My mother, Gerda Laura Clara Alice Sloan, nee. Friedman.

 In 2017 I stayed with a friend, Steve Shalet, at his home in Derbyshire. (We were fellow medical students in London in the 1960s).  He knew I liked writing and that I found writing therapeutic. He told me he had written about his two children and that he had restricted himself to three A4 sheets. I found his essay poignant and contained an account that could not be easily made verbally. He suggested I ought to do a similar thing about my mother after I had described some of experiences of her being a German refugee with a medical qualification coming to England in 1938.

My mother was born in Berlin and her parents, Richard and Lilly) were very wealthy and of Jewish background. She was the youngest of three and she and her brothers, Herbert and Ernst, were educated in their early years by an English governess, Miss Henderson. They could all speak very good English. They lived in a luxurious house in the diplomatic area of Berlin. She had a good education and studied medicine in the University of Berlin. Hitler rose to power and she and some of her friends had to wear a yellow armband at medical school because they were of the Jewish race, However, my grandparents and their children were brought up worshiping in the Lutheran church. My grandfather had significant business interests in England and moved to become a naturalized citizen of Great Britain in 1933 as did Lilly, his wife. They had a flat in Maida Vale in London

My mother was determined to complete her medical studies and obtained her Doctor of Medicine (MD) in 1938. She left Germany immediately after qualifying and only just escaped the country in time to save her life. Her parents had moved from London to Harrogate and my mother joined them there. The British Government announced that foreign doctors had to requalify by re-taking the final examination. She passed the conjoint finals (MRCS, LRCP) in Edinburgh. I thought that was very impressive. Shortly after passing those exams, the government announced that there was no longer any need for German doctors to retake them!

She applied for about three hundred jobs and got nowhere. My father (who was a General Practitioner in Airedale, Castleford, Yorkshire) was in the middle of a very difficult divorce and had advertised for an assistant. He read my mother’s application and said to a friend “I only hope she is not good looking.” They were married in 1944 and nearly one year later I was born. For the duration of the war she was under a curfew and was not allowed out in the evenings or at night. A policeman would check on her every evening and joined my parents for a relaxing cup of tea.  My mother thought this was a great luxury for a GP – not to be allowed out at night. My father must have done all the night visits.

What always amazed me was how the people of Airedale and Castleford took to my mother, a German in the second world war. This was because she was a refugee but also because she was so kind and caring to her patients. She was so thankful that Great Britain took her in and let her do the job of her dreams. Their housekeeper, Mrs. McGrath, had a son, Harry, who was a prisoner of war in Germany in the war and contracted TB there. He eventually died as a result of that disease in the early 1960s. Harry never had an ill thought about my mother and indeed used to drive her or my father occasionally.

My mother was a modern woman. She was the first woman in Castleford to wear trousers (slacks). She was a cultured woman and took us to the ballet, musicals in London and she read widely. She was a good bridge player and liked to bet on the horses (she had a horse when she was a young girl).

I saw how the war affected my mother for the rest of her life. She had problems sleeping and like she did in the war, listened to the news all the time on the BBC world service during the night. She knew that if Hitler had won that she was on a death list. She had a serious guilt complex that she had survived and had not died in a concentration camp. Her grandmother’s cousin Peter died in Auschwitz in 1943, I cannot imagine what it must feel like to have to leave one’s country.

Her parents moved back to London after the war ended. In 1953 her father died suddenly and shortly afterwards her mother, Lilly, committed suicide by cutting her wrists in the bath. I was 8 years old. I think they told me they had both died but I really can’t remember. I wonder if this was psychological repression. My paternal grandfather died about that time also and I know they did not tell me about that for a year. I cannot remember either of my parents being at all upset and my happy childhood simply continued. Lilly, liked my mother was a very loving person. My mother’s father was a gambler, drinker and womaniser. He was a character and I loved hearing the stories about him. We will never know why Lilly committed suicide. This selfish act had a considerable effect on my mother magnified by the fact that one of her brothers blamed her for not getting to her mother in London quickly enough after her father’s death. This added to her already significant guilt complex as a survivor of the war. She drank too much alcohol but mainly in the evenings. The drinking did not affect her job. My father was a tea totaller!! She developed oesophageal varices and had cirrhosis of the liver when she died in 1990 aged 77. I regret the rows we had in her later life about her excessive drinking. I wanted her to be well and loved her. I forgave my mother everything because she deeply loved my father, her mother and me.

