Here I was in a practice in the East End completely out of my depth. I mean the first patient was a family of Ethiopians. for example. to register – mother, father, baby and two little boys – no history at all, we couldn’t find the date of birth. The baby – twelve weeks – had had two injections, when were they? Had the mother had that? The three and five-year-old little boys were going round wrecking the surgery and I didn’t know what language to tell them to stop it, you know. And I just felt completely out of my depth. I knew from the College that we make a diagnosis just on the history in 85% of cases – I couldn’t get a history here. How many mistakes – I mean I had three complaints in the first twelve months after one in thirty years! And I realised that, I used to go – I was mesmerised, I’d go from the East End of London and drive to Princes Gate [where the College was then based] and the disparity between – how dare we talk in Princes Gate about how good general practice was when our brothers out in the East End were having such a bad time? A lot of London was super general practice, but here there were in the deprived thing and added on to that all the problems with no premises, no staff, no support.

Here is the person who's talking in English for the people who are born here, brought up here, educated here, living here, who know the language, that these are your rights. There is a need for them to know their rights. Then I said, as I said to you, I said, what about those who are not born here, not brought up here, not educated here, whose language is different: Asians and Blacks. Will there be a need for them? The answer was that yes, this is the right question to ask. […]

So, I registered myself with an evening adult course on journalism and media. Where I did the print media, radio media and television media. So, I will go to the Liverpool University and attend those classes in the evening and that was very good, that gave me lot of confidence, knowledge, understanding of the technicalities. So, I did that and it went very well. Then coming to how I used that extra knowledge into my practice. Now there I was interviewing the people: a dietitian, a nurse, a doctor for contraceptive so, I said ‘well, why not I do these things in my own surgery?’ I started communicating with the district nurses in charge and I said ‘well, if you want you can come, we have got additional room, you can do the things there, that room was available’. So, I started doing the Family planning clinic there. District nurses coming there. Dietitian coming there. Social worker coming there.

50:51 – 52.34

So, the '66 Charter then enabled general practitioners to employ staff and get 70% of that time reimbursed for their salary. So, it was encouraging GPs to have receptionists and secretaries and that. And also, there was a whole complicated business of, they could build health centres and get notional rents for them.  They could raise the money, build a surgery, and then get a rent from the National Health Service to pay for their mortgage basically, called the notional rent it was.  And that's when we all launched off! I mentioned the Caversham, the Caversham before that were an unconverted house in Kentish Town, and they got together with the James Wick and built a whole new health centre on that basis following the '66 Charter.  My health centre where I started in Goodinge, funnily enough, had actually been built by the Housing Department. Islington Housing Department had built a health centre on the assumption that they would get health service and general practice money back in terms of rent and community health services using it for rent. And the two doctors who were going to go into it died by the time it was built, so that's when I went there at that stage.  But those were the days again, working with the local authority!

What we talk about in the vaccine program - and actually across health, this is a legacy for health services - is how we care for underserved communities, because actually they're not hard to reach. We've just designed our services wrong. We haven't quite learned how to reflect what communities need, not just for their vaccination but for their wider health care as well. So, we've spent a huge amount of time and I've, you know, I've done it with the PM, I've done it with community and faith leaders nationally, I've done it locally in my own patch, you know, helping people to understand why vaccination is important. And one of the things that we've heard often is – ‘well you're telling us vaccination is important but black mums still die in childbirth more than white mums’ and so we're in that kind of bizarre scenario where we're both offering kind of this life-saving public health intervention, but equally we're in a position where we haven't quite solved some of the other things that people are worried about. So, I do see now that both through the vaccine program itself we will start to right some of those wrongs but also more widely through healthcare, through society, we have a legacy and a platform and a way of working now that will allow us to deliver more equitable healthcare and reduce health inequalities overall.

