NHS General Practice as it was in the 1980s

Posted by ap507 at Apr 20, 2018 11:30 AM |
Professor Rodger Charlton from the Leicester Medical School discusses how General Practice has changed over the years to tie in with the 70th anniversary of the NHS

Think: Leicester does not necessarily reflect the views of the University of Leicester - it expresses the independent views and opinions of the academic who has authored the piece. If you do not agree with the opinions expressed, and you are a doctoral student/academic at the University of Leicester, you may write a counter opinion for Think: Leicester and send to ap507@le.ac.uk

When I started as a GP partner in a busy suburban group practice in 1987 I had just left my training practice in Scotland and purpose built premises with their own dispensary. For a brief period I was to work in the old surgery which consisted of a semi-detached house, once the surgery of a two-doctor practice which now had 5 partners. There were two parking spaces immediately outside the building. Everyone else (staff and patients) parked on a busy road with their cars partially mounted on the pavement. There were 3 consulting rooms. The one I used faced the street and was dark with its maroon carpet and a gas fire for heat and a large tall bureau which was the consulting desk, behind which I sat.

There was a stainless steel trolley with a few instruments and a glass jar with cotton wool. In one corner was a sink with a gas fired water heater and against a wall sat the old wooden couch with a white cotton sheet and pillow and wool rug at the end and a mobile screen. Underneath the couch was a worn looking leather bag – the midwifery bag. Within a few months we had moved to a huge new purpose built medical centre with its own car park where we each had our own consulting room with our names on the door and a modern system to call patients from the waiting area. So much has changed since then including disposable instruments and disposable paper sheets for the examination couch and disposal of the old wool rug as part of infection control.

Receptionists and the Waiting Room

In the ‘old surgery’, the ‘battle axes’ as the receptionists were sometimes known wore white coats. There was a greenhouse type structure (reception office) which extended into the garden with a glass hatch which opened into the biggest room in the building where some uncomfortable wooden chairs were positioned close to the walls. In the centre of the room was a table with some well worn magazines. The reception office could not be referred to as a grand or even a modern day conservatory. There was a small fan heater for those cold winter days and wooden structures housed the famous ‘Lloyd George’ patient note folders where handwritten notes and hospital letters were pushed into until the folders tore apart. Their only great advantage being that they fitted easily into a sports jacket pocket (once standard male GP attire) for house visits. These days GPs seem to wear suits or more likely jeans and open neck shirts and there are many more female GPs.

Now many GP surgeries are paperless and when I moved to a village practice in 1995 the first thing I did was to convert the Lloyd George patient records to A4 folders which seemed like a revolution even then until computers came in. To see the doctor in the ‘old surgery’ there were no appointments. One started to queue outside the main surgery door before opening time and when door was opened everyone made their way to the glass hatch and patient names were put in a note book under the names of doctor who were consulting that day. There was no choice of doctor offered and the lists were filled up in order and equally and the length of time you waited depended on your space in the queue and the speed or otherwise of the named doctor. You then sat quietly on one of the uncomfortable wooden seats, if one was available, waiting for your name to be called and which room you were to go to.

Appointment System

This seemed to happen with the move to the new building in 1987 although the old system persisted for a few weeks. But then, there was more than one ‘glass hatch’ and several receptionists. The glass hatches were no longer, rather a wooden ledge where you could stand and freely talk to the receptionist who no longer wore a white coat and without realising it, the surgery architect had taken away barriers. There was a proper telephone system for enquiries and making appointments and so more than one extension and soon a second line was introduced for patients seeking a repeat prescription. Then the debate took place as to how long an appointment should be.

In the ‘old surgery’ each doctor saw the same number of patients so that time a patient had with the doctor depended on the length of the queue to see the doctor and so the pressure they felt under and the number of house visits waiting or having to leave in a hurry with the midwifery bag. Although we continued intra-partum obstetrics for a few years, for many reasons we stopped, not least the building of a new maternity unit and the increasing role of midwives and their new found practitioner status

Appointments were initially allocated 7.5 minutes, but with increasing complexity of the consultation and the GP’s role in chronic disease management, many GPs moved to 10 minutes. For the last 2 years in my own practice where we teach undergraduates and supervise postgraduates we frequently allocate 20 minutes to an appointment as GPs with a dual role in educational supervision, many consultations last 15 minutes. Now appointments are made on the GP computer system rather than a handwritten register and can be made by the receptionist or by the GP in the consulting room at the end of a consultation when a review or follow-up consultation is required.

How General Practice has changed in 30 years.

Ref: Charlton, R. Career life time advances – Changes in General Practice in the last 25 years; Clinical Medicine. 2010; 10(6): 600-604.

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