My mother was a very loving and generous person and not just to me. She always supported me as did my father until his death in 1966. I was petrified that my mother would commit suicide after my father’s death. They bought me a car when I became a student in 1963 and my mother bought me two further cars later. In 1970 when Felicity and I married she gave us a house she owned as a wedding gift. When I got a job as a GP in Cheltenham my mother moved down there to be near me. My second wife, Kath, and I sold that house and I bought a flat in Budleigh Salterton in Devon. The sale of that flat funded our setting up a General Practice from scratch in Airedale, Castleford, after my mother had retired. When I moved from Cheltenham back to Castleford my mother moved there to be near us.

Building up the practice was very difficult. Of course all my new patients had to come from neighboring practices. At one point my mother broke her agreement with her former partner not to practice again in Castleford for 5 years after retirement and helped me out when I was under great stress. She actually became my medical partner for over a year. Consequently, her former partner served an injunction on her and we had to close the practice for a couple of weeks. My mother would be proud that Kath and I built up a thriving training practice which won awards and ended up with a huge building with 19 consulting rooms. Kath was the practice manager. Our family had a street named after it – Sloan place – which I drive past every day. Kath and my parents are commemorated on the Foundation Wall of the Royal College of General Practitioners.

My mother lived alone from 1966 to 1990. She led a full life after my father died with holidays, friends, playing bridge, betting on the horses etc. I have learned a lot from her and others about how to cope with bereavement and living alone. Towards her end of life in November 1989 I sat with her in the nursing home. She could not communicate. On the TV in her room footage was being shown of the Berlin wall coming down. How she would have loved to see that momentous event.

Her ashes were buried in a joint grave with my father’s in Putney Vale Cemetery, London. Her parents’ ashes are in the adjacent grave. It was at the request of my father that his ashes should be buried next to his in-laws’ so that in the end my mother’s ashes  could be near his and her parents’.

November 2014 - two funerals

In November 2014 I went to two funerals. The first was of Norman Kennedy. He died aged 70.

I will explain how I knew Norman by quoting from the Pontefract and Castleford Express of Thursday May 14th 1982:

"Ferry Fryston

Hair's breadth

In one of the evening's major upsets, retiring Labour Councillor, Norman Kennedy, was ousted by SDP newcomer, Dr Richard Sloan by just four votes after two recounts.

Gerry Byrne and William Inman took the first two places but in a neck-and-neck contest for third place Norman Kennedy lost his seat in a traditionally Labour ward to Dr Sloan.

Dr Sloan said the result was "absolutely fantastic".

He put much of his success down to people using their vote as a protest, because Labour candidates in the ward had been unopposed for so many years"

The second quote from the same newspaper on Thursday May 12th 1983 is self explanatory:

"Ferry Fryston

Norman gets his revenge.

Labour choice Norman Kennedy gained revenge and his former seat by beating SDP councillor Richard Sloan. 

Last year Cr Sloan ousted Cr Kennedy from his seat by just four votes after a recount.

But Cr Kennedy regained his seat last week with a convincing though slender majority.

Ferry Fryston was the only ward in the Pontefract and Castleford district where seats changed handsand losing his seat Cr Sloan halved the SDP representation on the council.

Results - N. Kennedy (lab) 2362; R Sloan (SDP/Lib) 2119. Maj 143. Labour gain from SDP."

I was somewhat relieved to be "ousted" as the council work was complex and difficult for me to do justice to it as I was working full time as a GP.

However, the two recounts evening was very exciting especially as I believed Norman would easily win.

After the results had been announced in 1983 Cr Bill Inman mad a speech in which he said he did not get a leaflet from us. This insenced us as we had put 5000+ leaflets out in the previous 4 weekends as well as getting up at 5 am on the day to deliver several hundred more. We went back to our house and after more than a few drinks found 3000 leaflets we had over. John Little and I went out to find Bill Inman's house and post all 3000 through his letterbox. We did not find his house!!

Norman was far the better councillor than I and did some great work for our ward. RIP.

The second funeral I went to with Kath was that of retired consultant Obstetrician and Gynaecologist, Peter Howe. 

This photo was taken in France where he and Margaret had a second home. He had a deep stroke 15 years ago and Margaret, his wife, looked after him like gold. My friend Grahame Smith (now a retired Pontefract GP) and his wife Caroline knew him better than we did. Grahame and I visited him in 2013 and we knew he could undersand us but only spoke one word. It was after I asked him whether he remembered my mother. He said "Gerda" - her name. We visited him in SeSeptember his year and he had obviously deteriorated. He did not speak at all but certainly could understand us. 

