A COUNCILLOR who moved to Britain from Bulgaria ... [more]
Wednesday, 16 October 2019
AT the September meeting, local GP Dr Mark Puddy took a look back at the 70 years of the National Health Service and in particular how it influenced the provision of medical services in the village.
He considered the situation at three specific times: July 5, 1948, when the NHS was founded, September 1, 1989, when he joined the Wargrave GP practice, and the present day.
In 1948 there was one village GP, Dr John McCrea, and surgery was at his house in School Lane. Mark observed that to get up the slope to the house, patients must have been fit!
There had also been a district nurse, Olive Cameron, who lived in Blakes Lane. She had just retired after 20 years and in earlier times had also provided general nursing and midwifery
Within the village, Woodclyffe House had been the Evelyn Home, a convalescent home for mothers and their children from London.
The Eleanor Wemyss home, which was attached to the Evelina Hospital (now part of St Thomas’s) in London, opened in Crazies Hill in 1931 and continued into the Fifties.
As well as the Royal Berkshire Hospital in Reading, there were voluntary hospitals in Henley and Battle Hospital in Reading, which occupied the former workhouse buildings.
Specialist hospitals were Smith’s in Henley for mental health concerns and Prospect Park for those with infectious diseases. In general, all these provided for patients who paid when they had treatment.
Under the NHS, all those hospitals would be nationalised. Teaching hospitals were created as centres of excellence, district general hospitals were provided for the general care of people in their district and GPs became the “gatekeepers” to the system — patients needed a doctor’s referral to get hospital treatment unless they were an accident or emergency case.
In 1939, Dr Godfrey Black took over from Dr McCrea as Wargrave GP and was able to recruit Dr Joe Paton.
At that time village had 2,200 residents and patients expected to be able to have night calls.
The intention of the NHS was to provide a service “free at the point of delivery”. The idea was that as people were treated for their illnesses, the need for care — and hence cost — would lessen as they became fitter.
The result was somewhat different. The predicted expenditure for the NHS in 1948 was £170 million but it actually cost £305 million.
One of the unpredicted problems was that if a patient was cured of an illness that was cheaper to treat, they would live longer and so be more likely to suffer from a more expensive one later.
Little changed until into the Sixties. GPs were still paid on a per patient basis, and were not allowed to “recruit” patients to increase their income.
In Wargrave, the surgery moved to Dr Black’s house in Church Street.
Patients would queue outside to get into the waiting room and there was just one other employee, Lucy Jones, who was nurse, dispenser, receptionist and practice manager.
Help came in the form of a change to the administration and funding of the system in 1966.
Loans would be available to buy or improve surgery premises and those who owned their premises would be paid a notional rent for their use. Doctors would receive additional payment for patients over 65 and also if they met certain targets,
In the late Sixties Bobby Bramall had suggested that as part of the Elizabeth Court development a new surgery could be built.
When this opened, it had two consulting rooms, a nurse’s treatment room, a waiting room, reception area and office and it was still like this when Mark joined the practice.
Other staff, such as health visitors and midwives, became associated with GP practices, especially in rural areas. Further change came when non-emergency hospital treatment was charged to a local fund-holding practice, but many GPs felt it was not their business to be managing budgets. A GP contract in 1990 created more performance targets and also made retirement at 70 compulsory.
At the time, Mark worked two nights a week on call and one weekend in four as well as giving his morning and evening surgeries.
A decade later, Wargrave became part of the Reddoc system, whereby night and weekend cover was provided by pooling the resources of practices in the Reading area.
This ensured that 24-hour cover was provided but some GPs did not like the fact that the doctor would be seeing patients they did not know.
A new contract was introduced in 2004, under which doctors could opt out of overnight and weekend working but village GPs still work a 60 to 65 hour week.
When Mark joined the Wargrave practice, there were no computers, but he was keen to introduce some to handle administrative tasks.
Although the NHS helped towards the costs, there was no common format for data handling, programs being developed by doctors who were enthusiastic amateurs.
Some GPs did not like the new technology and one local GP regularly placed a vase of flowers in front of the screen rather than use it.
Dr Thurston had started to create a summary of each patient’s written notes in 1985 and in due course these were transferred to the surgery database.
More recently, the NHS has tried to link the various systems but concerns over expense and vulnerability to data safety together with government budget cuts have resulted in an incomplete system.
Wargrave surgery now caters for about 7,200 people and regularly scores well in patient satisfaction surveys.
The surgery has expanded with seven treatment rooms and a physiotherapist.
Mark hopes that in future the human genome project will become the basis of treating patients in the way best suited to them individually with the most effective medication.
The society’s next meeting will be on Tuesday, October 8 when Linda and John Evans’ subject will be Caversham Court and the families who lived there.
Meetings are held in the Old Pavilion at Wargrave recreation ground from 8pm. Copies of the society’s latest publication, A Brief History of Wargrave, are available at meetings.
For more information, call Peter Delaney on 0118 940 3121 or visit www.wargravehistory.org.uk
23 September 2019
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