Saul Miller is a GP in Wooler, Northumberland.
I retired abruptly. Well, pretty much. A management role ceased a few months before, but the rest continued till Old Year’s Night.
As the new year dawned, I was dazed to find myself not needing to return, nor even to set my alarm. Thankfully soon we were away on that long-promised long holiday.
So it took a few months to get back, agree to a few locums, then actually turn up and dive back in. Only then have I been able to decide how I still feel about medicine. And the answer has surprised me.
Doing surgeries and seeing patients has for years felt like swimming the length of a pool underwater – it needed a proper lung-full before launching in each time and pulling hard for the far end. This was despite being fortunate enough to work in a stable practice where we had high levels of personal continuity with demand largely matched by supply. I have enjoyed it but would also have described it as intense, oxygen-depleting.
As a locum though, it has felt different. Lighter, easier somehow. Surface-swimming maybe.
Doing surgeries and seeing patients has for years felt like swimming the length of a pool underwater – it needed a proper lung-full before launching in each time and pulling hard for the far end.
Do not think I have been protected in some way – I have not. My case mix is much broader than it has been for a long time, so I am being daily tested in terms of knowledge and skills that I have not had to deploy as readily in years. I have by now worked in multiple settings, been exposed to alien systems, unknown processes. Still the feeling remains: seeing patients seems so much less stressful.
No doubt having the choice helps – I am fortunate in this, for sure. But it seems to me more than just this.
What has disappeared are emails, instant messages, colleagues popping in to ask questions or discuss the latest political diktat, targets to be managed, and a host of other pressures.
For a start, I have more time in the consultation now. What has disappeared are emails, instant messages, colleagues popping in to ask questions or discuss the latest political diktat, targets to be managed, and a host of other pressures. Many of them I welcomed, particularly having an open door to colleagues, but with their absence I notice this change: all that is left is to focus on the patient in front of me.
Sure, I am not practising in a vacuum. I still do care about supporting the practice I am in to achieve its goals. But the key is that these are its goals and not mine. I will do what I can but knowing I can safely leave the pool when I have finished swimming each day.
I do believe personal continuity is a key ingredient for high quality care, and my new role arguably does not help with that. I reassure myself however that ensuring there are enough swimmers in the water is someone else’s role, mine is simply to help when there are not. It turns out to be very interesting too, being invited into varied practices to help out and see from the inside how they run.
For example, in recent weeks I have been in the far north of Scotland, working in a couple of practices run by the local NHS system with everyone salaried, including the GPs. Here, it has been interesting to see how far outside themselves my colleagues’ locus of control lies in relation to so many aspects of their working lives. System ownership has not been an unqualified success, it appears. As England moves inexorably towards hospital trusts holding all the levers of control over primary care,1 it is a timely reminder that greater system control often suffocates as much as it buoys.
For me though, the key question will be simply whether entering the water remains inviting.
Reference
1. https://www.england.nhs.uk/publication/neighbourhood-health-centres/ [Accessed 27.4.26.]
Featured Photo by Brian Matangelo on Unsplash