I think the College ‘Cum scientia caritas’ is fine, it’s quite a useful idea, but it’s not really very exciting, now. But it seems to me that the idea, if it could be expressed briefly, there is no such thing as natural justice.  Natural justice doesn’t exist. Nature is very unjust, we introduce the idea of justice, it’s a human concept, and it has to be implemented like that. We have to create justice, and there’s nothing wrong about that. It’s not saying that we dominate nature in the sense that people did when they were recklessly chucking carbon into the air and so on, it’s something we should be proud of. And the College ought to stand for that, that it wants more justice, you know, illness should be less unjust in its distribution. Sure, eliminate it if you can, then we could address the most difficult problem of all the problems that I can think of, this business about how we die.  How we have a time to die, because undoubtedly, we’ve got to move out the way.  The people who talk about thousand year lives, things like that, I’ve never heard anything so ridiculous and so immoral.  Uh, get out of the way! You know we look at our children, and we want them to take over, they’re better people than us - they so bloody well should be, you know! We’ve done so much work, they’re building on what we did, so shouldn’t they be ahead of us?

05.22 -> 06.42

“I don't think even the most hostile Tories anticipate the abolition of the health service.  I think what is more emerging is a two-tier system in which the very excellent health service is predominantly for those who privately insure and pay, and they’re a growing number.  And the rest of the health service is somewhat of the second-tier system. I think that primary care, the general practice and the associated health centres and so on, they are very slow at getting off the ground - painfully slow - are experiencing something of a genuine renaissance at the moment.  I think there is probably more going on in primary care and among general practitioners, some more radical experiments, and paradoxically, the independent contractor status, which many of us would feel is rather the small shopkeeper mentality, where the GP has to contract rather than is a salaried person. Paradoxically, that protected sheltered status has allowed more radically minded general practitioners the room to manoeuvre independently. And I think I'm impressed reading the material from general practitioners, their research and periodicals and so on, how much pioneering outreach work is going on involving prevention, screening and so on.”

Interviewed by Michael Neve in 1982 (Wellcome Collection).

00:01:42.830 --> 00:03:14.360 

“I qualified in ‘83 and I can vividly remember seeing the first patient with AIDS, as I was a casualty officer and at the time it was a little bit like we imagine with Ebola now: you almost had to close the entire department if somebody came in with AIDS. And when I started in Psychiatry HIV infection had moved from men who had sex with men to the intravenous drug-using population and estimates of up to 40, 50 even 80% of drug users were thought to be infected with HIV. So, it really was a crisis, and these patients were having to wait 18 months, two years, for treatment. So, I set up as a very junior psychiatrist what I called an Outreach Barefoot Doctor service in one of the needle exchanges. So, I used to take my little doctor's bag with blood-taking machines, some specula so I could do cervical screening on women, some dressings and some basic medicines and – it’d probably be illegal to do this now, probably CQC would have shut me down! But I used to provide very basic Primary Care Services to intravenous drug users and try to get them plugged into general practice and I did that, and I then started seeing drug users and it continued for the next 30 years. So that was my first example of working in a pandemic. 

The idea was to give pay in the inner-city areas in proportion to workload so that each GP got the same pay per unit of work – not an easy thing to do. And they decided that meant that the majority of GPs would be worse off and so it wouldn’t work. However, John being a fair person as I left the room he said come back Brian, we’ll give you one chance. If you come back in 3 months’ time, we will choose 5 areas randomly and we will ask the GPs at the LMC to shade the electoral wards according to the degree to which the patients in the area increase their workload or pressure on their services. And when we meet in 3 months we will see if there’s any overlap. And when we looked at the maps, there was only 1.4 or 1.6% of pairs of wards differed. So I then went for my first ever LMC GP conference at the Logan Hall. You have two minutes to speak … And I put it forward and they voted, having seen these figures, unanimously to accept the methodology. Purely theoretical, nothing happened, until 1990, the new White Paper – I suppose the Thatcher White Paper on primary care – came out and the day before, three parts of the department of health ask us for underprivileged area scores so I realised that they were going to use them. And they started paying GPs on that basis.