Old Lad

A journey through old age

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  • Characters

    I’ve been spending a week away in a cottage in North Yorkshire. It’s very relaxing with lots of time to read and muse on life. There’s a good local brewery nearby which also helps! For some reason I have had lots of thoughts about childhood and in particular the local characters that were about. I don’t know about you but we don’t seem to have these people any more, partly I suspect because we seem to be in an age of deep suspicion where any odd behaviour is seen as a threat. But when I was growing up we had these odd harmless people that as a child were just part of the fabric of small town life.

    We also had characters who did provoke anxiety, none more so than the “School Board Man”. His proper title was a School Attendance Officer and his job was to seek out truants and return them to school. In my case this role fell to Mr Brimelow who would be a familiar figure around town. A tall man with what you might call a military bearing, an ex policeman, always accompanied by his dog called Trigger, and wearing a long overcoat. Exactly what he did with truants I never found out but the threat was often voiced that if you didn’t go to school Mr Brimelow would come for you!

    Another character who remains in my memory is Billy who wandered around. Looking back he was a person who would now be described as having learning difficulties but Billy unfortunately was also deaf. This meant that he would shout loudly when he spoke. To children this was unnerving and although Billy was affable and tried to be sociable, we would often hide if we saw him coming.

    There were also characters who were regarded with awe by us children. None more so than the man who drove the local steam roller! Our town had its own highways department respond for road maintenance and as far as I know had one road roller. The man who drove it – and as I recall always wore brown corduroy overalls – was a figure of envy to us little boys. We would all gather if tarmac was being laid just to watch the roller desperate to have a ride on it. We never did. On the subject of tarmac there was also the strange belief that if you were chesty it would help for you to be taken where fresh tarmac was being laid an inhale the fumes! We also had a greengrocer lorry that came round twice a week selling fresh fruit and vegetables. This would be followed by children just in case the occasional apple or orange fell off it. The greengrocer also shouted to announce his arrival with a phrase to my child’s ears sound like “Terry ayup “ , which looking back was probably a version of potatoes. But for a long time I knew this man as “ Terry Ayup”! Another memory is the Salvation Army band who would appear in your road and play stirring brass music – alas sadly gone now.

    I am a regular reader of The Oldie magazine – worth a read if you haven’t tried it. Recently they had an article about the decline of whistling, which when you think about it is true. When I was growing up lots of people would whistle while they worked – the postman, the milkman, the man who swept the streets, builders, joiners , everybody. Now you are more likely to hear a radio blaring. Strangely though I still find myself whistling quietly if I concentrating on a task . Perhaps that’s another feature of being an Old Lad. It’s probably worth a bit of research. Do you whistle while you work?

  • Black and White

    I have a friend who is of the belief that the UK was on a downward slide since we switched from black and white television to colour television. As evidence for this he points to the fact that when we were in black and white, we won World War Two, The Football World Cup and the Eurovision Song Contest. Proof indeed!

    Recently I had a short trip to Edinburgh – one of my favourite cities – and went to see an exhibition in the Kings Gallery at Holyrood Palace. It was an exhibition of royal photography from the time of Queen Victoria onwards and featured the work of famous photographers such as Cecil Beaton, Lord Snowdon and Lord Litchfield among others. What struck me was how much more striking were the black and white portraits than the later coloured ones. They seemed to bring out the character of the subject in a far more striking way. It was particularly noticeable in comparing the coronation photos of the late Queen and King Charles. It is the same when I look through the wedding album recording our marriage – black and white just seems the right medium for formal photographs. It is a bit the same with films. Would Brief Encounter be such an emotional film if it had been shot in colour I wonder.