Margaret used to deal with his private appointments and my mother and I sent him plenty of these. Margaret was so friendly on the phone. When my mother died they sent me and Kath some flowers to the house after the funeral. We just did the same for Margaret.

There were several doctors at the funeral, some of whom were retired or practising GPs. There were also retired or working consultants there. I was reminded how friendly the GPs and consultants were to one another all thos years ago. This has all gone to a large extent. I met on consultant in about 2007 who told me his manager had warned him not to fraternise with GPs.

What was fun after the funeral was that we met some of the midwives who had worked with us in Airedale many years ago. Sister Mary Thornton was there. She retired 22 years ago. There were also another two midwives who had worked at Tieve Tara in the late 1970s and very early 1980s. They recounted to one or two of the naughtyish things I did in the early 1980s. I  wrote a letter to Mr Howe that said that in my opinion the patient I was referring had the IQ of a dead plant. I also offered to dance the fandango with him if another patient turned up to see him. I remembered forging a letter from Peter to me telling me how hopeless my partner, Anne Godridge, was. She used to forge positive pregnancy test results which were hers. She wanted to see the look on my face when I saw one. Once, in the very early days, three midwives came to the clinic when I only had two pregnant women patients (the practice was building up).

Peter was a gentle man and a gentleman. RIP.

Immigration debate

Recently, there has been lots of debate about immigration from the countries in the European Economic Union. In the last few years or so, we have stayed in several hotels in England and invariably most of the staff are from abroad, usually from a country in the EEC. The first contact is usually at reception and then in the restaurant. Invariably the staff are polite, friendly and efficient and look as though they enjoy their work.

My mother was a refugee from Germany and arrived in England just before the start of the Second World War. She had to retake her medical degrees in order to practice and she passed the exams the first time. She came from a wealthy family and she and her brother had an English governess (called Miss Henderson!). My mother and uncle learnt English from her from a very early age.

We go to Italy a lot as we have a second home there. Certainly the younger people we have met all speak pretty good English and they learned this at school. I wondered how all the waiters and receptionist at hotels had learned their English.

I today found a statistic on the Internet in in 2010 about 92% of all secondary school students in the countries of the EEC were learning English as a second language.

I am convinced that this is a major factor that determines employment in the UK of people from Europe.

A very sad day today . Our friend Gill's father died yesterday. Patrick Kavanagh CBE was deputy Commissioner of the Metropolitan Police from 1977 to 1983. We met him many times over the years and had lots of Sunday lunches with him at Gill's. When he was assistant commissioner he was in charge of "traffic".

A few years ago I told him, at a party, that I was taking my advanced driving test. As we were leaving he shouted accross the room "Don't forget - mirror, signal manoeuvre".

The photo of him and Gill was taken by me at Gill's 60th birthday party at her house. We had called a private taxi to leave but were so enjoying meeting old friends that I gave the driver £20 and sent him away. I did the same to the second taxi! We went home in the third.

Earlier this year he took us out (and he was in his 90th year) for a lovely lunch near where he lived. He had to walk supported with one hand on my shoulder. I told him I felt as though I was being arrested. Kath and I are really pleased we met him again in his final year

He had a great sense of humour but also a steely determination. One could see how he rose from a PC to such a high police rank. There is an entry in Wikepedia outlining his career. There is a full page obituary in The Times of 13/12/13.

We will miss him greatly.

End of the PCT

I went to the farewell coffee and cake meeting at the NHS Wakefield PCT this morning. What a sad affair. It was the last day of its existence and the last day of Gill Galdins working there. She was responsible for my getting me job there as education advisor and appraisal lead and for 7 years of happy working for me. All the best, Gill.

Recent Italy visit

We had a cold weather experience in March in Umbria with our friend Gill, who was with us for the third year running. However warmth was created by our meeting Johnny and Janelle Apodaca and joining them in a few glasses of red wine first in our house and then Aldo's bar in Panicale. I am planning to sell Johnny's easel for a huge amount of money.

Feeding the ducks at the beautiful Fonti del Clituno

Birds

This sparrow hawk sat on our fence yesterday. Later in the morning I heard an owl and a woodpecker. Loads of interesting birds here.

