1.         A Case of Supply and Demand - Graeme Wilcox
2.        From Kidderminster to Kamloops - John Peaston
3.        Mike Stroud
4.        News
5.        Northumberland House
6.        Patient's Charter 1938
7.        Retiring Member - Tom Mackie
8.        The Out of Hours Debate

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A CASE OF SUPPLY AND DEMAND

In the Wyre Forest area we have religiously adopted the out-dated and over demanding out-of-hours system for far too long without giving any consideration to the long term effects on our own health and well being and its likely effect on applications from the already sparse medical labour market.

In the previously cosseted surroundings of our quiet little backwater events have been passing us by and our colleagues in IN many parts of the country have made, or are making, increasing use of alternative systems including  deputising services, extended rotas, primary care emergency services etc. It is surely becoming more and more obvious to us all that we also must make changes - not only for the sake of our personal well-being and sanity but also for the sake of general practice in this area in the future. General Practice is once again becoming the Cinderella of medical careers where new graduates are less and less inclined to invest their futures in a business where they will be dragged unnecessarily out of bed more and more frequently - instead they will invest in a career which will offer him a regular good night's sleep and a fresh mind to face the challenges of the following day.

Moves are recently afoot locally to consider changing our out-of-hours responsibility in such a way as to relieve the burden on general practice and at the same time support our local A&E department which is experiencing serious staffing problems. Unless these moves are given some credence there are serious doubts about the viability of the A&E department, and if it did close, it does not take much time to realise where the burden of its workload would fall.

We sincerely hope that local general practitioners will enter into meaningful discussions on this very important matter and face the problem head on to try and ensure our own peace of mind as well as a service to our patients which we can be proud of.

Graeme Wilcox

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FROM KIDDERMINSTER TO CHESTER VIA KAMLOOPS

On April 1st 1970 I was appointed Consultant Physician to Kidderminster General Hospital after spending the previous six years in intensive care and clinical pharmacology in Liverpool . At that time, consultant supervision of medical patients in Kidderminster was by Pat Thorne from Wolverhampton , and by John Malins in his weekly diabetic clinics. With my appointment, Pat Thorne withdrew to Wolverhampton but John Malins continued to serve until his retirement.

Shortly after arrival, I was press-ganged by John Ball, Bob Gibbins, John Sheward and others to become Post Graduate clinical tutor - which I was delighted to accept, particularly as one of the country's earliest postgraduate centres had just been built after sterling work in fund - raising by the above and others. With the support of one part-time secretary we began an educational programme which I'm sure has since expanded out of all recognition. After a visit to Texas in 1972 as a visiting professor in clinical pharmacology I was approached to become Associate Professor in Calgary but, like Texas , declined. In 1975 however, I agreed to an offer to join a private clinic in Kamloops ( British Columbia ) and to help in the development of the intensive care unit at the Royal Inland Hospital there.

By this time I had been joined in Kidderminster by your lately retiring president, Richard Taylor, and we left many friends and colleagues with misgivings and sadness. I was not sorry to leave the medical wards - propped by wooden supporting beams! - but our links with Kidderminster were severed with regret. British Columbia is a magical place, with its mountains, lakes and rivers and National Parks. Many a summer's eve was spent afloat on deserted lochs fishing for trout and listening to the echoing lament of the Northern Loons. Even in Winter, ice-fishing in bitter drifts was a new experience to be savoured on windswept ice with only the watchful company of an occasional wary wolf.

After a fascinating year in British Columbia , Barbara and I had serious thoughts about the longer term future. If we stayed, but returned to the UK later, our daughters' education would be seriously con:lp'rqrnised and they would miss UK qualifications. Education in Canada was hardly comparable and in no way 'stretching'. We therefore decided that British Columbia for ever was not for us, and we came home to seek a new posf. Happily, after a few locums, I was appointed to Chester and again became Postgraduate tutor. We have now spent many happy years in Chester and look forward to retirement in the near future. I have maintained an educational interest and been chairman of our regional council for postgraduate medical education for many years, and more recently associate Postgraduate Dean, but make no secret of my disapproval of the much vaunted NHS reforms.