    Growing up in the 1950s there was not a lot of colour about. Browns and Greys typified day to day clothing and colour only appeared when you went on holiday. Colour exploded in our lives in the 1960s and what an explosion it was. Colour TV appeared, we all bought flowery shirts and ties and bathrooms changed from black and white to bright yellows, turquoise and shades of green. Lighting became much stronger and shopping became an almost psychedelic experience in boutiques and department stores. I remember my mother choosing a wallpaper for our house that had huge bright yellow sunflowers on it, which she regarded as the height of fashion. Looking at photographs of it now would probably induce a migraine! Maybe its the power of the retrospectoscope but life seems to have carried on at a much more frenetic pace since then. In black and white days we communicated by letter or occasionally by telephone from the local call box (Who remembers Button A and Button B!). Now of course communication by E Mail, Text and WhatsApp seems more pressured and we have fallen into the trap of needing to provide an instant reply to any communication. Is that better or worse for our mental well being?

    I am not a dinosaur and am as good a “Silver Surfer” as the next person, and I don’t regret the passing of the drab Fifties. I’ve recently bought a flowery shirt as well but still wrestle with the dilemma of should it be worn outside the trousers or tucked in! But when it comes to photographs I still yearn for the black and white era. Perhaps because it seems to offer a calmness in this turbulent age that we live in.

  • Vaccines

    When I was a GP, I used to often wonder what went on inside people’s heads about their health. Its what academics termed Health Beliefs and used to be taught as part of consultation technique. If I’m honest I think most of the time we had no idea until some bizarre question emerged.. In the case of people with a mental illness it was more challenging to identify the problem. A local Psychiatrist who I worked with had a simple pragmatic approach to this. His view, based on non verbal behaviours, was if a patient made you feel sad chances were they had an underlying depression. If they made you feel on edge it was probably anxiety, and if you sat thinking is it them or me it was probably schizophrenia. Crude but often surprisingly effective.

    Most of the time you would not know what strange beliefs people had apart from the odd people who might corner you in a pub and regale you with the latest conspiracy theories. However the advent of the internet has now blown this wide open and anybody with a keyboard can promote their pet theories, and often, defying logic , get lots of support.(Think Donald Trump!). Whereas most of the stuff is harmless, increasingly it becomes dangerous. And there is no bigger worry now than the growing belief that vaccines are harmful and as a consequence levels of vaccination are falling. Worryingly in the USA the President has appointed an opponent of vaccines as Health Secretary.

    I am the first to admit that there are rare events that can follow vaccination but in the scheme of things the overwhelming scientific evidence is that these are very rare. I think the bigger picture has been distorted because nowadays very few people have experience of diseases that we rarely see precisely because vaccination has almost eradicated them. One of the memories of my time as a Medical Student in the 1960s was being taken to a ward in Aintree Hospital in Liverpool which was full of adults in Iron Lungs -all victims of polio caught in the 1940s and 50s before polio vaccine was introduced. And in the 1960s we still had awful epidemics of measles and whooping cough which debilitated or occasionally killed children. Measles was the main cause of a chronic disease known as bronchiectasis where the air passages in the lungs are damaged and the sufferer has a life of chronic chest problems and infections. If you trawl through social media today you will find all manner of bizarre accounts of what vaccines are supposed to do to people. Often these accounts are peppered with that well know phrase “They say…” And of course in conversation with people there is a sentiment expressed that if its on Facebook or Instagram it must be true!

    It is an awful prospect to think that we would have to wait for an increase in the incidence of some of these historic diseases to make the anti-vax sentiment go away. When I was a GP people used to ask me if I had my own children vaccinated and the answer was always a resounding Yes. Whether this helped the waverers I never really knew. But my message still is if you are offered a vaccination against a particular illness take it! So this afternoon I’m off for my Flu and Covid vaccination!

  • Saturdays

    I am a regular reader of the Daily Telegraph. Before you label me as a right wing extremist I have to say that there are many of the opinions it promulgates that I disagree with. The history behind it is that when I passed the 11 plus and went to Grammar School, my Dad decided that our daily paper should contain some good writing and so chose the Telegraph.(I also was given a subscription to The Children’s Newspaper – anyone remember that). At that time the Telegraph was published in Manchester as well as London so We had a fair share of Northern news. And by and large the writing in it was of a good standard and must have helped me because i was very good at English. However in later years the Telegraph, along with that other quality newspaper The Manchester Guardian, moved its production to London and so by and large we lost the reporting of “Up North”.

    I still stick with the Telegraph because it generally has good writers but it is very London centric.

