Spectator: Leslie Geddes-Brown on the NHS

I haven’t seen a doctor for years, but even I can see that there’s something badly wrong with the NHS. My father was a York GP and I remember the phone never stopped, and nights when he would get up at 3am and wearily set out to make an urgent visit. I also recall 20-minute breakfasts when he would make a list in his black diary of whom to visit that morning-up to 30 patients between 8.30am and 12.30pm. In an article for a local paper in 1965, he wrote that, during one morning, my mother took 18 telephone calls and answered the door five times ‘for assorted reasons including one fairly bad accident’. Then, he had 15 minutes for lunch.

At 12.45pm, he went to his surgery next door to see patients. ‘My regular appointments start at 1.00pm and run at five minute intervals until 3.00pm. They start again at 5.00pm and go on till 6.30. This makes 42 appointments in the day but, in fact, it always amounts to more. Today I saw 48 patients by appointment and my receptionist dealt with seven people who didn’t need to see me personally.’

He reported that he only ran five minutes late for all appointments, so no one had to wait longer. In those two hours, the phone rang another 23 times. His tea break was 10 minutes, before another 20 appointments that ‘ran out dead on time at 6.30pm… then through to my house for a glass of sherry with my equally tired wife, and dinner. So far the evening has only been interrupted by one “emergency” visit three miles away and another five phone calls. However, I have grave doubts about tonight as two of my young mothers are overdue with their babies and a child I saw today could be nursing an early appendicitis.’

Amazingly, he started by saying he didn’t consider he was overworked, although ‘with 3650 patients on my list I am busy; and I firmly believe I am underpaid for looking after them for 24 hours a day, 365 days a year at the rate of 1s.8d (about 8p) a month each’. But the crucial point is that he knew all about his patients and, just as important, they knew him.

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His working day, he reckoned, was 11 hours’ work with 25 minutes off for meals plus another 13 hours on call. Thursday afternoons were off and ‘every third weekend the utter bliss of no work at all from Friday at 6.30pm till Monday at 7.30am’. Duty Sundays were rarely more than seven hours’ work. Seven hours-a snip! Our family had four weeks’ holiday a year, which we hugely anticipated, not least because my father became a different person, relaxed, funny, charming. Of course, he had to do extra work for his partners when they were on holiday. Later, my parents bought a country cottage 20 miles from York for days off.

There was no phone and the only callers came to say hello. At the end of the article, he listed the patients he’d seen that day: ‘15 seriously or moderately ill and needing a doctor; 17 chronic sick or old people only needing a bit of cheering up; 4 ante-natal or post-natal examinations; 14 assorted depressives, neurotics, hypochondriacs and malingerers; 2 inoculations for people going on holiday; 14 trivial cases only needing a little commonsense; 3 fat women trying to reduce weight; 9 people required by law to obtain certificates but not ill; 1 examination for litigation; and 1 conference with relatives.’ ‘Total 80. Of these about 25 needed me as a doctor. I wonder if it is all worthwhile?’

Well, I suppose it was. When he died at 63, a patient wrote to the paper praising his skill and humanity. I have it still. Do GPs work like that today? And what do they earn per patient per month? Not, I guess, 8p with 23 hours per day on call. Nor, I guess, does any GP or hospital see each patient within five minutes. Yes, something is badly wrong.

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