Archive for August, 2022

I did it my way

I qualified in 1965 and having sampled hospital clinical medicine in London and Cambridge for 3 years I decided that it was not for me – I neither enjoyed it nor found it particularly challenging (interestingly at University I was told that reading medicine was a waste of talent and that I should do something really scientific!). With a wife and three children by this time I looked for a job that allowed more time with the family and which paid more than a junior hospital doctor’s salary. It never occurred to me to become a GP which would have satisfied these two criteria and instead embarked on a public health career as a Medical Officer at the Birmingham Regional Hospital Board. This post which introduced me to health needs analysis and the planning of hospital services for a population of 5 million was not particularly interesting but it allowed me to embark on the formal training pathway to become a qualified public health practitioner. Although the London School of Hygiene and Tropical Medicine was then offering a brand new 2 year masters training programme, encouraged by my Scottish boss I applied instead for the Diploma in Social Medicine Course in Edinburgh which I obtained in 1971. 

Then I very rapidly climbed the new career ladder in Community Medicine as it was then called and following posts in Wolverhampton, Stoke on Trent and Wakefield I was appointed Regional Medical Officer at the North East Thames Regional Health Authority. Not only was a regional post as high as I could go in the profession, the region I was appointed to was in a class of its own among the 14 regions in England – It was in a very real sense the dream job.

After 7 years in this job I got itchy feet and fortunately another NHS reorganisation saved the day by introducing general management. So, having had a long term interest in management and been sent to the US by the NHS for management training, I applied for and obtained one of the new District General Manager posts in Frenchay, Bristol where I stayed for three years. Falling out with my Chairman who was an import from industry who knew absolutely nothing about the NHS and healthcare – such wrong-headed appointments were all the rage with the Government of that time – I moved back to community medicine and obtained a post as DPH for the Norwich Health Authority which I held for 5 years before moving to Wales, initially as a Senior Lecturer in Applied Epidemiology and then as a locum consultant in public health with the Dyfed Powys, Swansea and Mid Glamorgan health boards and ending my career as the Public Health Director for Ceredigion and Powys Health Boards.

While working in Wales I joined the Labour party, became Chairman of the Socialist Health Association and for a period was a City Councillor in Bristol for a deprived ward in the south of the City.

The only time I felt that I was practicing real public health i.e. public wellbeing, as distinct from applied epidemiology, was when I was a Deputy Medical Officer of Health in Wolverhampton and later a Bristol City Councillor. In both posts I had a real sense that I was working in an organisation that could control at least some of the main levers of public health – or more correctly public wellbeing – for the benefit of the local population.

The main influences on my career were Gerry Morris, Bob Logan and later Julian Tudor Hart. In it’s origins the Faculty was a relatively inaccessible organisation, and as such I was very supportive of the Public Health Alliance and its successor the Public Health Association.

A mistake made by the Faculty at its inception in my view was to limit membership to doctors only, and whilst the Faculty now has a much more open membership, as a young community physician this prevented me from engaging with or supporting the Faculty at that time.

Paul Walker

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Je ne regrette rien

My own experience was essentially positive, probably helped by working as a GP and as an academic in other countries, and away from the PH service work so I came back with new experiences and perspectives.

I qualified first in Dentistry in 1965 determined to continue with Medicine and a career as an oral surgeon or in dental medicine. An oral surgery job in Scotland was interesting but not for a lifetime and returning to Medicine I became fascinated by Social Medicine. The teaching was uninspired, but I got to know Jock Anderson, the Head of Department and he helped me to think things through (everyone else thought I was mad)!

I qualified in 1969 and there were house jobs at Guy’s and Guildford but a desire to go to Africa where Jock advised I could get maximum experience across the spectrum. Wife, 3-month son, we sailed for Cape Town and on to Zambia…. On my return 3 years later he supported my application for the 2-year MSc at LSHTM. The MSC.in Social Medicine was designed for the new Public health role of the 1974 changes, and a different background and content from the DPH. It was two years, a whole year for a research project and enlightened teaching in Sociology, Economics, Epidemiology, Statistics, Management – but best by far the other people on the course, with a good deal of clinical experience but a genuine interest in a community and preventive approach with an understanding of information and to make for efficient and effective services within a cost envelope.