The Hepworth Surgical Drawings

Yesterday a gang of retired GPs and a retired surgeon friend were given a guided tour of the Hepworth Surgical Drawings in the Hepworth Gallery in Wakefield. It was fabulous. There was a drawing of an orthopaedic surgeon who taught us at The London Hospital. Sir Reginald Watson-Jones - orthopaedic surgeon to the Queen. He had a maroon Rolls with his chauffeur in a matching maroon uniform. He once gave a lecture on amputation. Whilst brandishing a huge knife, he accidentally cut his leg and had to be taken to casualty.
Here is an interesting link:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61975-8/fulltext

The English Doctor: a medical journey

A couple of months ago I had my book published by Xlibris. Below is the introduction:

The intention of this book is to capture the essence of medical research and medical practice during the second half of the twentieth century and the start of the twenty-first. I have focussed on what happens behind the scenes as a student, house officer, undergraduate lecturer, research worker, GP, postgraduate educator, and NHS manager. I am sure the average UK patient, and indeed many health-care workers, including doctors, has no idea of what went on behind the scenes. Those doctors who were GP trainees in Yorkshire as well as those who were developed as trainers were so lucky to have some of the most interesting and skilled teachers in the UK.

This book is about my experiences, views, and the colleagues who have contributed to the direction of my medical journey. After the first chapter about my early life, I have purposely not written much about my personal life as the book is not intended to be an autobiography in the purest sense. I have included anecdotes and mentioned many people. This is because I do not want this book to be a text book. I apologise to those whom I have omitted to mention and who have contributed to my journey. I also apologise for not explaining fully some of the medical terminology used.

The British Medical Association has published guidelines for the medical profession when writing about patients. Written consent has been obtained for any named patients and an attempt has been made to anonymise the cases that have been described.

I am grateful to Dr Liz Moulton for feeding back to me on the final manuscript and advising me about any possible breaches of confidentiality and any other ethical matters.

Soon after I started writing, Dr Maggie Eisner and Prof. John Lord kindly read the first draft of Chapter 2 and gave me useful feedback.

I am most grateful to my wife, Kathleen, who gave me feedback after each chapter.

My godson, Nick Earls, a successful novelist in Australia, gave me valuable advice on a chapter in the very early stages of writing this book.

My good friend and colleague Grahame Smith gave me useful feedback on the chapter that covered our time together as preclinical medical students, Chapter 2.

Brian Lewis, an artist and writer, gave me valuable advice about publishing.

The last chapter involved talking to many people about their work. They gave up their valuable time freely, and I am most grateful for that.

Prof. Christopher Dean, professor of Anatomy at University College, London, kindly showed me around his department in March 2012 and introduced me to Daniel Wornham, a third-year iB.Sc. student. I am grateful to Daniel for informing me about the preclinical and B.Sc. courses as they were in 2012.

I am grateful to the dean of research at the Barts and the London School of Medicine and Dentistry, Prof. Thomas MacDonald, for meeting me. He showed me the state-of-the-art research facilities and explained the situation with Ph.D. students and academic teaching. Prof. Mike Roberts, dean for students, arranged for me to meet three junior doctors working at The Royal London Hospital.

Drs Emile Khan, Natasha Atchamah, and Viyaasan Mahalingasivan told me about clinical medical students and work as foundation year-one doctors.

Thanks to Carol Ward (practice administrator Roehampton Surgery) and Sue Careswell (Leckhampton Surgery, Cheltenham) for talking to me on the telephone and telling me how these practice have developed since I worked there.

I am grateful to Anthony Nicholas (events manager), Linda Reynolds (quality outcome framework lead), Karen Tooley (performance improvement manager), Monica Smith (partner, Tieve Tara Medical Centre), Alison Evans (Wakefield District appraisal lead, NHS Calderdale, Kirklees, and Wakefield District), Adrian Dunbar (associate postgraduate dean, Yorkshire and the Humber Deanery), and David Brown (programme director, West Riding General Practice Specialty Training Programme) for meeting me in 2012 and informing me about their areas of work.

Thanks to the following at Xlibris who have supported me with the writing and publication of this book: Sophia Blake, publishing consultant, Naomi Orleans, author services representative, Chris Lovedice, author consultant and James Calonia, manuscript series representative.

The royalties from this book will be donated to charity.

The two charities I have chosen are:

Children of Peace is a UK based charity that works with both Israeli and  Palestinian children to build relationships for a future generation whose communities might live and work in peace, side by side. It is supported by all three UK mainstream political leaders as well as other worldwide leaders. For more details look at www.childrenof peace.org.uk

CAFOD is the Catholic Agency For Overseas Development. My wife, Kathleen, works for the Leeds office in a voluntary capacity each week. It works with partners across the world to bring hope, compassion and solidarity to poor communities to end poverty and injustice. For more details look at www.cafod.org.uk

Follow the link below to see the coverage in our local newspaper. 

