RCGP Heritage

Women as patients Image credit: Under Wraps by Liz Lee and Susie Freeman ©2021 Chloe Stewart 

The feminisation of general practice is something which considerably worries me.  I would rather have a gender balance in general practice and that is partly because of gender-based styles, and how some people would like to have somebody doing a more brisk, ‘masculine’ thing.  If you ever watch videos of two men doing a consultation – it is quite different, or it can be quite different and it’s been said that the style of consultation promoted by the CSA exam was a middle class, female style of consultation, and I’ve been highly amused by videos of consultations between men talking about manly things in a manly way, but communicating much, much better than they would do if they came to see me.  So a little bit of banter about the football, for example. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

Women as patients Image credit: Under Wraps by Liz Lee and Susie Freeman ©2021 Chloe Stewart 

Now which partner, do you think was running the cervical smear clinic, who was doing the cervical smears, doing the family planning clinic, looking after the ladies and doing as many deliveries as he could?  That was me.  Then they put this thing called a female partner, or female trainee in, and I had to look after men, and it was you know, this was tough!  So it was, I suspect a little bit of me was a little bit sort of reticent, reluctant, but the nice thing was that, of course, when they failed to do something, or they had difficulty doing something, they always came to me, ’cause I was the one that knew, so that was all right.  

So, no, those are changes and then, yes, I think what they’ve got now, and they haven’t got any bigger, not significantly bigger, the number of partners is the same – they’ve got one more woman partner, because they’ve got two women who share it, which is exactly what I would like to see now.  A lady partner can’t be a full-time partner and work part-time, half-time.  She’s not a full-time partner, so I think you, you should always employ women in your practice, but I think you should employ two for the price of one so that, you, ‘I employ you, Mrs Jones or Dr Jones and you Dr Something-Else, you’ll work together, you’ll do half a week, you do half a week, but when you’re away you do full-time, when you’re away, you do full time, and so on, and I think that would work very well, and the women would get exactly what they wanted from the point of view of children, and responsibilities, which I’m fully aware of, and it would be, it would work much better than the men doctors saying, ‘Oh, they don’t hardly turn up,’ because they’re only here for a little while, and it would stop all of that. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

International perspectives Image credit: WONCA Africa conference Women’s meeting, Uganda 2019

I think general practice in this country has been slow to learn across international borders. But I think we have begun to, and I think – won't be helped by Brexit – but I think there's been a lot of cross-border research particularly with the Netherlands, Denmark, lesser extent Australia, and I think that's been really positive. I think the international networks have developed massively.  The regional WONCA and then the world WONCA thing, and the young doctors’ Vasco da Gama movement thing, for the trainees and the ‘first five’ doctors. I think that's been hugely positive, it's one of the really decent things that's happened for young doctors. I mean, the Dutch College sends a third of their trainees to every WONCA Europe conference which means it completely transforms the age set up of those sorts of conferences. It's full of young people and once that's happened then more young people want to come, ’cause they see that it's, it’s an interesting environment for young people whereas it had become really fossilized at one stage. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

International perspectives Image credit: WONCA Africa conference Women’s meeting, Uganda 2019 

Off we went to Tanzania when the second baby was three and a half months old.  John got a job through a system that’s called the Inter-Universities.  So, he was going to a medical school in Tanzania, in Dar es-Salaam, and I got work when I arrived there –  I was working a few sessions a week for the Tanzanian Family Planning Association and I also had a very complicated, involved arrangement with the High Commission and British Council to be their GP, for a while because I met various mothers who wanted to have a GP they could call on if their kids had earache, and I had to jump through an awful lot of hoops to rationalise this, and have it agreed and allowed, because I didn’t want to be a private GP but there weren’t enough people on this potential list to make it viable to be paid in the same way as GPs were being paid at home.  [So you’ve gone out there with two young children. How was that?] That was great, because, um, it was very easy to find someone to look after the children, and I worked part time, again, and chose my own hours, really, and that worked out very well, and it was a nice experience.Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

The wider team Image credit: Hanover House Practice waiting room sign, Sharon Messenger 

I think the, the sort of work that the staff had to do changed massively and the role of the practice manager changed very much. So the practice manager had to get up to speed with all the new changes, all the new ways that you could earn your money and try and come up with some plan as to how to deploy the relevant staff to do that. And I think we've mentioned about nurse-led clinics – they helped in chronic disease managements, but certainly some of the staff were then looking for information, you know, we've talked about immunisation, smears.  They would be checking those lists coming in, making sure the results were filed. The secretaries’ role changed from being more a sort of PA type role to having to take the next tape from the basket, and that wasn't quite so popular with them. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

The wider team Image credit: Hanover House Practice waiting room sign, Sharon Messenger 

