Georgia Avon is the ‘Nomme de plume’ of a London GP.*
Friday (The Handler)
Peter, Rula, Hana and Niva all started their morning shift together at 7am, and settled themselves in front of their monitors in good time. Gareth came round with the checklist and electronic timesheet and held the face scanner in front of each of their faces in turn to register their arrival for the start of their sessions.
Wendi was having a rare day off, and had arranged to meet Seamus near the ICAC for a coffee later that afternoon. Peter had heard a lot about Seamus and was keen to meet him to hear about his stories and experiences of being a GP, and to get some pearls of wisdom from him about what he should do in the future, as the way things were going Peter couldn’t see himself holding out as an IHP for much longer. Peter had watched an old film called Dr Zhivago, set in revolutionary Russia, the previous evening, which he had never seen before; he thought it was fantastic. He found himself incredibly moved by a scene, early on in the film, where Dr Zhivago was in a lab, looking down a microscope, when his Professor comes up to him and asks him what he wants to do as a career in medicine: “General Practice” says Yuri, with certainty. The Professor tried to persuade him to do pure research, but the hero repeats again emphatically “General Practice”. The Professor then pauses, looks at Dr Zhivago and says “ah, life, he wants to see life”, and then looks down the microscope and adds “you’ll find that pretty creatures do ugly things to people”. How true.
Peter wanted to see life. He was also now wanting to visit Russia and the rest of Eurasia; he hoped and prayed that the ceasefire would now mean peace after nearly a decade of constant war.
Gareth finished scanning them, and was just about to walk off to the other side of the ICAC when he turned around to Peter.
“Just to let you know I’m your IHP handler, so if you have any issues at all you come to me first, ok?” Gareth said to Peter menacingly.
“What’s a handler?” said Peter
“It’s the new ICG term for line manager” said Gareth. “Do you know what line manager means?” he continued sarcastically
“Yes, sure do…” said Peter, looking at his monitor at the list of 85 clients to speak to: all TAs and HVAs.
Niva, Rula, Hana and Peter made good progress through their clinics, and it looked like that they would finish in time to meet Seamus and Wendi for the coffee later that afternoon.
Rula looked through the window-slit to the outside concourse, where the door to the ICAC atrium led out to. She could see in the distance a familiar figure walking down from the far end of the concourse.
“It’s Seamus!” said Rula out loud, excitedly.
“Seamus!” Hana also called out, waving at him.
Hana watched as Seamus slowly walked down towards the café opposite the far end of the ICAC. She saw that Seamus had stopped walking, and was standing there motionless. Suddenly, Seamus started swaying, and then collapsed dramatically to the floor, and Hana could see blood start dripping on the ground from a gash on his head.
“It’s Seamus, he just collapsed!” Hana screamed loudly at Peter and Niva
“What do you mean?” said Niva, concerned
“Seamus has just collapsed outside in the concourse, we’ve got to go and help him!” said Rula
Hana, Rula, Niva and Peter started to rise from their seats, to head towards the door to go and help Seamus.
“Get back in your seats now!” a voice yelled from the back of the atrium.
It was Gareth
“But it’s our friend Seamus, he’s just collapsed outside”, said Niva
“Nothing to do with you” growled Gareth. “You three have still got an hour left of your shifts”
“But we’ve got to go and help Seamus, or at least call an ambulance” cried Hana
“Nothing to do with you!”, Gareth now shouted. “Get on with your shifts….”.
Peter looked at Gareth, and then looked out of the window. He could see that Wendi was now with Seamus and was helping him to his feet. He looked ok, and Seamus now had his arm around Wendi and they were slowly making their way to the café. Wendi was a superb IHP, so Peter was sure that Seamus was in safe hands.
“You should have let us go and help our friend who was unwell and collapsed” Peter softly said to Gareth, fixing him with a stare.
Gareth turned his head and stared back at Peter
“No, I shouldn’t” Gareth said
Gareth leaned towards Peter and Peter instinctively recoiled, thinking that Gareth was going to hit him, but Gareth turned his head and whispered into Peter’s ear.
“Remember… mate… I’m your handler…you do as I say”, at which Gareth turned away and made his way to café 101for his tea break.
Recommended soundtrack: ‘The Handler,’ by Muse
Sunday (Drones)
Recommended soundtrack: ‘Drones,’ by Muse
Seamus thankfully was ok, and it had just been a faint with a slight gash on his temple. Wendi had luckily been able to get some steri-strips and had done a good job in sealing the laceration up.
They had postponed the coffee until today, and they all met up at a new coffee shop on St Anne’s Place, near their flat at Endeavour Mansions. After years of post-Brexit coffee shortages, finally there seemed to be more coffee available this year, although it was still on a strictly rationed basis: Wendi’s February ration was almost used up already and she only had one stamp left on her Cof-card for the month.