Our two daughters flourished and I'm sure our retirement will be greatly enriched by seeing more of them and of our two granddaughters. We still feel a great warmth for Kidderminster and our former friends and colleagues, and will certainly hope to see more of those who did so much to make us happy in our five years there. May your society flourish for 1995 and beyond.

John Peaston

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MIKE STROUD

On Wednesday 15th February, at the Post Graduate Centre, some 100 members and guests were given a superb illustrated lecture by Dr. Mike Stroud.

Dr. Stroud, a well known explorer of the polar regions of the earth gave us an introduction by way of a description of earlier expeditions to the Arctic and Antarctic. However, the major part of his presentation was spent describing his unsupported journey across the South Pole in the company of Sir Ranulph Feinnes. In 95 days they manhandled all their supplies over the entire Antarctic continent, a distance of 1320 miles, pulling initially a weight of 485 pounds each and climbing to a height of 11,000 feet, with the occasional use of wind power (a mixed blessing).

After a superbly illustrated description of his trip, he finally gave a short description of the results of research performed during the journey. The lecture was followed by a buffet supper prepared by Angela McCarthy.

We were delighted to welcome Phyllis Oxberrow and her husband who were on holiday in the UK from their present base in Tanzania (see newsletter No.9).

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NEWS

At a meeting of the General Practitioners Association on Monday 13th March the question of G. P. out- of-hours cover was discussed. A decision was made to form an investigative committee (chaired by Graeme Wilcox & secretary Barrie Davies) to look at all the alternatives including linking in with the Casualty Department.

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NORTHUMBERLAND HOUSE

The Northumberland House Practice is not among the longer established practices in Kidderminster , but its story is nevertheless an interesting picture of change. Sadly, the sudden death of a single handed doctor can simply erase a chapter of history, and so it was when Dr. Mildred Latham died in the late Summer of 1957. However, we do know that she succeeded one William H. Jervis (MD Lausanne 1930) who came to Foley Park from Bolton in1939, moving on to Little Wenlock about 1944. Dr. Latham continued to practice from the residence at 221 Sutton Park Road ; but by the time of her death the list had fallen considerably.

A practice vacancy of 1500 patients was advertised, and John Ball, then a trainee with Donald Black in Stourport, was the successful applicant. He started in November 1957 and became one of the 5 single handed doctors in the town at that time. In the event, the actual list size proved to be only.900 souls and the first year profits were 1128  so the influenza epidemic that Winter was something of an economic bonus!

By offering a comprehensive range of services, maintaining its hospital links, and with Pam as an assistant the practice gradually grew in size and activity (baby clinic attendances totalled 88 in 1958). In 1960 it became possible to move to converted premises on the opposite corner at 54 Connaught Avenue , there to be joined by Graeme Wilcox for 18 months from 1965. Subsequently, Dick Herbert and Jimmy Jethwa joined the practice together in 1967. However, further growth meant a move to the Stourport Road premis~s which were completed in 1968. The following year brought the addition of Hugh Hickman from Birmingham , with Anne Mucklow (Parker) coming soon afterwards. Eight years later they were followed by John Parker and Vic Schreiber. Before that in 1974 the practice had commenced training, coinciding with a major extension to the premises with yet a further one in 1981. Nevertheless in 1991 further expansion to meet demand and extend services brought a total redevelopment which was opened by Lord Jenkin. By this time the quite indispensable staff had grown from the original part timer to a payroll of over 20 plus a full range of valued attached staff. Meanwhile, the original floor area of less than 30m2 in 1957 is now 670m2. Tony De Cothi joined the practice in 1988 and the 8 handed partnership, which is now fundholding, has included job sharers Judith Hardwick and Sally Riding since April 1993, in anticipation of John Ball's retirement this Spring.

John Ball

(John Ball went from the founder chairman of the Kidderminster & District GPA in 1965 to chairing the GMSC in 1980 and then the MPC until this year. He is now serving on the GMC. John was voted an honorary member of the Society at this year's Annual General Meeting)

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PATIENTS CHARTER 1938
(? Doctor's Charter 1995?)

