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Through the eyes of a locum

Euan LawsonIn the world of NHS reform, there’s little room for anything else but doublethink. Dr Euan Lawson, a locum GP from Cumbria, shares his views

It’s tempting for locums to take the ostrich approach to NhS reform. The business end of treating patients doesn’t change much. A slightly different set of pop-ups decorate the PC screen. A new sheaf of referral guidelines bow the shelves. Yet it is hard to ignore the GPs who seem greyer, more harassed, and demoralised.

The future of the NHS looks distinctly dystopian, even Orwellian, as the state is reaching out, controlling the working life of GPs. Our rural PCT will be subsumed into the new Local Area Team. Sorry, Area Team. Orwell would have appreciated the irony of an organisation that stretches across several counties trying to brand itself as local. Someone twigged and there has been a hasty renaming.

Speaking to one GP of my concern that I found the changes difficult to fathom, he paused and sagely told me it was probably to do with my locum status. In fact, he told me with a dead-eye stare, most GPs were entirely happy with the new structures. The telltale flicker of one eyebrow betrayed my thoughtcrime as I nodded politely.

One positive change is that a handful of local surgeries have managed to secure new premises. Few GPs will complain when they move from cramped, converted residences into purpose-built health centres. For me, the change isn’t entirely welcome. Surgeries are being homogenised. I miss the charm of floral curtains, anaglypta wallpaper and the bamboo screens around the examination couch found in one surgery.

Surgeries are being homogenised. I miss the charm of floral curtains, anaglypta wallpaper and the bamboo screens around the examination couch found in one surgery

Do clinics really have to look so soulless and, well, clinical? None of the new surgeries has carpet. They all have those funny little concave skirting boards so bugs can’t hide away in corners. I can imagine a few patients who may start licking the skirting boards in their own home, but it has rarely been a significant problem in the surgery.

There are a few pockets of resistance. I’ve seen practices where the partners cling stubbornly to the Lloyd George notes. These GPs refuse to be assimilated. They laugh in the face of patient pathways and favour their own, carefully crafted, back channels. The PCT may be lining them up for a slot in the nearest gulag but their patients generally adore them.

At the moment, I get the impression that the change relished by most GPs is the one that retirement will bring. In the surgeries, the coffee rooms are now refuges for locums and medical students; the partners are buried in their bunkers counting down the days. I bump into haggard GPs as they pore over the visits book. I try to offer a few crumbs of nourishment with the words a wise trainer once gave me, “When the going gets tough,” I tell them, “lower your standards.” They usually manage a wan smile. I’m only half-joking but in the world of NHS reform there’s little room for anything else but doublethink.