Wendi and Peter went on ahead of the others striding towards the coffee shop. Wendi turned to Peter, looked into his eyes and softly whispered to him. “Do you like me?” Wendi said.
“More than ever” Peter immediately said back, looking ahead without hesitating.
The others then caught up with them as they reached the café entrance.
Peter, Niva, Rula, Hana and Wendi all entered the coffee shop – Endeavour coffee – and saw Seamus sitting in a corner looking a bit bruised and battered, already sipping his double macchiato.
“Hi Seamus” said Peter. “Really great to finally meet you!”
“Likewise” said Seamus, smiling, looking up at Peter, Niva , Hana and Rula
They all sat down together, and got chatting.
“So , how are you finding IHP-land Peter?” asked Seamus, smiling.
“Oh God, terrible” said Peter. “I was going to ask you about that Seamus, how do you see the future for us IHPs?”
“There’s the problem” said Seamus… “IHPs”
“Basically, they should never have got rid of the old GP system; if that had remained, we wouldn’t be where we are now. If the GPs at the time, back in the 2020s had stood up to Janus, Chase, Hemmingway and then now Morningbird, the GPs would have remained independent and not manipulated and controlled by the government of the day, or even worse by the private companies that now run most of the ICACs”
“Really?” said Niva sadly “do you think it’s too late Seamus, to go back to the old system?”
“Not sure” said Seamus , finishing off his coffee…” probably, but time will tell”
“Yes, not until we’ve all got PTSD”, added Rula
“I’m already dreading my shift tonight” Wendy said as he looked at Seamus, “and I’ve got two AIADS to authorise and despatch.
“Remind me what’s AIADS again?” said Seamus
“It stands for Artificial Intelligence, Assisted Dying Service” said Peter, “and it’s shortened to “ADs”
“no the ‘S’ stands for system I think Peter” Hana interjected.
“Anyway, I hate it” said Wendi. “ I haven’t even met the clients, and I have to authorise and despatch the AIADS drones to their houses where they then self-administer the barbiturates in the presence of an AIADS officer” “Sometimes, they don’t even have the correct stuff put in the drone at the depot, due to the Brexit shortages, so sometimes you don’t even know exactly what you’re sending there”
“Sounds awful” said Seamus. “So pleased I retired before all of this started”. “Can’t you refuse to do it?”
“They’ve made it a condition of working as an IHP that you do AIADS now…it’s in the contract” said Hana. Hana knew about these things.
“Bloody Morningbird!!” growled Seamus. “ I thought the previous lot were bad enough, but I can’t believe Morningbird is now Prime Minister”….”twerp” Seamus muttered under his breath…he didn’t want anyone else in the café to hear, just in case any ICG or ICMRG members were there. Even though he was retired, the ICG still had a lot of power and direct links to the police and NHSE@DOH
They all left the café, and Peter , Wendi, Rula, Hana and Niva headed back to the ICAC to start their nightshift.
They got to their booths and logged on.
Wendi saw that the two AIADS had been put right at the beginning of her shift. She had to call them first, check with Peter, who was sitting in the adjoining cubicle, verify the identity over video with a specified code, speak to the AIADS officer and then despatch the drone from the depot, all electronically of course.
She clicked on the name and the client appeared on the screen, with two, what looked like presumed family members standing next to him as well as the AIADS officer.
“Hello it’s Wendi Smith , IHP here, please can you confirm your name and code number”
One of the presumed relatives answered saying out loud the name and number
“No, sorry” said Wendi, “I need the client to speak and for him to say his name and number”
The other relative, started speaking, appearing agitated and said “we are the relatives, and have power of attorney; can you now despatch the AIADS drone as we are running late already”
The AIADS officer nodded, standing in the background. Wendi could see the client trying to speak, but he was immediately cut off and blocked from vision by one of the relatives.
“I’m sorry”, again said Wendi “If the client is able to speak – which I know he is able to – I need him to verify his identity and code number”
The AIADS officer suddenly interjected “Can you despatch the drone now, we are running late and I have two more ADs to go to tonight, and also the transplant team have been here and waiting for the last thirty minutes and they have three more AD – organ retrievals after this AD to do today.”
Gareth, unheard had come up behind Wendi’s cubicle
He put himself on camera and started speaking “what’s the problem, I’m the handler IHP, Gareth here, can I help?”
“This IHP won’t despatch the drone” both relatives said in unison
On the holo-prompt at large blue flashing prompt had appeared flashing “DESPATCH AIADS”
Gareth leaned towards Wendi’s side and sneered and then hissed at her “Press it”….”Press the prompt!!”. “DESPATCH THE DRONE NOW!” . He glowered at Wendi.
Wendi looked at the screen, the holo-prompt, the client, the relatives, the AIADS officer and then finally turned to look at Gareth, and stared into his pale, soul-less eyes. She swivelled on her chair, tripping Gareth up so that he landed face first into the monitor, disconnecting the consultation, and then landed sprawled amongst the wires, straddling the cubicle.