What they did do, one of the receptionists had to write out, by hand, all the repeat prescriptions.  People would come to the desk or ring up, and say, ‘Can I have another repeat prescription?’ and she would spend the morning writing these things out so that by the time we came either – some were ready at coffee time and some at the end of the morning, and she would have written a sheaf of these things out – which we barely looked at, to our shame – and scribbled things on the end of them.  But this poor receptionist had to spend the morning looking up notes, in the Lloyd George envelope notes, writing them out, and then putting them in our boxes, so, before we went out for lunch, at lunchtime,  you would pick up two lists, one of these prescriptions which you had to sign, which you had to do there, and another receptionist would write up a noticeboard of the visits we had to do, under each person’s name – so if there were four doctors there were four bits of paper, and the name and address, which is why they would know where we had gone during the day, to visit these people. [So there’s a huge amount of background administration going on?] It was very pen and quill kind of time, really, it was before computers or anything like that. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

The wider team Image credit: Hanover House Practice waiting room sign, Sharon Messenger 

I envisaged that the receptionist would be much more empowered, not just to ‘I can make you an appointment for a doctor in three weeks’ time,’ or something, you know, kind of negative way that – good reception work is so important and that’s kind of navigating a practice, and I’ve been involved in designing Health Centres and it’s very difficult to make the reception desk as confidential as possible, and yet open, and it’s a big problem that.  But for the receptionist to pick that up, and say, ‘Look, I think you need to talk about this, separately, can you come round the corner?  And I’ll leave the desk here and I’ll come and talk to you about that.’ – obvious things, like getting a cervical smear test done, or I don’t know, sex, or mental health, all these things which people come to the doctor every day with. So I think we GPs could have done better.  I know that my own practice, the reception desk was completely open.  I wouldn’t particularly, I might feel embarrassed about some rather more intimate thing, about peeing at night or something, you know, you know, everyday things, or even when I come to College, and we haven’t done enough on that, of reception work. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

The family unit 

Image credit: detail from Professor Sir Denis John Pereira Gray, Carlos Luis Sancha, 2000, RCGP collection Tamás Kolóti Photography

[laughs] So I have two children.  They were born ’83 and ’86 and when I was on call, when the telephone rang my children would sit down and they'd say, ‘Dr Hull here.  Box 153, uhum, uhum, take two paracetamol and ring back.’ [laughs] So they'd got the script absolutely perfect [laughs]. But yeah, of course, it had an impact. Luckily, I think my family were pretty tolerant of it. But it does curtail where you can go, what you do, and so you’re just very aware all the time that things are going to be interrupted. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

The family unit Image credit: detail from Professor Sir Denis John Pereira Gray, Carlos Luis Sancha, 2000, RCGP collection Tamás Kolóti Photography 

I was in charge of the ‘phone here.  So when he was on duty, the ‘phone was here, and he was on-call, even lunchtime, had to be here.  Fortunately, the boys went to a local school and they came home for lunch, and he came home for lunch, so that was easy.  He had a half-day, on a Wednesday, so that was the only time that he was off – if he was off for the weekend, it was lunchtime on Saturday until Sunday evening, and that was a weekend off – so it wasn’t very much. [And was the ‘phone constantly ringing?] Quite a lot, yes, quite a lot.  I mean, people, patients mostly rang the surgery but if they couldn’t get through there, they came here – I mean, John’s patients – ’cause those were the days when he had his own list.  

Fortunately we did have an ex-directory number which we could switch, when he was off-duty. But it was night-time, and day-time, and it was before the days of mobile ‘phones, So, when he was out on-call, he had to know the positioning of all the telephone boxes, and have cash in his pocket to be able to ring here to see whether there were any more calls, while he was out.  If a call came in when he was on his way home, I used to shut the garage door, so that he knew he couldn’t back straight into the garage. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy. 

Leadership 

Image credit:  Lotte Therese Newman, Christian Furr, 1997, RCGP collection/Tamás Kolóti Photography 

So I'd been training for a few years and the great and the good in the College were looking to suspend training in North East Thames region because the directorate was so dysfunctional. We had a meeting out in the eastern suburbs, Ilford, and I remember driving out there and I remember driving back even more furious than when I went out. And Denis Pereira Gray had come to speak to us about it. And I have huge respect for Denis now. I certainly didn't then. And they just wouldn't listen to us. 

Anyway, I was so angry I came back, and I saw in the College journal, ’cause I was a member by then, that if you stand in the national ballot, at that time you had to make a fifty word election statement. 

I just wrote – sadly I haven't kept it, it’s a real shame that I haven't kept it, but it was a rant about how out of touch the top of the profession was, and I just wanted to you know, vent my anger. I hadn't realised that it was very easy to get elected. So, I got, topped the ballot, put Marshall Marinker off Council. Poor old Marshall, it wasn't fair. So then I was on College Council all of a sudden. Not intending to be at all. I just was wanting to be cross. And again, of course, that was very interesting. I arrived a complete unknown. They were all very wary of me, who'd made this statement about how terrible they all were. But, you know, I was on College Council until I became President so, for a long time and it was very interesting, and I learnt a huge amount. Please note that the views expressed in these recordings are those of the interviewees, within their historical context, and may not represent RCGP views or policy.