    For that reason I am now convinced that in the North we live in a parallel universe! The machinations of politicians and the Greater London media bubble are of no interest to me. I don’t really care if Angela Rayner has 300 houses or who scored points of who at PM question time. And I never cease to marvel about how people in the south must be to pay the prices they do for a pint of beer! We are more interested up here about having decent railways and buses, a health service that works and less anti-social behaviour, as well as protecting the good name of the Cumberland Sausage!

    The Telegraph comes into its own, however, on Saturdays when its edition includes supplements covering the arts, food, travel etc.. Invariably though much of the writing about arts and culture, restaurant reviews or other features rarely describe things north of Watford Junction. I read an article recently about the best pubs in the country -only one listed in the North! One particular feature that I always read and which is now my evidence of the different world “Down South” is entitled My Saturday. This is a column where some individual who is famous or in the public eye describes what they do on Saturday. It is often a worthy candidate for the feature called “Pseuds Corner” in Private Eye. Invariably it will describe what the person has for breakfast Consider this one: “I get the scrambled eggs going with avocado and toast with peanut butter. Sometimes I’ll do overnight porridge with chia seeds and banana”. Or this one: “I have a simple breakfast of kefir or bran flakes with dried fruit. Or an egg with really ripe organic tomatoes and rye bread together with an occasional glass of champagne”. The column then usually goes on to describe a walk in one of London’s parks and an evening dinner party with friends.

    Its a far cry from my breakfast of either a bacon sandwich or a boiled egg with soldiers. Of course the other issue about becoming an Oldie is that Saturdays are much like any other day of the week (Every day is a Saturday when you retire!). Although we do have the advantage in the North of being able to watch Rugby League. For all its faults and occasional pretension I still like reading the Telegraph but I do wish we could have a bit more coverage of things of interest up here.

  • Rituals

    I’ve just been to a funeral. It reminded me of how much rituals play in our lives. And as I get older I find some rituals reassuring and helpful. When you are younger of course rituals can seem exasperating and pointless – its the urgency of youth to get things done. There are long standing traditional rituals in life – Births, Marriages and Death – which are a focus for these major events. Although in the case of marriage and death these are changing with the decline in religion, the use of varying venues for weddings and unconventional funerals.

    I was a child in the 1950s and life was marked by daily rituals. Monday was wash day – no automatic washing machines then – and was labour intensive. Tuesday was Drying and ironing day. Wednesday was cleaning downstairs (we were posh, we had a vacuum cleaner) and Thursday was “Doing the bedrooms”. Friday was the day the Co-op travelling shop called and my Mum being hospitable would provide a cup of tea for the driver. And so the weeks rolled on but the ritualistic nature of all this meant that I had no problem knowing what day it was! Sunday of course was the ritual of the Sunday Dinner!

    The interesting thing about rituals though is that if a routine changes a person can feel unsettled. For example every morning when I shave I always start on the Right side of my face. Occasionally for a bit of bravado I have started on the left side, but it just doesn’t feel right! There is a ritualistic order in showering and drying which means of course that you can do it while thinking of something else. Rituals can become very negative things if they form part of an Obsessive Compulsive Disorder and can pose quite a challenge to the sufferer and their immediate family. And rituals are often a feature of an autistic spectrum disorder.

    Medicine and medical practice is full of rituals. The majority of them do have a value although their true value is not often recognised. When I qualified in 1971 hand washing before and after examining somebody was the expected thing. Indeed when I started as a GP doing home visits (remember those)it was often the case that I would be offered a clean towel and use of the bathroom for hand washing. Its significant that with the rise in hospital acquired infections we have had to reinforce the ritual of hand washing. One of the rituals in the medical consultation that is often being debunked by modern practice is the physical examination of a patient. It is probably true that a good medical history and listening to the patient’s story will give the diagnosis in 90% of cases. Similarly the use of the stethoscope will often not reveal anything of note. But my view of practice is that this physical “laying on of hands” is an important part of the job. Just before I retired I was a member of medical tribunals hearing appeals against a decision not to award disability benefits. The job often entailed looking through a person’s medical records and very often no physical examination was recorded. And conversations with people who are dissatisfied with a visit to the doctor express frustration – “The doctor didn’t examine me – I was just sent for a scan”. Which reinforces my view that the ritual of examination is therapeutic and probably instils confidence in the doctor’s advice.