Wendi, had by now come into Peter’s cubicle, and turned to Gareth, who, having rolled over was now lying face up on the floor and she looked him in the eyes
“F**k off Gareth you total creep” , Wendi softly said to Gareth , looking straight at him, as he lay on the floor entangled amongst the cables and wires. Wendi and Peter then disconnected their headsets, and both then walked straight out of the front doors of the ICAC atrium hand in hand.
“Follow me”, Wendi whispered and gestured to Peter as they walked thought the doors of the atrium.
(Recommended soundtrack: ‘Follow Me,’ by Muse)
Niva, Rula and Hana had been watching this, open-mouthed , from the other side of the ICAC and the all started slowly, silently , clapping their hands…
Niva looked out of the window slit and saw a beautiful crimson and white butterfly land on the ledge, and remain motionless. “Look at that beautiful butterfly!” Niva exclaimed to Rula and Hana
Rula and Hana both looked and just caught sight of the butterfly as it flew off the ICAC window ledge, into the sky away from the ICAC.
“That reminds me of the Butterfly Effect”, said Rula
“What do you mean?” said Hana confused
“In Chaos theory, you know the so called “Butterfly Effect”, they say that something as small as the flap of a butterfly’s wings can trigger and cause a huge event in the future, even at a far off distance, through unforeseen and unpredictable events; even something extreme such as a like a hurricane” explained Niva
“Wow, a hurricane!” exclaimed Hana
Recommended soundtrack: ‘Butterflies and Hurricanes,’ by Muse
Thursday (Defector)
Wendi and Peter had walked straight out of the ICAC, and the first thing they did was to call Seamus to tell him what had happened.
“What you mean Gazza was left lying on the floor, entangled in the cables ?!” asked Seamus chuckling, as he heard what had happened. “Well done you two!”. Seamus continued , laughing.
“Have you been back to the ICAC since?” Seamus asked, continuing
“And what about Niva, Rula and Hana?”
They were sitting in Endeavour café mulling over the events from Sunday over some double-cortados. The café had just received a shipment of some great Scandinavian coffee, (which due to the change in climate over the last decade could now be grown in the Scandinavian lowlands), which they all thought tasted spectacularly good.
“Hana, Rula and Niva are fine” said Wendi, “although I think they were a bit shocked about what we did!”
“We’ve received our official dismissals today”, said Peter. “I’m going to print mine out and frame it I think” Peter said, laughing
Peter continued “You know what, I really feel a huge weight has lifted from my shoulders, since Sunday. The ICAC is just so miserable and soul-destroying. Now I just need to find somewhere else to work and something else to do! I’d better start thinking”
“What sort of thing are you thinking of?” said Wendi, who was having similar thoughts to Peter.
“Well, it would be a shame to train for so long to be a GP, and then just give up…I mean it could be an amazing job, it’s just the system and the structures and ethics that need to be right I think? What do you think Seamus?”
Seamus stroked his beard, and started nodding, glancing out of the window towards Endeavour Mansions where they all were living. It was a beautiful old large mansion block, with big rooms, but was now only half full since the exodus from London after Brexit and the pandemic. Rents in general were still fairly high though, but luckily the landlord was an old school Irish aristocrat who was generous and kind to the tenants, and had lowered the rents recently.
“I totally agree with you Peter” said Seamus, stroking his beard. “It could be and should be the best job in the world; you just need to get the ethics right first, and then build things up around the ethics, then it will be solid” said Seamus
“Do you know of the poet WH Auden?” asked Seamus (who himself dabbled in a bit of poetry)
“No, not really” said both Peter and Wendi
“His father was a doctor and he had a huge interest and respect for the medical profession, but he thought the best type of doctor – to see as a patient – was one you could imagine going to the pub or a coffee with and having a drink and a friendly chat” laughed Seamus…. “something I totally agree with!”
Seamus got out his phone “there a great quote from him about doctors, let me try and find it on my phone”
Seamus fiddled with his phone for a bit, peering over the top of his glasses.
“Ah here it is!” exclaimed Seamus smiling
Peter and Wendy peered at the I-phone screen (Seamus hadn’t upgraded to the H-phone yet) and both read the quote at the same time:
“A doctor, like anyone else who has to deal with human beings, each of them unique, cannot be a scientist; he is either, like the surgeon, a craftsman, or, like the physician and the psychologist, an artist. This means that in order to be a good doctor a man must also have a good character, that is to say, whatever weaknesses and foibles he may have, he must love his fellow human beings in the concrete and desire their good before his own.” — W. H. Auden
“There we go” said Seamus, grinning. “Auden also said something about medicine being ‘the intuitive art of wooing nature’ or something similar…..fantastic!” said Seamus, taking a sip of his Cortado, although it really should say “she”, but I suppose in Auden’s era in the mid-1900s the vast majority of doctors were men.
