If you ask GPs what they like about general practice the usual reply is that most of the patients are lovely but it’s the system within which they have to work that grinds them down.
Here’s one positive example – a delightful man called Bertram who invariably brightened my day. He kindly allowed me to video him and use the recording as part of a ‘history of SWF’.
I mentioned before that there were changes afoot in the 1980s. The controversial ‘New GP contract’ was introduced by Ken Clarke and this sparked a tsunami of change within general practice, bringing with it new funding rules. As a result, many NHS GPs were ‘practice hopping’. Some liked the new contract because they felt that fundholding would give them a genuine opportunity to improve the service they offered whilst others saw it merely as a way of making a quick buck. And quite a large percentage thought that it would result in a two tier system and add to the already overwhelming bureaucracy … which in my opinion it did!
As previously pointed out, the sensible GPs kept their heads down, didn’t complain, and tried to go with the flow or make the best of a bad job regarding the new contract (depending on which way they looked at it.) I, on the other hand, was one of a group of GPs who felt the new contract was legally flawed. I was involved in the getting the contract judicially reviewed by the courts, which did not endear me to the local ‘powers that be’ in the NHS. The head of our ‘local NHS’ announced that he would “kick” GPs who didn’t fully comply with the new contract “from one end of the county to the other” – so I knew I was in line for a good kicking if he got his way!
Not only was I raising concerns about the new contract, I was also drawing attention to the concerning confidentiality breaches that were taking place in mid Essex where patient records were being accessed for purposes not connected with the patients’ treatment and without the patients’ consent. Given the NHS has a track record of ‘dealing with’ whistleblowers, this didn’t endear me to the powers that be … or to my partners. I was also doing a certain amount of media work (mostly writing and mostly out of hours e.g. for ‘The News of the Screws’) … but looking back I can see that can also cause friction in general practice.
All in all then, I wasn’t the best person with whom to be in partnership at such a difficult time … so in April 1990 the existing Greenwood partners decided to go their different ways (two to another practice in SWF and one to a teaching practice in Chelmsford, with me staying at Greenwood) There was a great doc waiting in the wings to join me and the staff (including our regular locum docs), by and large, wanted to stay put … so it all seemed to be progressing smoothly.
Little did I know that my activism – and unpopularity with the NHS powers that be – would lead to a scheme being devised that would transfer patients to the new SWF practice most of whom would have remained at Greenwood. Patients were wrongly told that the GP moving to Chelmsford was moving to the SWF practice – although he never was nor did. This scheme was dreamed up to try to deprive my practice of the ‘capitation payments’ for these patients which could put me in financial difficulties and, at worst, out of business.
The GP relocating to Chelmsford left Greenwood Surgery on the last Friday in June 1990 and started work at the Chelmsford practice on the first Monday in July. His patients, having received letters in official NHS envelopes saying he was staying in SWF, started ringing the phone number they had been given in early July asking for appointments … and they were told by the somewhat perplexed receptionists that he wasn’t there and that there was nothing to indicate he’d be there in the foreseeable future!
Needless to say many patients were furious at being transferred to a new practice without their permission, even more so when they found out that one of the GPs was not actually in the new practice! Greenwood was inundated by patients demanding to return, and I had the truly excellent Dr Hilary Allan waiting in the wings, keen to become a partner, so we could open our doors to our former patients. Even then the NHS administrator concerned thought he could delay that for three months and that he could impose a limit on my ‘list size’ (how many patients could register with me) in the hope that the patients concerned would have calmed down by the time I could reopen the ‘practice list’.
It was obvious what he was up to … and it ran contra to the NHS mantra of ‘Patient Choice’ … so I just ignored him and continued taking on patients. When I complained about what had gone on behind the scenes, the NHS (as usual) went into ‘cover up’ mode – refusing to conduct an enquiry or to issue an apology to the patients affected. The shenanigans were covered in a Private Eye article dated 9th April 1993 and brief details were given in the medical press and local newspapers.
Eventually I felt that my only remaining recourse, in order to make progress and ensure there wouldn’t be a repetition of this incident, was to issue a High Court Writ alleging that the then NHS body responsible for GP Services in SWF and its head had committed a tort (Civil wrong) called Misfeasance in Public Office. The NHS tried unsuccessfully to get the action struck out, but the court refused and the matter would have proceeded to trial, had the NHS not then settled my claim. The satisfactory outcome was published in The Gazette on 21st September 1998.
Needless to say the costs weren’t borne by the perpetrators so a great deal of taxpayers’ money would have been saved if firstly the plan had not been put into effect, or an apology for misleading the patients concerned had been issued at the outset.
I don’t want to infer that I attach any blame to the young doctors involved. When you are told by senior NHS managers how to proceed, the docs might reasonably deduce that, because they know how the NHS works, this is sound advice. With hindsight it clearly wasn’t!
Dr John Cormack