Local newspaper

I have had positive reports from friends and relations.

It can be downloaded to a kindle and bought from various booksellers including Amazon.

Sloan Place

This photo of me and Kath was taken by Mike Dixon and is part of a calender made by my niece Mary Sloan.

Last year Wakefield District Housing named a street after our family. It is very close to where Kath and I live. In the photo is Mark Traffod, our area manager of WDH. I have known and worked with him for many years. He is leaving soon and will be sorely missed by those of us on the Airedale Neighbourhood Management Board (a voluntary group working to improve all aspects of the area). He has been a great supporter of the work of the board.

Kath and I went to the opening in November 2011. Have a look at this write up:

http://www.wdh.co.uk/news/newsItem.aspx?NewsItemID=1924

The opening ceremony guest was Paul Hudson, the weather man from BBC Look North. He spoke first and then me. In the middle of my speech a schoolgirl fainted and I had to stop while she was taken outside. There was a competent nurse dealing with her so I had no medical input. When I continued what I was saying, Paul Hudson said she fainted because I was boring. I told him later that fainting due to boredom was a delayed action.

Fairburn Ings 27th December 2011

A bank holiday and mild and sunny weather. We went to our local bird reserve, Fairburn Ings, in the afternoon. It was packed with people and there were more birds that we have ever see. It was teaming with birds. We saw robins, sparrows, green and gold finches, ducks coots. We saw a woodpecker and a jay. There is a relatively new kingfisher viewing area. Kath saw one. I missed it as it flew off. What a great facility to have near where we live.

Visit to Abdul

Yesterday three of us who were at University College with Abdul (Steve, Grahame and I) drove in my car to North London in the morning to spend some time with Abdul, another fellow medical student. I had not seen him for many years and the others had seen him more recently. The three of us from Yorkshire had a good old catch up in the car. The round trip for me was 375 miles but I was grateful to Grahame
e who shared the driving. We all have our medical problems at our ages now and it was good to see Abdul in such good form despite a complicated neurological condition. He is a really talented artist and we looked at lots of his excellent work . Above is an example of his work that he emailed me a while ago.

We had a great lunch at an Iranian restaurant in Finchley. Beautiful food. Then back to Abdul and Yasmin's house (she was at work, unfortunately) for a quick coffee before setting off back home.

We must not leave it so long next time.

Abdul was so generous. He had already posted me one of his works. He gave Steve and Graham a painting each and insisted on paying for lunch. Thank you, Abdul.

Family Doctor

My father, George, was the first Dr Sloan.

QEGS

I had a wonderful morning yesterday. I contacted my old school after I was awarded the MBE in this June's Birthday Honours (I will write up that experience on my Professorpavov blog later). Neal Rigby, retired history master and President of the Old Savilians' Club, took me on a tour. He was absolutely great. The last time I nosed about the school was in 1980. I was a pupil there from 1953 to 1963.
What fantastic changes have been made. However, I could picture the biology and chemistry labs even though they were in other use. I remembered all the other classrooms I had been in. He gave me the latest tie and a fascinating book on the history of the school to celebrate its 400th anniversary in 1991. I note that my headmaster, Mr E J Baggaley, is the only head since 1591 not to have gone to Oxbridge and the only head with a science degree!!! I am so grateful to the school for setting me up with my education.

Easter Sunday 24 4

We had a great lunch with a friend at Monk Fryston Hall Hotel. The first photo is of Kath there today and the second in 1966.

22 4 2011

Friday 22nd April 2011
Fantastic weather here day after day. A week of firsts. Yesterday I went with the group of retired G Ps and locums on a tour of an estate of the ECO houses that are being built near where we live. I manage these monthly meetings which have been held for about 4 years) It is the biggest such estate in the United Kingdom. The houses are very heavily insulated and heated by a huge communal wood burner. The ash from that can be used as a fertilizer. Each house has a cleansing device so the bath and washing up water can be cleansed and used to flush the lavatory.