    So next time you are pottering about just take a moment to think about rituals you may have. Are they a benefit or a hindrance?

  • Sod 70

    Arriving in your seventies has been described as snipers alley. You can be congratulated in having dodged the illnesses that are fatal and if you are extra lucky have also dodged the disabling chronic diseases. A comforting statistic is that the average expected lifespan of a healthy male at 70 is 20 years. But this then opens up the unsettling vista of what it might be like to be 80 or 90!

    I have been in relatively good health apart from mild high blood pressure and being a bit overweight with a BMI of 28 that keeps me out of the Obese bracket. However in the last 9 months there has been a distinct increase in aches and pains particularly affecting my back and hip joints. And moving around has been slower. So I decided to seek a consultation about it. To cut a long story short after navigating the labyrinth which is obtaining a GP consultation I eventually ended up seeing a physiotherapist (Now known as a Musculo-skeletal Practitioner!) and had some X rays. The X rays were comforting in that I don’t need new hips but there were signs of degenerative changes. Its a wonderful term degenerative changes isn’t it signifying the onset of decrepitude. I know that the only “treatment” is exercise and pain killers when it is very bad. The Physio (MSKP) was sympathetic but added to the gloom by reminding me I was getting older and may have to modify my activities!

    So I looked for expert advice and turned to Sir Muir Gray who was a respected senior doctor who among other things was the founding director of the National Screening Programmes and is now Director of the Optimal Ageing Programme and is leading a national plan for Living Longer Better. (No I hadn’t heard of it either!) Anyway he has written a wonderful book called “Sod 70”,which he describes as a guide to living well in your seventies, eighties and nineties.. Muir Gray’s thesis is that the decline people experience with old age is largely due to what he calls the Fitness Gap. This involves sorting out obvious problems like vision loss, hearing deficiency and taking advantage of the vaccination programmes offered to older people, as well as losing a bit of weight and eating healthy food. As far as physical fitness is concerned it involves the “4S Fitness programme” – improving Stamina, Strength, Skill (balance) and Suppleness. Joy of Joys there is no jogging or going to the Gym involved! The book sets out lots of practical advice and the time commitment is Twofold. Firstly a doable 10minutes a day focussing on strength, suppleness and stamina. Secondly at least five longer sessions of brisk walking for about 30 minutes. Many of the exercises can be done while you do other things so Muir Gray gives tips like doing bends and stretches in the kitchen while waiting for the kettle to boil, or standing on tiptoes while cleaning your teeth.

    So this book has now become my bible. I have a dog so the walking is not a problem although the dog tends to dawdle as it sniffs its way in the world so I need a few walks without the dog. I have actually loaded a step counting App onto my phone so its serious! I’m told that the late Prince Philip followed the 4S programme so it seems to work. And I quite like the idea of shouting Sod 70 when I stiffly get in and out of the car! I’ll let you know how I get on.

  • Shopping

    I used to enjoy doing “the big shop” when the family were growing up. We would all go together and combine it with snacks in the supermarket cafe. But as the family grew and children left home it became more of a necessary chore. And as I have got older its become a much more impersonal experience with the advent of self scanning and self checkouts. I recently shopped at Lidl. What is it about the two businesses Aldi and Lidl that make them train their checkout operators to compete for who can rush items through at high speed and overwhelm the customer! But I digress.

