Better Health For All

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…19^th 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