The Maldon & South Chelmsford Primary Care Trust (PCT) duly took over the running of the practice and, initially, patients wouldn’t have seen much difference.

Without discussion, somebody I’d come to despise whilst playing a role in the PCT’s Professional Executive Committee was put in charge of the overall direction the surgery would take – so that was a bad start. She didn’t trust me and the feeling was mutual. I, therefore, elected to continue working at the surgery as a locum rather than as an employee in order to minimise contact. This further weakened my position but fortunately there were a couple of people working for the PCT who were sympathetic to my cause.

One example of the lack of trust occurred when I was due to have a meeting with the aforesaid manager. I was tipped off by my contacts and went prepared. I subsequently acquired a recording of a conversation that had taken place prior to the meeting. It sounded as if it had been recorded on Thomas Edison’s original phonograph circa 1877. You could just about hear the voices through the crackles. A doctor who is central to this story was urging her to have two people present at the meeting. This is an old NHS strategy as it gives scope for the minutes of the meeting to be somewhat economical with the truth. (If there is a subsequent complaint about accuracy, it’s two against one.) She confirmed that she’d done this and added: “Don’t worry – he’ll be wired for sound.” In other words she planned to record the meeting. The doctor concerned indicated his approval and the conversation ended. Although this is indicative of a complete lack of trust, this did mean that there had been an accurate record of what was said (which was to my benefit) … although for all I knew only selected excerpts might have been shared with her PCT colleagues.

Meanwhile, in SWF it was ‘business as usual’. Here is Gillian Booth talking about an Exercise Referral scheme which had been in operation for some years when the recording was made. The video is a bit glitchy in the middle but it’s still worth a watch. As we all know, exercise is vital for good health and longevity … but putting good intentions into practice is where we tend to fall short.

The PCT showed no appetite for signing an agreement for the use of the surgery premises, part of which were still jointly owned by Dr Hilary Allan and myself, Dr McGeachy having decided against buying in … so I videoed the surgery and as much of the contents as possible and sent them a copy with a covering letter saying the PCT was welcome to use the surgery but when they left, they must leave it as they found it … as a fully working surgery. The reason for this was that I could foresee that the PCT people would screw up sooner or later and would eventually hand it over to somebody who could do a better job. This prediction eventually came to pass when the PCT handed the surgery over to a private company (The Practice) prior to closing it for good in 2017 and dispersing the patients amongst the other practices in the town.

But that was some way down the line. The original arrangement continued until early in 2004 when I discovered that Greenwood Surgery patients’ data (in other words material taken from their confidential medical records) were being sent to a private company without the patient’s knowledge or consent – and, needless to say, without them sharing in the value of such data. The data was supposedly anonymised – but it is difficult to fully and permanently anonymise patient medical records because there is a risk of re-identification through jigsaw identification when data is linked with other datasets or when identifying details are removed inconsistently. Bear in mind this was in the comparatively early days of widespread GP computer use when everyone was feeling their way. Nowadays, processes like pseudoanymisation and careful removal of direct identifiers are used – but even so, achieving complete anonymity is very challenging.

Confidentiality is the cornerstone of general practice. The Hippocratic oath bound ancient Greek physicians to respect confidentiality in these words: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.” Hippocrates didn’t add: “and in regard to the life of women too” but I’m sure that was just a typo. Patients must be confident that what they tell a clinician is not passed around willy-nilly. Particular care must be taken when potentially embarrassing details are shared. And in domestic abuse cases it is of paramount importance that no information (including contact details) are ever leaked.

This was the last straw as far as I was concerned. It may seem like an overreaction to some but, as previously mentioned, I had fought a long hard battle to preserve the principle of confidentiality (with the help of a brilliant local lawyer) in the early 1990’s when a the local NHS ‘head honcho’ tried to send members of staff out to GP surgeries to read through patients’ confidential medical records without their knowledge or consent. We had to go to the top (incl. William Waldegrave Stephen Dorrell and Robin Cook) but we won that battle. And now Greenwood Surgery was doing this – a surgery where, when questioned, patients had always confirmed their support for confidentiality … and, later, in a more formal survey the patients had voted overwhelmingly to have their records kept safe (in 2012). In the busy downstairs waiting room there was a large (A3) colour poster saying that the practice took confidentiality very seriously. The only indication that this breach was taking place was a tiny (A5) B&W sheet in the relatively quiet upstairs waiting room. The number of patients who spotted the A5 leaflet must have been miniscule!

I saw red and wrote to Hopeless Harrison saying there had to be a change of direction.

Dr John Cormack