We need old-fashioned family doctors like Dad - The Jewish Chronicle

I write this holding in my hand my father’s weekly work diary for 1975. He was one of the first NHS GPs, and by then had been a Lancashire family doctor for 25 years. He was not typical of Lancashire: there were few Jews in our town and early in my childhood my parents had converted to Christianity. Yet my father was an educated professional and intellectual, from a Jewish educational tradition.

In the 1950s, we lived in what had been a doctor’s house and surgery for decades. I was taught to pick up the phone and say, “two four five one. Doctor’s surgery. Can I help you?” and find a parent if the caller needed medical advice.

Apart from his daily surgery hours, my father made house calls. On Monday 13 January, 1975, in his almost illegible manuscript, my father listed seven such calls, two of which were repeated later in the week. In earlier years, there had been an even greater numbers: I used to accompany him in his Austin A35 to enjoy the exciting extravagance of his car radio and his many stories of a doctor’s work in our poor but proud industrial town. Such was his commitment to his relationship with patients that, as a family, we decided that there should be two words only on his gravestone after his name and dates: “Family Doctor”. It defined what and who he was.

His story is typical of GPs of his time, though overlaid (as he told me years later) by the scars of a medical education in Poland in which Jewish students were not permitted to perform their practical anatomical education on non-Jewish bodies. The essence of his relationship with patients was professional and personal. As a result of the Attlee government’s reforms, the service was free. But to my father and his colleagues, patients merited the same duty of care as from any privately-remunerated professional.

In my later life, as a rural MP in Wales, I saw GP practices still maintaining those standards, and perhaps a few still do. However, the reality is that many patients no longer know who their GP is and rarely see the same one twice. Perhaps the de-personalisation of highly confidential medical relationships was an inevitability of the inexorable programming of our lives. If so, is the GP system now a necessary subject for root-and-branch reform, as proposed recently by Sir Keir Starmer and his shadow health secretary, Wes Streeting? And, whatever it says pre-election, does any party have the courage to dismantle and reform one of the shibboleths of the NHS?

On the 30 April, 1946, Aneurin Bevan moved the Second Reading of the momentous and historic NHS Bill. In one of the great parliamentary speeches, he said: “Our hospital organisation has grown up with no plan, with no system; it is unevenly distributed over the country and indeed it is one of the tragedies of the situation, that very often the best hospital facilities are available where they are least needed.”

Et plus ça change? Must we really accept with resignation the fundamental immutability of human institutions and put up with failing, inefficient and expensive public services? Surely Bevan would be enraged by the state of parts of the 21st-century NHS.

For the most part, today’s patients are more knowledgeable than those of my late father’s era. When recently I suffered from tennis elbow, I was too polite to tell my GP that I had lateral epicondylitis or enthesopathy of the extensor carpi radialis, but I had written it down just in case.

On many occasions we know that we need a specialist intervention and the NHS GP acts merely as a staging point. What if the GP and some of the most frequently-needed specialised interventions (physiotherapy, paediatrics, gynaecology) were available in the same place?

The Labour Party is right — and courageous — to take on these issues. The changes should be achieved within one parliament. There is clear evidence of dissatisfaction among GPs about the service as it functions now, but they need not fear for the future if they are willing to participate and even lead the re-structuring of primary care.

For five years, Sir Keir Starmer ran an important public service, the Crown Prosecution Service. He built on its sense of purpose, and learned the elephant traps that are hindrances to objectively desirable reform.

Of course, the NHS is much bigger than the CPS, and GP services cost billions. Nevertheless, Sir Keir’s success in managing as well as motivating a major public service is unique among political leaders — and welcome.

Change inevitably acts as a lightning rod to a Luddite tendency inherent in all of us who are accustomed to particular ways of working. That should be resisted, not because it would achieve better value for taxpayers (which it would), but rather because it would produce a health dividend for the whole nation.

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