I found, a couple of weeks ago, where one of my ex trainee doctors was working in California. Adrian Rawlinson. My second favourite trainee!! I could not be obtain his email address is so I posted him a letter. I got a great he email back with photographs of his lovely wife and children. He told me what he was doing and wants to talk to me for 30 MINs about of project. He wants is to use Skype. He also wants to be a patron of the Castleford Choral Society!! I have this on my computer but have never used it. I contacted Martin Smith, our relation in Leeds and asked him if I could try it out with him. He phoned me this morning and told me to set up a video link with him. We had a chat while he was eating his porridge for his breakfast before going to church. What an amazing facility. The other thing I’ve done this week is to speak to publishing company based in the USA. I have written about 6000 words about my experience of the first 18 months being a medical student. I’m not sure anyone will be interested. The publishing company has an editing facility and looks good to me and makes me think of writing a book about what I think has been my fascinating life. Have I got delusions of grandeur?

20 4 2011

Wednesday April 20th
For the last few days we have had wonderful weather with temperatures warmer than Greece. Kath and I have twice been for walks. We went to Stanley Marsh in Wakefield at the weekend which was a new discovery. Yesterday we went on a 2 mile walk near the river Aire at Fryston. Lots of new paths have been made and there is a map of the walks there that I have printed. We are having loads of work done on the inside of Hill House – decoration and new carpets and bedroom furniture. The bedrooms have not been touched for decades. The lounge carpet was successfully cleaned yesterday and we have had to walk about wearing blue shoe protectors until it dried. Yesterday I met Liz Moulton for coffee at the Deanery in Leeds University. I was the first associate director of postgraduate general practice education and Liz is now the deputy director. We had a good catching up session. We have had a great professional relationship for many years. It was good to meet Esme again. Head from Katia in Italy that our cleaner of our Italian house, Luisa, has had an operation on her knee but all has been sorted out for our forthcoming visit.

April 11th 2011

Monday April 11th
On Saturday we sang in the Castleford Choral Society’s Spring Concert. Kath is the secretary of the society for very many years and I have been the Patrons’ Secretary since 1997. I have resigned as I want to do something different for the choir. Kath and I also open up the church where we rehearse and I am responsible for putting out the chairs. Kath works very hard indeed for the society producing all the tickets and programmes and has had to take over as seating organiser from Colin who has been ill. She has also done the publicity in our local paper. The society has its own website: www.castlefordchoralsociety.co.uk. We rehearse each Wednesday evening in the United Reformed Church in Castleford. The programme we put on was a great mixture and the venue, Trinity Methodist Church Castleford, was packed. The soloist (Pam Waddingon Muse), trumpeter (Anthony Thompson) made the evening a success as did our accompanist, Claire Burden who played the organ. We had really good positive feedback. It is a hard day for me and Kath, particularly Kath. In the morning a small gang helps to erect the stage and put out the seats. In the early afternoon we have a dress rehearsal and this year the conductor was particularly grumpy. I decided to change how I treated the patrons in the interval. In previous years I had brought all sorts to eat and used a small back room. There was always loads of food wasted. This year I decided to have a table in the main interval hall and serve coffee and teas to the patrons. The society gave the church a contribution and they put out chocolate cakes and biscuits for the patrons. These went down particularly well. I mis-judged the time and effort it took to serve teas to 30 people and thank goodness Kath came along to help. I managed to talk briefly to some of our friends before the second half of the concert.
Someone in the audincewas given permission to video parts of the performance you can look at the itenms on youtube by searching for Castleford Choral SocietyI then helped putting away the chairs and dismantling the stage before going home. We always have some (quite a lot) red wine and cheese and biscuits after a concert. This year Kath had pate as she had given up cheese for lent.
On Sunday, after we had prepared two rooms for the decorators, we had a day of rest. While Kath was at church I went for a walk in Fryston. It was a beautiful day and the walk is next to the River Aire. In the afternoon we failed to park at the Pugneys Park because of the crowds and drove up to Emly Moor TV mast ( the highest freestanding structure in the UK). The views from up there were pretty good. A curry in the evening followed by Lewis.

Diary 7 4 2011

Wednesday April 7th
Plasterers came on Tuesday morning to work in our conservatory before the decorators start next Monday. Mike, the chairman of the Airedale Neighbourhood Management Board came to get a cheque from me (which I forgot to sign) – a contribution to the board to pay some young lads to deliver the newsletter I have organised.
Today I delivered newsletters to Fryston village and half of a long road called Fryston Road. Occasionally I met people I knew as a GP which was very nice.I could write an essay on letterboxes. It was a beautiful day – the warmest of the year and the first day I did not wear a jumper. I practiced singing some music we are doing for the Castleford Choral Society concert on Saturday and in the evening went to a choir rehearsal. Kath is stressed with all this as she is the secretary of the choir and two people who do significant work are ill. So she is doing the work of the seating secretary as well as everything else.

