Goodbye, Dr Finlay?

Writing in the 4^th century BC, the Greek philosopher Socrates came up with a piece of wisdom which seems an apt aphorism for these present, chastening times. He wrote:

'Remember that there is nothing stable in human affairs; therefore avoid undue elation in prosperity or undue depression in adversity'.

With the publication of the Health and Social Care Bill on the 19^th January, I am trying to remember those words of Socrates, although in this case I cannot help but think that there may be extremely good reasons to be justifiably pessimistic. Perhaps I am too cynical, having become worn down by three decades of sailing on the NHS sea of constant change and reform.

Nonetheless, I cannot help but fear for the future of the National Health Service; or more to the point, I fear for the intimate caring nature of the service which generations older than me will remember with some fondness through the rose-tinted characterisation of programmes such as Dr Finlay's Casebook. That said, I would be one of the first to say that even I was delighted not to have to work round the clock anymore when, as a general practitioner, I was able to stop night work and weekends a few years ago. After all, years of working 120 hour weeks do take their toll; I would not wish to return to such times.

However, aside from all the glowing nostalgia of yesteryear, I genuinely fear for the role of the family doctor within the evolving world of the NHS. Note that I said 'family' doctor, for it is there that change is likely to be most felt by patients; perhaps more so than at any other level of the NHS. I have no doubt that the doctor who practises as a generalist will remain in demand, because it is within the general practice setting that the vast majority of health care takes place. What is likely to continue changing is the intimate knowledge a doctor gains of generations of families during his or her thirty or so years practising in the same town, seeing the same people year on year. The wisdom a doctor receives from older partners in respect to previous generations is invaluable when caring for subsequent generations of the same families. It is a form of 'corporate knowledge' which gets passed on from one practitioner to the next during tales told over a hastily snatched cup of coffee during the progress of the morning surgery, and then added to by further experience. I have often found such learned information of great assistance in forming a professional 'special relationship' with patients, which in turn enables a genuine degree of empathy to be offered in respect to the various ails and misfortunes which life presents to us all. That is something all the government reforms can never rebuild once it is lost to society.

Nevertheless, having expressed such a morose view of the future, there has been a source of humour amongst the 'on the hoof' proclamations from Westminster in recent times. The debacle over the influenza vaccines is the source of my amusement. GPs have been blamed by the Department of Health for the lack of vaccines this year. We get used to such blame-shifting, so no real concerns there. However, the government then went on to suggest that it might take the future ordering of the vaccines out of the hands of GPs to avoid future 'debacles' of the same nature. Will the wise readers of this column please explain to me how that sits alongside the concomitant drive to hand GPs control of 80% of the NHS budget? In medical politics truth remains stranger than fiction.

This article was first published in the Scunthorpe Telegraph, Thursday, 3^rd February 2011