Weekly Meeting

John Kerr celebrated 70 years of the NHS by sharing with us some thoughts on his own involvement as a local general practitioner.

President John inducted Willie Lang into Rotary and into the fellowship of this couthy Club. Photographs are courtesy of Andrew Kennedy and Sandy Davis. Click to enlarge and cycle through.

John Kerr, club member and retired GP, was speaker at the Rotary Club of the Howe of Fife on 14 August and talked about the seventy-year history of the National Health Service. John reflected on the changes in Primary Care, better known as General Practice.

In 1948 when the NHS started, GPs worked on their own, usually from home, and were paid by the number of patients on their list. The personal service which doctors provided was cherished, but the workload and expectations grew to the point where the service was overwhelmed, recruitment fell and many doctors emigrated.

1966 saw a new charter, which created incentives, the development of group practice, more appropriate premises, the employment of staff and the start of primary care teams. That said, even by the mid-1970s many practices had no appointment system and a ratio of one home visit to two that were surgery based. Everything was handwritten. There were no mobile phones. Doctors usually had to live in the Practice catchment area and someone had to be at home to answer the 'phone while the doctor was “on call”. GPs were on call on a 1 in 3 rota – a weekend could mean from 8am on Friday till 6pm on Monday - an 82 hour shift.

Gradually in the 1980s there was funding for the development and training of staff and medical students. Recruitment was high and teams flourished, with a seriously enhanced quality of patient care. For many, this was the golden era. Appointment systems were developed, communications and records were improved and computers were used for the first time.

The 1990s saw the introduction of the market system - fund holding by Practices; doctors being encouraged to buy and commission services; workloads began to escalate out of control, resulting in out of hours reforms and an erosion of the unique, personal contact between doctor and patient.

In 2004 another new contract arrived, with GPs being able to opt out of 24-hour care and gradually Health Boards became responsible for running “Out of Hours” services. Targets and audit were introduced and doctors looked at the computer screen rather than the patient. This was a regrettable mistake – in many ways the end of personal doctoring. Initially the new contract brought with it better funding, but from 2008 the NHS has seen a financial crisis, austerity, an unprecedented financial squeeze – combined with a surge in need. Low morale and poor recruitment in Primary Care are once again the order of the day.

As for the future, John flew a number of possible kites – a special tax for the NHS perhaps or maybe payment for some services. A more limited provision by the NHS, greater efficiency and the end of procedures that are not evidence-based as being beneficial. On one issue he was very clear – no cost-effective health care system can survive without strong, high-quality primary care as its basis.

His talk was well received.