“Doesn’t sound much like the ICAC to me, with it’s pseudo-medicine and digital vapourware!” Peter said laughing.
“No…. not with Gazza in charge”, Seamus said still chuckling about the thought of Gareth lying on the floor entangled in the cables and wires. Seamus had briefly met Gareth once before and had immediately disliked and distrusted him.
Seamus continued “All that Artificial Intelligence claptrap that’s peddled at the ICAC as well….well.…its just bullshit isn’t it!”. “For good medicine, decision-making and patient care, you need a human being and human consciousness, grounded in the right ethics and values, in the humanoid form of a General Practitioner, that’s my view! The AAIBS gets it completely wrong most of the time doesn’t it?”
Wendi and Peter both nodded in agreement
Seamus continued, now getting irritated: “Despite the ICGs claims, AI can’t make clinical decisions, it can only lead you to a decision, and most of the time it’s the wrong one. For goodness sake I tried it myself the other day and it can’t even diagnose an ingrowing toenail! There’s billions of pounds of government and private digi-tech investment for you…. an ingrowing bloody toenail – even my six year old grandson can diagnose that!”
“There’s a fundamental flaw with all the claims about AI. Have you heard of John Searle’s arguments about this?” Seamus continued. Wendi and Peter now both shook their heads, but were interested to hear.
“In the end this is a question of our humanity and also that other mystery that is human consciousness. John Searle the philosopher in his “Chinese Room” argument demonstrated that a computer executing a program cannot be shown to have a ‘mind’, ‘understanding’ or ‘consciousness’, regardless of how intelligently or human-like the program may make the computer to behave.” “Look it up” gesticulated Seamus, excitedly throwing his hands up in the air; his Ulster accent got more pronounced when he became animated or angry.
“Consciousness, embedded in the right values is fundamental to good decision making as a doctor – ‘Artificial Intelligence’, if indeed you can call it that, in it’s very fundamental essence and nature can never, ever replicate this. Searle showed this definitively!”
Wendi and Peter found this discussion about philosophy fascinating, but their thoughts turned to what lay ahead of them.
“Well, where else could we work?” asked Wendi, as she was finishing off her Cortado ; she pressed her Cof-co app and re-authorised her account for the next month, and her quota was reset to four. The Danish coffee was so good, she thought she’d have another one now: she pressed on the Mocha option, and within thirty seconds the coffee appeared in the centre of the table via the central portal. She sipped it and it was amazing. She was hoping the Brexit coffee shortages would soon be over, and that rationing would stop.
“Mmmm….” mused Seamus, “why don’t you and Peter set up your own GP surgery?”
“Our own surgery?!” said Peter, excitedly. “Wow, that would be amazing, but are we allowed to?”
“Yes” said Seamus “when they transitioned over to the ICGs in the mid-2020s, the RCGP, (as it was known at the time, before the change to the RCPCP) insisted that the pre-2026 GPs could still set up their own surgeries and see patients if they could find premises. This still holds, and I’m sure that the RCPCP still would have to support this, as it is still in the legislation and constitution I believe”
“I didn’t know that!”, said Wendi. “The ICG must have kept that quiet when the ICG changes came it”
“Yes I think they did” said Seamus. “I think they wanted to corral, and keep the GPs and rest of the Primary Care workforce in the dark until the IHP changes occurred, and unfortunately it worked as there are hardly any small GP run practices left in London”
“But where could we work and use as a GP surgery do you think Seamus?” said Peter
“The answer is staring straight at us I think?” laughed Seamus. “How does “ ‘Endeavour Medical Centre’ sound to you?”
Peter and Wendi paused briefly and then both simultaneously exclaimed “Yes !” excitedly
As Endeavour Mansions was half empty the whole of the bottom two floors of the building were pretty much unused and had great spacious rooms, bathrooms and various other utility rooms.
“Yes it could definitely be converted to be used as a GP surgery”, said Seamus. “I can contact the landlord, the Duke of Leinster , Patrick, and ask him, but we’ve been great tenants, and I’ve actually given him loads of medical advice over the years, so he does owe me a favour I think”
“Yes that sounds a great idea!” said Wendi
“Do you think we can get other doctors to be involved as well” said Wendi?
“Oh yes I think so”, said Peter “I’m sure there will be some more defectors from the ICAC; most of them hate it there – there’s Hana, Rula and Niva for a start”
“Good idea” said Seamus “ lets speak to them and see what they feel about it, they are definitely potential defectors”
Recommended soundtrack: ‘Defector,’ by Muse
*Name and address supplied to the BJGP team
‘Narrator’ Photo by Christian Holzinger on Unsplash
Featured Photo by Aditya Vyas on Unsplash
