‘My 25 years in a changing NHS’ by a Thame GP

DUNCAN Keeley was a GP Partner at The Rycote Practice in Thame, for nearly 25 years before retiring in December of last year. Since then, he has been reflecting on his two and half decades working within a changing NHS, and has agreed to share his thoughts with Thame.Net – and he doesn’t pull any punches!

Dr Duncan Keeley

“WHEN I left the Rycote Practice in December I had been working in the NHS for 37 years and working here for nearly 25 years. It’s a strange experience, saying goodbye to people you have looked after for a long time and I am very grateful to my patients. Our patients look after us well here.

“In 1991 I was a partner in London, but when my wife’s job moved to Aylesbury I needed to find a practice nearby. It has been an enormous privilege to be part of a caring & supportive team that provides, I think, excellent care for patients. Much has changed since 1992. Our health centre buildings have been redeveloped & upgraded three times. Our team of nurses, healthcare assistants & administrators has grown in number, and their expertise and their role in patient care have developed enormously. We have taken on a steadily increasing amount of the outpatient medical care that used to be done in hospitals – and do this work to a high standard.”

What are the challenges for the NHS & for the practice?

“Doctors differ in their views on what the major problems are but these are my thoughts. Health care funding in the UK remains low by international standards, and the share of NHS funding going to patient care in general practice has fallen in the last 10 years – while our workload has increased. This is exactly the opposite of what is needed if more care is going to be done closer to home.

“In 2004 general practitioners lost the duty to organise care for their patients outside normal working hours. Responsibility for this grave mistake was shared between government and the GPs. Things could not have continued as they were, but the change was badly handled & has never been put right. Better investment in out-of-hours urgent primary care is badly needed. Growth in the size of primary care teams & the increase in part time working by doctors has reduced continuity of care. Continuity of care is better for both patients and doctors. Repeatedly, poorly thought out re-organisations of the health service by governments of all political parties have wasted money and energy over and over again. The biggest problem is the foolish notion that the NHS would work better as a patchwork of competing private businesses. This has been far too influential and now threatens the NHS itself. Co-operation is better than competition in the provision of health services.

“I believe that the Rycote Practice has handled these challenges as well as any practice I know. We have managed to keep the atmosphere of care and mutual support among colleagues that I appreciated so much when I came here. We have an excellent team and growing support from our patient participation group and the wider community. At a time of difficulty in recruitment we continue to attract great people to work with us. We play a major role in training the medical students and GPs of the future.

“I hope and trust that the Rycote Practice will continue to provide great care for the people of Thame. I hope it will continue to defend the founding principles of the NHS – they need defending. And I hope that a young GP starting out now will in 25 years look back on their career with as much pleasure as I do mine.”