever there were lots of photographs. A patient gave a short speech on setting up a survey to persuade the local NHS to keep the Health Clinic in the town centre rather than closing all health facilities down overnight. Sue made a short speech (an excerpt from which was recorded) giving a synopsis of our ‘history’ … meeting on a geriatric ward when she was a student nurse in Cambridge and I was a junior hospital doctor. She assisted when I was putting up a drip on a stroke patient – and we’ve been together ever since. She left out the bit about her being a terrific nurse and morphing into a wonderful Mum and a much loved grandmother. This, then, was her goodbye to our patients – retiring to be able to spend more time with her family. I followed on with a short speech peppered with bad jokes (to which my patients had, fortunately, become immune over the years.)

There were lots of memories shared and lots of hugs … and, thankfully, no tears.

+++

Looking back over the years at the good and bad and what could have been done better was an interesting exercise. My last years in practice were definitely the best. We had known most of our patients for decades and many had become friends.

Despite the near impossible circumstances under which we were made to work, the atmosphere in the practice was very good, Our patients shared a version of ‘the spirit of the Blitz – the feeling that we were all on the same side – which made the clinicians’ working life a pleasure. The NHS really only works when everyone is pulling together and there is a feeling of mutual trust.

As for my ‘disagreements’ with local NHS management, as I’ve mentioned before, GPs with common sense keep their heads down and don’t criticise. That’s all verywell when things are going smoothly but when people do unconscionable things like knowingly mislead patients or intentionally put them in harm’s way, I think you have to stand up and be counted. It’s well known that being a whistleblower in the NHS results in a great deal of angst for whoever dares point out the failures – and taking a manager to court is professional suicide – but the problem with keeping shtum is that the failures continue and patients are harmed.

The NHS is not unique in the way it tries to cover up ill deeds, mistakes and incompetence. Anyone who has watched ‘Mr Bates and the Post Office’ and/or Dirty Business will know how organisations with a similar ethos work. When viewing these programmes I wondered why the victims didn’t record more examples because those in charge tend to obfuscate, sweep problems under the carpet, and lie and lie and lie. In the Post Office scandal, for example, postmasters were seen talking on the phone to an ineffectual helpline (at night when the post office was closed) whilst at the same time the screen was showing rapidly increasing debts for which there was no explanation. Why these people didn’t put the phone on loud speaker whilst a video recorder was recording what was showing on the screen and the phone conversation was being laid down on the soundtrack was a mystery to me. Without evidence there was no way they could effectively defend themselves.

In the NHS recording was accepted practice. Some time ago I was sent a very short audio recording that sounded as if it had been made by Thomas Edison on his prototype recording device on an off day. In it you could just hear a PCT employee called Georgina Howard talking a SWF GP who had very close ties to the PCT about a meeting she was going to set up with me. The GP suggested that she should have two people present – and this is a well known NHS ploy because you can then write up the record of the meeting in any way you like … and, if the interviewee cries ‘foul’, then it’s two against one. Howard replies: “Oh don’t worry, he’ll be wired for sound” … meaning that, as well as having two people present, she’d have a hidden recorder.

There was an interesting programme on Radio 4 in which Alan Bates (The Post Office man) was talking to Ian Hislop about his experiences and they agreed that they were very Kafkaesque – and that was my experience too.

Even in practices which don’t attract the unwanted attention of the ‘powers that be’, mixed with the good times there are the frustrations that all NHS GPs share – the bureaucracy – the large amounts of time spent form filling and doing pointless tick-box exercises. The yearly ‘appraisals’ were a particular bugbear; the huge amount of time and effort expended takes GPs away from patient care, and has done little to improve practice. Every year the main hurdle was grossly inadequate funding – about which the GP appraiser, however sympathetic, could do nothing – so we ended up going round in circles.

But the good aspects of general practice far outweigh the downsides. Having a job where the joys totally eclipse the daily irritations that are part and parcel of any occupation is a huge privilege and it was a great honour to be able to serve my patients for 40 yearsI

Dr John Cormack