The new surgery opened in June 1991. Overnight, the Practice suddenly had a fully fitted treatment room and nurses’ room, four modern and equipped doctors’ consulting rooms, a spacious reception area and generous offices and meeting rooms. What luxury! Mrs Margaret Baynes, the Practice Manager for the next five years was succeeded by Mrs Sue Evans who is pictured (far left) with members of the staff of the time who may be familiar to some readers. Drs Hunter, Holcroft and Czerniewski were joined in partnership by Dr Elizabeth Roberts in October 1991. Child health surveillance, maternity care (increasingly involving midwives at the practice), homeopathy and minor surgery were regularly offered by various partners in addition to 24/7 availability of an on-call partner. The out of hours system was, however, under pressure nationally. Whereas in previous decades waking a GP to attend at night was reserved for serious illness and thus infrequent, attitudes were changing and by the 1990s night calls were increasingly frequent. As the same GPs were typically working during the next day, the situation became untenable and during the 1990s various GP Cooperatives were set up in localities (RADOC in Rugby). They arranged rotas for a single Rugby GP to cover all calls in Rugby on each night, thereby protecting the sleep of colleagues. There were also centralised urgent surgeries during evenings and weekends. Ten years later the GP Cooperatives were replaced by bespoke Out of Hours providers, accessed through 111. The rapid evolution of IT also affected the NHS in the 1990s and medical summaries and prescribing were gradually transferred from paper to the practice computer. This required doctors to learn new skills and to summarise and transfer information, which was time consuming and onerous, and had to be done alongside their normal duties. Most consultation notes were still handwritten in the 1990s but the practice moved to completely computerised notes for everyone by 2003. These changes in working patterns also coincided with the announcement of the retirement of two partners in 1997. Who would step into their shoes?
GP Training involves established GPs taking on junior doctors in the practice for 6 to12 month periods in a form of an apprenticeship. The Trainees (or Registrars) are fully qualified doctors with three or more years of hospital experience who have committed themselves to a career in general practice and need to become familiar with the community-based work of family medicine. At the end of their training and after passing exams for membership of the Royal College of General Practitioners (MRCGP) these doctors qualify to practice independently as GPs. In the 1990s, GPs could become Trainers after five years of practice and it had been Drs Czerniewski and Roberts’ ambition to establish GP Training at Dunchurch since they had joined the practice in 1991.The process stimulates learning, introduces new skills, ideas and personalities to the practice which in turn keeps established GPs up to date and ultimately benefits patients. Apart from completing a course as a GP Trainer, the host GP had to bring practice procedures up to certain standards and to summarise patient records which were still mostly kept in paper form. When candidates for partnership were interviewed in 1997 and 1998, one key requirement was that they should be interested in GP Training. Dr David Carne was already a qualified Trainer at his previous practice in Croydon and Dr Kate Reynolds had trained in a practice with very strong training credentials. The four partners set about summarising 6000 sets of notes and preparing for training. Dr Carne was instrumental in driving the process and was the nominated Trainer for our first Trainee, Dr Fiona Thomas in 2000. Dr Czerniewski became a Trainer in the same year and Dr Reynolds followed. Since then, there have been almost 50 GP Trainees at the practice, many of whom have become successful local GPs and several have become trainers themselves. Apart from training, the partners also continued to adapt to the endless NHS re-arrangements going on around them.
Arriving in Dunchurch in 1997, Dr David Carne quickly became an integral part of the practice, contributing enthusiasm and ideas from his education in Melbourne and experience in practices in Australia and Surrey. His dedicated work ethic and shrewd clinical acumen were respected by colleagues, while his relaxed antipodean twang and friendly manner were immediately popular among patients and staff. He soon developed a loyal following among patients. Dr Carne drove the development of training at the practice and helped to maximise the potential of the surgery building with extensions and adaptations. He also contributed to the ongoing computerisation of the practice and the transition to paperless electronic records in 2004. This was also the time when the new GP Contract came into effect nationally and primary care had to negotiate and adapt to changes. Dr Carne represented Rugby GPs at the Warwickshire Local Medical Committee (as Dr Hunter had done), while Dr Czerniewski was one of the first GP Appraisers in Rugby and Commissioning Lead for the Rugby PCG (Primary Care Group). The PCG structure was an early attempt by central government to enhance collaboration between practices which has now evolved to the current Primary Care Network (PCN). Despite the endless changes and reconfigurations, the noughties were an optimistic period in the NHS as resources appeared to improve. We obtained cryosurgery equipment and extended the scope of minor surgery and joint injections. Dr Roberts developed her women’s health and family planning clinics at the practice. Dr Reynolds became an accredited GP Trainer and has led the GP Training programme at the practice for many years. When Dr Carne announced his return to Melbourne, the Practice reflected gratefully on nine busy and productive years. Although it was suggested that England’s Rugby World Cup triumph over Australia in 2003 or the glorious England Ashes win of 2005 had been too much to bear and played a part in his decision, he had taken these Aussie setbacks surprisingly well! He left Warwickshire on a wave of goodwill and affection.
