Doctors

The bishop hit us in the face. That was the best thing about confirmation. When I was 12, along with every other boy in the school, I was formally prepared for the sacrament that marked our passage from infancy to adulthood. Confirmation lacks the festive atmosphere of a bar mitzvah where families enjoy booze, dancing and speeches along with the exchange of gifts. For us, it was a cheerless affair held in the vast, under-heated parish church where 200 fidgety 12-year-olds waited to receive the appropriate blessing from the bishop. He was called Cyril. We were familiar with his name from Sunday Mass when he was cited as an appropriate subject for our orations. ‘We remember our Bishop Cyril in our prayers,’ said the priest.

Edward Gibbon was troubled by a swelling in his lower abdomen. I have the same condition. ‘Wow. That’s huge,’ said my GP as he gazed at the affected area. ‘Huge?’ I said, trying to sound nonchalant. ‘I wouldn’t know. It’s the only one I’ve ever seen.’ My cyst has been expanding steadily for decades and I was told a few years ago that its intentions were peaceful. My new GP was trying to scare me, obviously. I don’t blame him. It’s dull work staring at sick bodies all day and he was trying to amuse himself with a spot of scaremongering. ‘You’ll need a scan within two weeks,’ he added. ‘Cancerous perhaps?’ I asked. He nodded with a sly grin.

How a profession speaks to its subjects is always of interest to a writer, sometimes perversely so. Over the past few weeks a persistent problem with my foot worsened and appeared to take charge of things. (This isn’t going to be a piece moaning about ill health, I should reassure you.) The hospital took soundings of the ulcer, now turned into infection: first with a probe, then an X-ray, then an MRI scan, and finally the consultant manifested himself. The infection was in the bone and showed no sign of retreating under the antibiotics. It looked as if an operation was unavoidable, to remove – the consultant paused in his explanation – ‘We’re just going to take a kind of little nibble at the toe,’ he said. I regarded him levelly.

There is a war being waged in NHS hospitals. On one side are overstretched junior doctors in understaffed wards. On the other: physician associates (PAs) or, to use the more disparaging term, ‘noctors’.   Since 2003, non-medical graduates have been able to gain entry to hospital wards and GP practices if they complete a two-year clinical course that leaves them a ‘physician associate’ or ‘anaesthesia associate’. At first, PAs were rare – ten years ago there were fewer than 150 in England. Since the pandemic, however, the numbers have exploded. There are now approximately 4,000 PAs working in England and Wales.  PAs are supposed to help doctors with the time-consuming administrative work.

Arch rivals Justin Welby served longer as Archbishop of Canterbury than any of his four immediate predecessors, but others have served far longer. The longest since the Reformation was Randall Davidson, who held the position between 1903 and 1928, when he retired aged 80 – becoming the first not to die in post. Before the reformation, several Archbishops served stints of nearly three decades, but none so long as Thomas Bourchier, who was Archbishop between 1454 and 1486. Another long-serving Archbishop was St Dunstan, who held the post between 959 and 988, surviving to the age of around 80 in spite of having been beaten, bound and thrown into a cesspit in his youth. Digital divide How buoyant is the market for jobs in the digital sector?

Nye Bevan did not make old bones, and perhaps that’s just as well. According to a recent British Social Attitudes survey, 52 per cent of those polled are dissatisfied with the NHS, in particular with the difficulties in getting a GP appointment, with long A&E trolley waits and with huge delays for hospital appointments. All this, in spite of ever more money being chucked into its maw. If invited, I could immediately save the NHS a packet by dialling down the thermostat that has turned hospitals into Hotel Tropicana for bacteria, and by asking, wherever possible, patients’ relatives to provide food, thereby reducing the amount of unappetising slop that goes straight from plate to bin while the sick go hungry. But that is not my theme today.

In March 2020, as the health service prepared for the first Covid wave, NHS England encouraged GPs to adopt a new system called ‘total triage’. The aim was to reduce the number of patients in clinics in order to protect GPs, their staff and patients themselves from the virus. If patients hoped this system was a temporary, emergency measure, they were wrong. Under ‘total triage’, patients had to provide far more details of their (sometimes sensitive and embarrassing) symptoms to a receptionist or on an e-consultation form. They would then be allocated a telephone consultation with their GP or another health professional such as a nurse, pharmacist or physiotherapist.

Most jobs have their own joke books. If you’re outside the job, you don’t get the joke — and if you do get the joke, you’re on the inside; which is what the jokes are for. (It’s the same with all comedy: some, if not most, of the appeal of Stewart Lee is in being the sort of person who finds Stewart Lee funny.) But some jobs have joke books which, from the outside, are not just unfunny but actually offensive. Usually the most stressful jobs, those that involve the rawest emotions, have a gallows humour that is thought to relieve that stress. If you didn’t laugh, you’d cry. Or have to go to therapy. It’s been a mixed week for this sort of gallows humour.

Only later, perhaps even a decade later, as the pandemic of 2020-22 shrinks in our rear-view mirror, may we be able to assess its enduring consequences. So I am only speculating when I suggest that one of these may be the beginning of the slow death of general practice in the United Kingdom. And, no, this will not be a column attacking Britain’s GPs, whom I think to be mostly dedicated and hard-working men and women whose careers are demanding, whose work is difficult, and who are not paid excessively for the hours and expertise they bring to their vocation. Rather as with the class for which we use the generic term ‘politicians’, public discontent about ‘GPs’ is felt towards the generality.

Out of practice Sir: GPs are not ‘hiding behind their telephones’ (Leading article, 4 September). In-person appointments are the core of general practice, and practices have been delivering millions of them throughout the pandemic. GPs share patients’ frustrations with the limitations of telephone consulting, which can often take longer than a face-to-face appointment, and with longer waits to be seen. However, as with other areas of the NHS, practices continue to follow national infection control guidance to keep patients and staff safe. You talk of pubs and nightclubs reopening — but how many nightclubs force very sick people, many of them elderly and living with a number of long-term illnesses, into a confined space at the same time?

Nye Bevan famously said that he was only able to persuade family doctors to support the creation of the NHS because he ‘stuffed their mouths with gold’. But at least he obtained good service from them — including home visits. Until Tony Blair awarded GPs hefty pay rises while allowing them simultaneously to opt out of night-time and weekend work, they were responsible for their patients’ care 24 hours a day, seven days a week — with practices often pooling resources to provide continuous cover. But the role of GPs has become increasingly unclear: do patients have a right to be seen in person? It was revealed this week that locum GPs are being offered £100 an hour to conduct telephone appointments from their own homes.