NOTICE

The committee require an insured person on receipt of medical benefit to comply with the following rules as to conduct :-

(a) He shall, when applying to a practitioner for treatment, produce his medical card, if required by the practitioner to do so.
(b) He shall obey the instructions of the practitioner attending him.
(c) He shall not conduct himself in a manner which is likely to retard his recovery.
(d) He shall not make unreasonable demands upon the professional services of the practitioner attending him.
(e) He shall, whenever his condition permits, attend at the surgery or place of residence of the practitioner attending him on such days and at such hours as may be appointed by the practitioner.
(f) He shall not summon the practitioner to visit him between the hours of 6pm and 8am except in cases of serious emergency.
(g) He shall, when his condition requires a home visit, give notice' to the practitioner, if the circumstances of the case permit, before 10am on the day on which the visit is required.

The rules of the committee also provide that any complaint by an insured person which is adjudged by them to be frivolous or vexatious, shall be regarded as a breach of their rules. Any insured person who is guilty of a breach of any of the committee's rules is liable to a fine not exceeding 10/0d, or in the case of repeated breaches, 20/0d or to be suspended from Medical Benefit for a period not exceeding 1 year. These rules are liable to alteration, due notice of which will be given in the public press.

Taken from a medical card issued in 1938 and kindly sent to the editor by Tim Wadsworth.

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RETIRED  MEMBER

I joined the York Street Practice in 1951 as a trainee assistant after National Service and 15 months obstetrics in Swindon . I was attracted by the prospect of working at the Lucy Baldwin Maternity Hospital . Drs. McArthur and Carmichael Mackie had run the practice and obstetric services in Stourport during the war years by themselves. They were joined in the late 40s by Dr. Emily Winter. After 2 or 3 years, I became the first fourth partner in the practice.

The hours worked then were quite ridiculous - a hangover from the war years I suppose. I had half days on Tuesdays and alternate Sundays from 1 pm to midnight and so I was in effect working an average of over 150 hours per week. I had 2 weeks holiday a year. We had 2 receptionists working alternate shifts of 8am to 2pm and 2pm to 8pm. There are approximately 30 on the practice payroll today!

During the 60s John Bywater and Charles Mackie joined us and in the 70s, Peter Batty and Tim Chew. Just before I retired in December 1987, Lesley Hickman joined the practice. When I started, Dr. MacArthur owned York House and the adjoining practice premises. His surgery was in his sitting room. Three surgeries, a small dispensary and a waiting room were tacked onto the end of it. When he left York House to live in Hafren Way the practice bought the adjoining premises which were extended to provide additional surgery space. Later, major alteration involved the building of an upstairs storey. As I was leaving, the practice was acquiring the neighbouring solicitor's premises. York Street has now virtually twice the capacity it had when I left.

We were fortunate in having for most of my time the services of Lorna Kimberlee who worked as receptionist, dispenser, secretary and practice manager from 1948 to 1982. She was a founder member of the Association of Medical Secretaries. Chris Jenkins was a very able successor. Despite what was always a very heavy workload, especially at first, I enjoyed my life in General Practice, but in the last few years I was becoming somewhat disillusioned by the increasing administration, computerisation and threat of litigation. When the time came to go, I had no regrets.

Tom Mackie

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THE OUT-OF-HOURS DEBATE

I was recently in contact with the FHSA over the out-ot-hours contentious issue. In reply to my letter I received the following (paraphrased) letter from Elspeth Metcalf, the FHSA Chairman, which I felt would be of interest to all local GPs.

'I am deeply concerned at the pressure felt by our excellent tamily doctors in this county, not only with all the extra day time activities now carried out in general practice but also with the pressures in out-ot-hours work. As you know, we are 100% committed to supporting our practitioners in any way that we can to make practice life more efficient and more effective in the interests of both doctors and their patients. To this end, we are in discussions with GPs in a number ot towns in tbe county about ways in which the out-of-hours service can be more efficiently organised so that fewer doctors are on duty at night and that the out-of-hours links in effectively with either community hospital services or even A&E departments if this is appropriate. The very successful out-of-hours pilot scheme based on the community hospital at Evesham is proving very acceptable both to patients and GPs in that area and I will ask John Gregory to get in touch with you to discuss whether practices in Kidderminster would be interested in developing a scheme that might be appropriate to the Kidderminster practices which have a long record of working together.

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