    I grew up in a small industrial town in Lancashire called Tyldesley. In the 1950s the dominant retailer was the Co-op, and we were a Co-op family. Tyldesley had its own cooperative society and boasted 13 grocery shops, a mobile shop that visited areas in the town, a Fashion store with bespoke tailoring, Butchers, a bakery, a furniture store and its own undertaking business. The “big shop” didn’t really exist largely because many households did not possess a fridge or freezer and foods like meats, bread or vegetables would be bought fresh on the day. Its interesting nowadays to see the introduction of supermarket loyalty cards and home delivery services. The Co-op had these in the 1950s. Anyone who was not able to carry their groceries home could have them packed into a recycled cardboard box and have them delivered. And of course the Co-op pioneered the system of sharing its profits with its members (the customers) in the form of a quarterly dividend payment. The “Divi” as it was called was eagerly awaited by families and could be quite substantial. Customers received a small cheque with each purchase and these were collected on a gummed sheet at home until “Divi day”. The pay-out depended on how profitable the quarter had been but could be as much as 10p for every pound spent (Two shillings in old money). We were definitely a Co-op family. Its goods were good quality especially own brands with the CWS label. My first long trouser suit was tailored at the Co-op by a kindly man called Mr. Thompson. When I became a student I had a holiday job as a relief van driver for the Co-op and used to deliver goods from the whare-house to the shops as well as doing home delivery runs. I even got to do a round with the electric bread van. I even got to get behind the wheel of the hearse – admittedly only moving it around the garage and empty but an experience! The Co-op model was a socialist experiment that worked and because customers were members they had a loyalty to the business. Sadly the model did not survive the relentless march of the big supermarket chains and although the Co-op as a business still exists it has lost its localism

    Now as I get older I like doing shopping in the old way and fortunately I now live near the small market town of Cockermouth. Although it has a branch of Sainsburys in the town centre it still has a good selection of small food shops – butchers, green grocers, bakery, fishmonger -and joy of joys a re-opened Jennings Brewery. Free range eggs can be bought from a local farm. By shopping locally we are preserving the high street. The other thing about shopping as we get older is that for many people doing the daily shop is an incentive to leave home and interact with people -important for staving off depression and dementia. Its a shame we can’t bring back the old Co-op though!

  • Classics

    I’ve never been a fanatic over cars. I was never one of these people who drooled over high performance motors. To me a car was a necessary item to be able to travel from A to B, preferably in comfort and with good load carrying capacity. My favourite car was the Volvo 240 Estate car -not a glamorous looking vehicle but it did the job for the family plus dog. Any form of motor sport watching cars go round and round a track is a form of purgatory! So why in the twilight of my years have I just bought a Classic car? Its a 1979 nutmeg brown Triumph dolomite 1300 for those who like the technical details.

    The official reason I bought it was for my grandson who is a petrol head, and who is going to make a career in motor engineering, having just secured an apprenticeship with a company called M Sport which builds rally cars. But to my surprise, I have now become hooked on classic cars. I think its another manifestation of the nostalgia germ that infects us Oldies. I learnt to drive in a Ford Anglia – you may remember those , they had an angled rear windscreen. This was our first family car in the 1960s – my Dad only passed a driving test when I was about 12. This car transported a family of four plus dog, but when I see one now it looks tiny and I wonder how we all fitted in! The Dolomite similarly looks small now but my memory of it at the time is that it was quite a reasonable sized car. Its interesting to read the sales blurb for this particular model which boasts “luxury extras” such as a walnut dashboard, carpets, windscreen washers, a wing mirror on the driver’s door, carpets and front seat belts!

    During this summer my grand son and I have taken it to a couple of classic and vintage car shows. This has been fascinating and enjoyable in equal measure. It soon becomes apparent that the majority of the classic car owners are of a mature age, and when you turn up they are incredibly friendly. So what are we all trying to re-create with a classic car. The nostalgia thing certainly. There’s a certain simplicity under the bonnet with an engine that can be worked on as opposed to being plugged into a computer. (So far I have drawn the line at polishing bits of the engine but there are those who do). There’s also the challenge of driving a vehicle without aids such as power steering or servo assisted brakes – Steering after an hour or two provides a good upper body workout and you return to a style of anticipatory driving to take account of braking distances. The Dolomite always provokes interest if I go shopping or go to a petrol station and inevitably somebody will come over for a look. we had an emotional encounter at one of the car shows with a man who disclosed that the exact model was his first ever company car and could he have a photo with it.