Diary April 4th

Monday April 4th

The morning was spent organising painters and a plasterer as we are doing decoration of 5 rooms of our house starting with the sitting room and conservatory. Quite boring for a diary. The main thing for today was that the minister of state for health, Andrew Lansley came to the commons to make a statement about having a pause for the dreadful new health bill he wants to get through which could end up privatising large elements of the NHS. I have been writing loads of letters and submissions about this. I have followed the bill’s progress closely and below is my submission to the scrutiny committee:

1. I worked as a general practitioner in Castleford from 1978 until 2005. Throughout most of that time I was deeply involved with postgraduate general practice education and worked as a GP trainer; vocational training scheme course organiser; continuing medical education tutor and an associate director of postgraduate general practice education at the Yorkshire Deanery. Towards the end of my general practice career I worked part time for our Primary Care Trust, now called NHS Wakefield. I managed the education courses as well as the appraisal scheme for approximately 250 general practitioners. I was responsible for the training and development of 17 appraisers. I also dealt with underperforming and ill GPs. I was an appraiser myself as well as a quality outcome framework medical assessor and mentor. I retired from the PCT job at the end of May 2010. My qualifications are MB, BS, BSc, PhD, FRCGP and I have a post graduate certificate in primary care education.
2. I would like to outline what I feel my “relevant expertise and experience” is before informing the committee some factual information about general practice in the Wakefield District and then my views. During the many years I was involved with the training of prospective G P’s I taught communication skills both one to one and on an annual deanery summer school. I was an assessor of consultation skills. For several years I was tutor in ethics on a deanery summer school. When I was a course organiser I had to visit and inspect many training practises. More recently as an appraiser and quality outcome framework assessor I visited about 26 practises a year. Undertaking an appraisal could take up to 3 and of conversation with a general practitioner discussing in depth his or her work and plans for the future. No one is disputed that in the last six years of my work for the Primary Care Trust that I met more general practitioners than any other person working in this area. As the PCT’s appraisal lead, each year I read approximately 250 GP appraisal documents and made a note of each personal development plan.
3. This paragraph is about my ethical concerns. I was a very reluctant fundholder when this was introduced and resisted cooperating until we were forced because financial resources were being taken away from our practice. The reason I was anti fundholding was on ethical grounds. I could see savings being made by practices referring less to secondary care, prescribing cheaper drugs and are undertaking less investigations. It is obviously good practice to honesty look at referral patterns and see if the result of this indicates inappropriate referrals that could have been dealt with in house. It is also good practice to look at prescribing patterns and rational prescribing which could mean prescribing a similar drug that costs less. I am sure the fundholding created a conflict of interest during the consultation. One GP told me that he was telling patients they could no longer have a particular drug and that the government had instructed him to prescribe an alternative. When I pointed out to the GP that this was unethical he simply agreed and continued with his approach. At the time of fundholding I was a disability living allowance assessor. I was appalled that some of the patients I was assessing were not being referred to secondary care. Savings made by fundholding practices could be used to benefit the patients and also to build on to surgeries to provide extra space. There is nothing wrong with that but GPs generally own the surgery buildings and therefore are able to sell the building either to remaining partners on retirement or to a private company and realise very significant profits. I can see a similar situation arising if the bill is implemented. Section 223L (1) states “the board may after the end of the financial year, make payments to commissioning consortium if, in the light of an assessment carried out under section 14Z1, it considers that the consortium is performed well during that year.” Section 223Z (7) states “A commissioning consortium may distribute any payments received by it under this section among its members proportions as it considers appropriate”. I am grateful to Alice Miles writing in the New Statesman on the 7th of February, 2011 for pointing me towards this part of the bill. This reminds me very much of the ethical problems I saw with fundholding. The members receive money from the board and if the rule is that this money should be used to improve patient care then I can see buildings being expanded again and profits taken from this. I cannot see a surgery building owned by GPs extended and that extension owned by another body.