I was appointed to Tower Hamlets as DCP in 1976 and was there until 1981. I was single handed and also managed Infectious Disease/ hazards like asbestos. There were major health issues with homeless alcoholics with TB and Bengali immigrants in sweat shops, in squalid accommodation and with TB, Typhoid, Diphtheria…19th century stuff. Nobody quite knew what a DCP did, so I followed my instincts in a deprived part of London with a famous teaching hospital. I also worked quite a lot in the old MoH model with the LA, attending meetings, medical housing, school health…and the Winter of Discontent plus major industrial action by the Health Unions. Frank Murphy was at Area, you came to Region, Spence Galbraith had set up CDC Colindale – there was HIPE, HAA (neither very useful and full of errors) and RAWP

I persuaded the HA to let me do a year as a P/T trainee GP as the next re-organisation was coming. I had done a lot of locums by then as we had a young family, I was offered a partnership in Bedfordshire where we had done several locums and the practice agreed I spend 2 days a week in PHM my salary going into the practice earnings and I did 2 days a week in Luton working mainly in planning and supporting /deputising for the DCP (the unfortunate David Josephs who became a good friend and took his own life).

After 8 years as a partner we wanted to get away from the London orbit and after a few attempts got the DPH job in North Devon in 1989. We have lived here since. Again (as in TH) I was singlehanded and had time and space to do my own thing. (There were excellent secretaries, a registrar and information expert to help). Again I worked across the interface with the LA and in the MoH mode, this worked well and with excellent GP’s and Consultants, a new Hospital and no serious deprivation it worked well. I got much involved with the health problems of sheep dip in farmers. And the Cinderella services as we worked through Purchaser/Provider, contracts, and a new Trust.

When North Devon joined with Exeter, I did not get the DPH job and after several tries in Britain I went again to Zambia as an academic teaching Social Medicine and an MPH course for 3 years. There was quite a bit of clinical medicine too – I visited a mission hospital alternate weekends where there was no doctor. There was the chance for research too – I have always tried to publish stuff and with moderate success ever since Zambia in the 1970’s.

Returning to Britain in 1998 I could not get a job in PHM – too old, too experienced, a loose cannon… several long locums and the best a long appointment looking at rare diseases which cost a lot and have to be planned and organised at regional or national level. This was fascinating and with computers and enlightened statisticians it was possible to build costed models of care reflecting need, demand, and practice.

However when I had struggled to get work I had applied for an academic job in Papua New Guinea – they tardily got in touch and after some heart searching went again alone (dangerous for wives)  to teach mainly PHM as an MPH but also a whole range of stuff to undergraduates – from biochemistry to forensic psychiatry…

On return, and I had my NHS pension by then, I did 5 years as a GP with the British Army and became involved with various national bodies e.g. NICE. Information Standards. The best things in PH to my mind – The CDC at Colindale, The Cochrane Foundation and NICE

I liked being in the NHS rather than the LA and being able to talk “doctor to doctor” with clinicians. I was working before the purchaser provided split and in North Devon acted as a personnel manager for the Consultants. I liked being between Medicine and Management and trying to explain one to another. On the whole I was lucky with Chairmen and Chief Executives who let me get on with things, more or less unfettered. It is now much more difficult, tight job descriptions not much room to pursue possible problems.

I think there were lessons to be learned for the Faculty in their response to Nuclear weapons and opportunities to challenge Government. The BMA Board of Science produced good science, Brian Jarman measured deprivation and health.

Other doctors in PHM, generally good experiences, (a few rogues, idlers, and villains but so it is everywhere) and excellent registrars, I helped to train. The newer younger GP’s and Consultants seem more open and easier now we need care ourselves!

I have been very fortunate; I am glad not to be working in the NHS now but also miss the struggles and occasional triumphs!

Peter Sims

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