    I suppose the attraction of a classic car is its another manifestation of another of the features of growing older and painting a picture of our past where we can gloss over reality – such as the fact that the car is not that comfortable and getting in and out of it is not as easy as my present car with its higher seating. I think classic and vintage cars represent a yearning for a gentler less frantic age – or maybe that’s a myth too. But its a bit of fun. And in your seventies you need a bit of Fun.

  • Life is Risky

    There seems to be more anxious people about than when I was younger – or perhaps that’s just the rose tinted spectacles of old age! However I do think that now that we have 24 hour rolling news, multi media churning out scare stories, and a type of journalism that does not believe in treating news in measured tones, its not surprising that people are generally more anxious. Or as my Gran would say – “On top Note”! Open the daily paper or watch the news on TV and you will believe that the country is going to hell in a hand cart. For example according to today’s paper we are heading for civil disturbance, nuclear conflict, penury from financial mismanagement and the effects of eating and drinking the wrong things!

    A notable feature of life as I have grown older has been the rise of Risk Management. One of my annual delights is to dress up as Santa Claus and be driven round the streets on a sleigh by my local Rotary Club. It delights children as we roll up outside their door and we collect a fair bit of money for charity. Now however this simple activity has to be preceded by a written Risk Assessment document. So this contains such gems as Santa being asked to hold a baby for a photograph. Perceived risk – Santa drops baby. Mitigating factor – no holding babies, parents to stand next to Santa with Baby! And so the document goes on identifying the most unlikely outcomes and gradually squeezing the joy out of the event. Who demands this – why the Insurers of course. In the public sector and particularly the NHS Risk assessments abound but they don’t seem to contribute to notable improvements in service. But the risk assessments provide a comfort blanket for managers.

    One area that has increased is in producing risk measurements for individual diseases. This of course is based on the mantra that Prevention is Better than cure. The problem here is that much of this practice is based on the science of epidemiology, which looks at overall populations rather than individuals. Let me give you an example. The population of Finland has generally lower levels of heart disease and this has been attributed partly to genetic factors and partly to a diet rich in oily fish like herrings. So the message promulgated from the research in Finland is that a diet rich in oily fish may prevent you from getting a heart attack.. However the sting in the tale is that if you stuff yourself with oily fish there is no guarantee that you will not have a heart attack. If your whole village ate lots of oily fish then the overall number of heart attacks might fall but its not possible to know if you will be one of the lucky ones. The only areas where prevention works tend to be where there is a direct individual risk. So stopping smoking will prevent lung cancer because we know that the carcinogens in tobacco will induce cancers to form. Also the various screening programmes such as bowel screening will improve early diagnosis and prevent deaths.

    Journalists of course love reporting medical research that purports to show a link between certain activities or treatments and the chances of disease or death. What you need to know when making a calculation of what this means for you is to look at how the risk is being described. Which is where I jump on my hobby horse about the difference between relative risk and absolute risk. Lets take an unlikely example. Researchers decide that there is a problem of people developing brittle finger nails. Say the rate in the population is 5% of people having brittle nails – i.e. 5 in a hundred. The research shows that those who use a certain brand of nail varnish have a 7% chance of brittle nails – i.e 7 in a hundred. The relative risk will be reported as a 40% increased risk(2 being 40% of 5) but the absolute risk is actually an extra 2 in a hundred – i.e.2%. You can bet your bottom dollar that the press will report the 40% figure which of course sounds alarming to women rather than saying you actually only have a 2% extra chance of having brittle nails. So which figure do you think generates the anxiety? It happens all the time. So next time you read a story about the risk of this disease or that or which wonder drug is being introduced see if you can find the absolute risk.

    The thing that becomes apparent as you become an Old Lad is that life is a risky business and the best we can do is just relax and be careful, and not get anxious about things we cannot do much about. I suggest the Winnie the Pooh approach. There is a story that Piglet and Pooh are wandering through the woods and a storm is brewing with high winds shaking the trees. Piglet who is naturally nervous says to Pooh – “Oh dear, suppose the wind blows over a tree and it falls on us, whatever will we do”. And as they walk on Pooh says in his laid back way – “Well suppose it doesn’t”!