4. I would now like to inform of some of the activities of general practices that I have observed and heard about in this area over the past five years or so. One or two practices (and these were dedicated fundholders in the past) have created huge businesses by purchasing the buildings of small practices and employing GPs on a salaried basis. This has resulted in the absence of some of the partners from their base practice in order to pursue business or clinical activities in these purchased surgeries. The situation has caused one partner to move from one of these practices to another in order to continue with the excellent clinical care he wants to provide without having to deal with business affairs. The majority of GPs in this area are like him. Another practice has an operating theatre and secondary care consultants provide a service there which on the one hand is a good thing for their patients but on the other hand is diverting secondary care clinicians from their base. I have no idea what the financial arrangements for this are but I am worried about a conflict of interest here when the practice is involved with commissioning decisions of its consortia. I know that all these activities are allowed under the rules and are within the law. A few GPs make huge profits whatever system of primary care organisation is in place. These same few general practitioners who profited from fundholding, primary care groups and trusts and are now becoming seriously involved with the consortia.
5. I mentioned above that I was responsible for managing the appraisal scheme for NHS Wakefield for 6 years. Annex 1 is an extract from my fairly recent annual appraisal report (2009/10) which I believe was presented at a meeting of the PCT’s Board which was open to the public. These are examples of what GPs want to focus on in their learning plans. I did not have to remove anything for confidentiality reasons. “Maintenance” means “keeping up to date”. You can see from these, which are representative of the learning plans of the whole group, that the focus their education not on business matters but on clinical matters. It is to be noted that one GP put “let go of management” in his or her personal development plan.
6. The people I worked closely with for six years at the PCT were hard working, loyal and had the improvement of patient care as their main objective. I had two line managers, who were directors, one of whom was an ex midwife and the other worked for one day a week as a general practitioner. Part of my job was to deal with underperforming and ill general practitioners. I worked with each of these two directors on this. This was complex time- consuming work and required knowledge of employment law, the General Medical Council and the National Clinical Assessment Service. In the past there was the Local Medical Committee’s Professional Support Group of which I was a member. This attempted to do similar work and the members undertook this work voluntarily. Meetings had to be in the evenings and we had a senior member from the health authority to guide us. That work was amateurish compared with the approach of the Primary Care Trust. The expertise to protect the patients from underperforming and ill general practitioners will disappear on the abolition of the PCT’s. This is just one example, as I see it, of the consequence of the new proposals. Both of these are directors have left the primary Care Trust, one to work in secondary care and the other returning to fulltime general practice. There is no one working in this area with that experience or expertise. I could give other examples of a highly skilled and experienced people are leaving or planning to leave in the near future. The Primary Care Trust was a model employer with an excellent human resources department. I am afraid to say that many general practices are certainly not model employers or as good managers and I am worried that this will be reflected in the activities of consortia.
7. I am a member of the British Medical Association and proud to be a Fellow of the Royal College of General Practitioners. Of each of these bodies are representing my worries and I know each will be giving evidence to you. I feel so worried about the future of the NHS as a consequence of implementation of this bill. . I am not sure how much weight the committee gives to the views of individuals. However, the title of the guidance for submitting evidence is entitled “now have your say” he and I feel I have done that. I feel I have addressed matters contained within the bill, concentrated on issues where I have a special interest or expertise and included factual information of which I want the committee to be aware.
I watched the Minister of State for Health’s statements and the questions that followed this afternoon. Towards the end of all this a labour MP asked a question that was obviously very hostile. Mr Lansley answered that the MP should talk to Stewart Findlay who is the lead GP in Northumberland. Stewart is married to my second cousin Lorna and they live next door to William Hague. When we meet we leave talking about the NHS to just before we are leaving as we have such opposing views. I have emailed them to tell them I am embarrassed at having someone in the family with such views but in order to maintain family unity I will not tell the opposition all I know about Stewart. Actually, he is a very nice bloke and like us, has a property in Italy. Here is the Hansard entry:

Grahame M. Morris (Easington) (Lab): I would like to thank the Secretary of State for single-handedly destroying the Government's reputation on the NHS through this Bill. No amount of minor changes or slowing down of the pace will address the Bill's fundamental failure to protect the public from privatisation by stealth. If he refuses to resign, is he worthy of his nickname, Broken Arrow-he doesn't work and he can't be fired?
Mr Lansley: The hon. Gentleman might like to talk to Dr Stewart Findlay, who is among those leading the pathfinder consortium in County Durham. He might like to talk to people locally who are piloting the new 111 telephone system, which will give better access and better urgent care to patients. Instead of sitting there making rather absurd political points, why does he not go and talk to people who are delivering services to patients? That is what the NHS is really about.


I am very pleased that Shirley Williams has come out against this bill. She is very articulate and incise and I have great respect for her.