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Personalisation of care

Coalface tales

James Booth

Thursday, 08 March 2018

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AdobeStock_72287942_familypractice.jpgI’ve been away from blogging for a few months; unfortunately, work has taken a marked turn for the busier and alongside the winter pressures we’ve all had to face, I’ve had my own particular challenge. However, it’s also given me something rather important to reflect on, and that’s something that I think is in danger of being lost to primary care, to all of our detriment.

My practice is, in many ways, much more typical of a practice that was common a generation or two ago. We’re pretty small, have low staff turnover, and we’re family doctors in every sense of the term because my partner is my Dad. He’s been here for 35 years now, and that small size and length of service has given him an encyclopaedic knowledge of our patients and their families. When he started, a lot of practices locally saw relatives working together: parents, siblings, spouses. They also often had a clear continuity from the time they were set up – Dad started as the youngest partner of the GP who set ours up at the very beginning of the NHS. We’re now the last of these family practices in town, and we’re seeing the change moving ever faster towards federated networks and super-practices.

The challenges we’ve had at work have stemmed from the sudden discovery of a cancer diagnosis, meaning Dad’s needed urgent surgery and he’s now off recovering (and he’s doing very well, thanks to the peerless NHS care he has had). What has been wonderfully touching, though, has been the very real concern of not just our staff but our patients. Every day, we take in get well cards for him, and so many of my appointments now finish with someone asking me how he is. They don’t just ask that, either: so many people relate their own experiences to me. Just earlier today, a patient told me how she’d had the early signs of her own malignancy detected some years ago by him. On Monday, I saw three generations of a family for an eight-week check, and the grandmother of the new baby told me that the first doctor her daughter had met was my father.

These last few months have brought home to me just how much a part of our local community our surgery has been, and what a fixed point in so many lives a GP can become simply by doing his or her job with care and commitment for years. I’ve always loved the fact that when I mention a consultation over coffee I’ll often get a quick rundown of the entire family history from memory, alongside discovering that the patient is also related to that other patient, who had that rare diagnosis way-back-when. What I’ve seen now is how much that has meant to our patients, how it has engendered trust and confidence in their care, and how lucky I have been to share in a part of that these last ten years.

It’s terribly easy to romanticise the past, and as the child of a doctor I can only too well remember the strains of the job in years past – the weekends on-call from home, the late-night call outs, the fact that there was really only one way to be a GP. However, as we move into a world of federated super-practices, and portfolio careers, I think we will lose something – indeed, I think to a great extent, we have already lost it. Large practices bring great advantages; they are more sustainable, they attract new GPs, they offer models of care that are going to future-proof UK Primary Care in my view. However, that personalisation of care will change; that sense of the local community knowing their doctor will be diluted. As I write this in our large, modern, custom built, slightly anonymous health centre, I am about 75 yards away from the small maisonette that was the home of our practice for 40 years, a place where a few doctors devotedly served a community with continuity, care and kindness, and it’s on their shoulders that I stand when patients ask me if I’ll now be their regular doctor, having been looked after by another Doctor Booth for nearly 40 years.

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the vice-chair of Mid-Essex CCG and the named GP for Safeguarding Children locally. All views expressed are his own.
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