  • General Practice

    So what do you think about GPs these days. That’s a question I am constantly asked seeing I was in the business for quite a long time. Despite the fact that I have not practised for 10 years I still get stopped in the street or the supermarket for a quick ad hoc consultation. In a way its quite flattering that people still recognise me. But here’s a question. Do you know who your GP is and would you recognise them in the street. My hunch is that the answer may well be No and No. Ten years ago just before I hung up the stethoscope I suggested to a colleague that UK General Practice would not last more than a decade. My opinion now is that I was right and it is steadily being reinforced as I enter the world of being a patient – it happens to all us Old Lads!

    Why did I become a GP? I started my career wanting to be a Specialist – Rheumatology as it happened – but the thing about being a specialist is that you end up seeing the same conditions over and over again. I liked variety and the challenge of making a diagnosis from first principles. I also was influenced as a boy by watching Dr Finlay’s Casebook and was in thrall to Andrew Cruickshank’s portrayal of Dr Cameron. There was something attractive about being part of a community. And so it was when I joined my first practice. Because we did our own nights on call it was a condition to live in the practice area. My children went to the local schools, we shopped amongst our practice population and gradually over time I developed a deep knowledge of families and their relationships, the places they worked and got used to being recognised and consulted informally. In the 1970s and 80’s general practice training and education came of age and as I moved into teaching in practice we began to emphasise the benefit of this community approach. We also taught the skills of face to face consultation which involved not only a wide knowledge of medicine but the skills which are demonstrated in the Sherlock Holmes stories- the value of observation and the “Non Verbals” as we called it. The workload was heavy and at times arduous but the satisfaction of a “good” consultation with the correct diagnosis and a satisfied customer kept the enthusiasm going. Computerisation came and brought enormous improvements in record keeping but the trick was to not let the screen dominate the conversation.

    So when and why did what I perceive as the slow death of general practice start. Its difficult to put a precise date on it but several factors seem to have come together. First there has been a demographic shift with more and more talented women entering general practice but bringing a desire for part time working. The latest figures suggest that 80% of GPs now work part time. The removal of the requirement to be on call at night meant that doctors no longer needed to live in the practice area so could commute, and the community identity began to be lost. Continuity of care began to decline before the pandemic. When I retired from active practice I worked as a medical adviser in the Tribunal Service and we often had to request a print out of a person’s medical record. These almost universally showed a pattern of multiple consultations with a multiple number of people and no clear plans for follow up, the onus being on the patient to arrange a further consultation. The pandemic necessitated a dramatic reduction in face to face consultations and greater use of telephone doctoring, and this has never recovered. There is now great dissatisfaction amongst the population about the difficulty in getting to see a GP. In mitigation of my colleagues they have actually been encouraged by the NHS to adopt methods which make the process of seeing a GP less straightforward. The old mythical “Dragon at the Gate” (Receptionist) has been replaced by the internet! The practice I am now a patient with ( which happens to be my old practice) has adopted the model called Total Triage. So if I want to start the process of a consultation I first have to fill in an online form stating my case. were I not computer literate and resorted to the old fashioned method of ringing the surgery or calling in, a receptionist would fill the on line form in for me! This on line form then goes to a triage centre where a decision is taken as to who I will see – not necessarily a doctor – rather than who I want to see. If a consultation is deemed necessary there is a 50:50 chance it will be by telephone. And quite probably with somebody I have never met!

    These new ways of working are said to be extra efficient and as the jargon has it “Make the best use of resources”. Perhaps in these days of social media, WhatsApp, the next generation will be quite happy. But we have lost the personal touch. GPs have become anonymous figures working in episodic medicine rather than forming any relationship with patients. Worryingly face to face consultation skills and the ability to elicit physical signs of disease may well decline and telephone consultation is high risk. The knowledge of a patient’s circumstances that I used to get on home visits has all but gone – in fact many practices have a home visiting team of nurses or paramedics

    Does any of this matter. I leave it to you to judge but sadly my style of general practice aint coming back. Which makes me sad because looking back on a deeply fulfilling career I have had to admit that I would not like to be a GP now.