Standing: Mrs Caolyne Hyndman (Practice Nurse), Mrs Margaret Whitfield (Receptionist), Mrs Carolyn
Watts (District Nurse), Dr Eileen Berridge (salaried GP), Mrs Marilyn Greenwood (Receptionist), Dr
Kate Reynolds (Partner), Mrs Janice Wright (Receptionist), Mrs Jacqueline Rushbrooke (Health care Assistant), Mrs Sue Evans (Practice Manager),
Dr Liz Roberts (Partner), Mrs Gayle Cigdem (Senior Receptionist), Mrs Valerie Hiddleston
(Housekeeper), Mrs Jenny Blackman (Secretary), (inset) Mrs Helen Pilley (Practice Nurse). Front row:
Mrs Margaret Wearn (Secretary), Dr David Carne (Partner), Dr Ian Czerniewski (Partner), Dr Sam
Chesser (Partner), Mrs Karen Nottage (Receptionist). (Names in bold are still at the practice in 2022)
With Dr Carne’s departure in
2006, Dr Sam Chesser joined
the partnership. Dr Chesser
trained and worked in Leeds, has a
strong medical family background, and
had experience of the frustrating world
of NHS management. He also brought
experience of minor surgery which he
continues to perform.
The team had changed over the years
and only four members of the 1995
practice picture in part 9 were still at the
practice in this picture in 2006.
Dr Eileen Berridge was the first salaried
GP at the Practice working on a sessional employed basis for over ten years,
providing child health clinics as well as
general medical services to a loyal following of patients.
The national arrangement of GP
services was revolutionised by a new
GP contract in 2004. Core duties
of GPs were defined, and more
emphasis was placed on systematic
screening and monitoring of several common medical conditions
such as asthma and diabetes, which
has undoubtedly led to improved
outcomes in these conditions.
At the end of the noughties, in 2009
the global swine flu pandemic threatened to cause havoc, but thankfully
receded. Dr Chesser was called to
a potential outbreak in Dunchurch
and dealt with and examined several
patients and carried out swabs while
donning gloves, apron and face mask.
This was a novelty at the time but of
course, turned out to be the forerunner of a much greater threat.
Public health outcomes had steadily improved in every decade since meaningful records began. Better hygiene, better Health and Safety, immunisations, fewer smokers, healthier lifestyles and better medical care had all contributed to lower mortality and increased life expectancy, decade after decade. Until now. In the decade from 2010–2019, life expectancy stopped increasing (and actually fell for some subgroups). Increasing obesity may have contributed, but was the quality of NHS care a factor too? Was the personalised patient centred NHS being replaced by a ‘one-size fits all’ conveyor belt approach based on algorithms? Waiting times for ambulances, queuing in A&E and waiting for routine surgery were considered tolerable at the start of the decade. Targets to deliver care were largely met. By 2019, targets were pipedreams and the delays much longer (even before the pandemic) and no longer tolerable. The Health and Social Care Act of 2012 set out regulations for private organisations to tender for and be commissioned to provide services. So now, a private company can cherry-pick and carry out all the easy hernia repairs for a profit, leaving the more difficult cases with longer stays, more complications and more cost for the NHS to deal with. The Act also set up Clinical Commissioning Groups (CCGs) to replace Primary Care Trusts (PCTs), announcing that it would put GPs in charge of organizing and purchasing care for patients according to local need. The change of structure had limited effect on services, while the top-down red tape and regulation from central government constrained GPs at CCG level to such an extent that ‘local’ decisions were impossible. ‘Bed-blocking’ and consequent increases in waiting times caused by insufficient social care provision is also a major concern which Boris Johnson promised to ‘fix’ in 2019. These and many other factors contributed to worsening morale in the whole NHS and to discouraging doctors from entering General Practice. In 2015, Jeremy Hunt famously announced that 5000 new GPs would be recruited by 2020. In fact, the initiative failed and the total fell slightly over that time. Dunchurch Surgery has endeavoured to provide traditional family medicine despite these difficulties and despite a growing population as housing development continued. We could not have done this without the help of our loyal staff and the support of our patients.
The end of the decade brought another change in the partnership. After 28 years as a highly respected and much-loved Dunchurch GP, Dr Elizabeth Roberts decided in 2019 to join her husband in retirement and a life of travel and dog training! She was well known as a caring and kind doctor with excellent clinical judgement and a calm and unflappable manner. She developed her interest and skills in women’s health and for many years provided a local Family Planning service. Dr Roberts was also responsible for overseeing staff welfare and latterly took on the unglamorous but essential task of writing, updating and presenting practice protocols to ensure compliance with the regulations of the Care Quality Commission (CQC) which monitors and inspects GP services. She presented this data with her typical calmness and aplomb and impressed the inspectors. Her retirement coincided with the completion of training of Dr Laura Harris, one of the outstanding GP registrars who trained at the practice, who has now succeeded Dr Roberts as a partner. They are seen here together at Dr Robert’s (left) retirement event.
Her retirement coincided with the completion of training of Dr Laura Harris, one of the outstanding GP registrars who trained at the practice, who has now succeeded Dr Roberts as a partner. They are seen here together at Dr Robert’s (left) retirement event.
The year 2019 was also when the Practice joined the other 11 practices in the Rugby area to form a PCN (Primary Care Network). PCNs have been created all over England to serve populations of 30,000 or more patients (Rugby’s has over 110,000) to provide ancillary staff such as occupational therapists, physiotherapists, pharmacists, counsellors, etc who can be employed by the PCN and provide services across several practices. Individual practices often do not have sufficient patients to justify employing such staff. The process has since gradually developed, and we now have a physiotherapist who visits the practice weekly and access to other staff such as dieticians and so on. The PCN also provides extended hours clinics which our patients can access. All of these changes were inevitably delayed by the biggest health crisis which the NHS has ever faced. The effects of Covid-19 on the practice will be discussed in the next instalment.
The first hint of a possible global health threat appeared at the end of 2019. Initially, we hoped that Covid-19 would be no worse than the previous outbreaks of avian and swine flu which had mostly fizzled out. It soon be came clear that this was different. We all watched with horror as Italian hospitals were overwhelmed by life-threatening illness and when Covid hit the UK the reality was frightening. Doctors understand the process of illness caused by viruses, but we could offer no treatments. We, too, were in awe of the power of nature. Handwashing, face masks and social isolation seemed to be our only weapons. The national lockdown was the most socially momentous event since 1945. Suddenly the surgery was almost deserted. Most patient contact was by telephone. Treatments were prescribed remotely, without examination. There was anxiety that other patients, practice staff and clinicians might be at risk of exposure. Patients with suspected Covid were advised to isolate and keep away from surgeries. If they had to be seen for other reasons, suspected Covid cases were seen in a specially prepared room with minimal furniture (which could be deep cleaned and disinfected efficiently between patients) which was accessed from the rear of the building. Masks, gloves and gowns were worn. Patients kindly made and provided us with vizors. Many practices literally locked their doors and many reported high staff absences. Some reported extensive public dissatisfaction and abuse. Dunchurch Surgery never locked the doors. Our loyal and courageous staff continued to work throughout the lockdowns despite personal risk. Our patients respected the restrictions, did not abuse them (or the staff) and demonstrated remarkable stoicism. There was, of course considerable anxiety and patients who tend to worry, worried even more. We watched the rocketing hospital admissions and the dreadful death toll. Six of our patients sadly died of Covid during the first wave of the pandemic. Many more were seriously ill, some on ventilators in hospital, but pulled through. While General Practice did what it could, it was the heroic ambulance personnel and ITU hospital staff dealing with the sickest cases who really deserved the Thursday evening applause. Treatments evolved slowly but only slightly improved outcomes. Would we ever get a vaccine?
December 8th 2020. A milestone. The world’s first ever Covid-19 vaccine was given in Coventry. The product of intense work by world-class scientists and a glimmer of light after nine months of fatalities, near fatalities, fear, anxiety, lockdowns, and toilet roll shortages! Ten days later the vaccine arrived in Rugby, but with high global demand, only restricted quantities were available. The vaccine had to be stored at minus 70 degrees Celsius and there were strict protocols for preparation and administration of the vaccine. The vaccination area had to be ventilated through open doors and windows which proved a challenge in late December. The local solution was a dedicated vaccination centre at Locke House near the railway station in Rugby shared by all the Rugby practices over nine months. The doctors and nurses from each surgery took turns to vaccinate their patients at the centre, initially supported by our own staff, then later by the many wonderful volunteers from the area, people of all ages and from all walks of life who stood for hours and helped process the patients for vaccination for months on end. In December 2020 we started to vaccinate our oldest patients who were most vulnerable to the disease. The first Dunchurch session was carried out in freezing cold (ventilated) conditions with staff and nonagenarian patients wearing overcoats and scarves. Everyone was stoic, good natured and grateful. Blitz mentality! This was not the end of the pandemic, but perhaps the beginning of the end?
To those of you who have read these articles over the last five years, thank you for sticking to the story. We began with “The Medical and Vaccination Officer for Dunchurch District”, Dr Thomas Ellis in the 1830s through the utilisation of X-Rays, the advent of the motor car, and the discovery of penicillin. Then there was the wartime bombing of the doctor’s home, the formation of the NHS, the medical information revolution of the Internet, the many changes in General Practice, the horrible pandemic of the 2020s and so to the present day. Much has changed, medical capability has improved beyond recognition and the shape of primary health care has constantly evolved. Yet the fundamental principle of the patient doctor relationship hasn’t changed. It depends upon mutual understanding and trust and of course the continuity of care, with the long-term knowledge of patients, their families and their circumstances which helps to determine the most appropriate course of clinical management. In a world of instant information and the often impersonal nature of medical consultation, the practice at Dunchurch has tried to maintain the traditional model of continuity of care, so well established by our long serving predecessors. It helps of course to work in a practice which is not too big, in a community where the population is stable and not transient and where so many of our patients are respectful, understanding and realistic. We hope to maintain these traditions despite the possible threats of AI and GP-bots! We, the doctors all appreciate and value our loyal and long-suffering staff and you, the wonderful community within which we work. Here’s to the next 190 years at Dunchurch Surgery!
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