To celebrate the NHS 70th birthday this year our Chair Dr Tim Moorhead talks about the developments he has seen in general practice since he started 20 years ago and how working as a GP has changed over the years. Tim is a GP and Senior Partner at Oughtibridge Surgery.

"I think many GPs would agree that the most overwhelming difference to being a GP in 2018 compared to 20 years ago is how much busier it is now. When I first started, a typical day would be doing a morning surgery, finishing at 11am and making my house calls. Then I would go home to spend some time with the children and be back at the practice for evening surgery.

"Now we start at 8.30am and usually do a straight 12-hour day. More people are living longer now but often with one or more long-term conditions - there are more interventions we can make now and more medications, some of which require intense monitoring. Over the years the illnesses and conditions I have seen have also changed. In the early days we used to see a lot of emergency cases such as heart attacks but people know now to call an ambulance.

"These days it is also common to see diagnosis of attention deficit hyperactivity disorder (ADHD) in children, whereas when I first started there wasn’t any diagnosis of this. One theory is that ADHD itself is not becoming more common, but that we are just more aware of it now and have the skills to recognise it.

"When I first started it was remarkable to have a patient reaching 100, but it is not that unusual now. Due to the ageing population, and other lifestyle factors, we are seeing more cancer but as people are more likely to talk about symptoms and go and see a doctor and with more advanced detection and treatment we are seeing an improvement in cancer survival rates.

"Mental health diagnosis and treatment has also improved over the years with more talking therapies and effective medication with fewer side effects available. It has always been a feature of general practice but people spoke less about it, particularly men. We still have a way to go and it will be a challenge for us over the coming years.

"We’ve also seen a big change when it comes to smoking. When I first started it was not unusual for some doctors to smoke during consultations! People are much more aware of the health risks of smoking now so it is less prevalent and one of the reasons why people are living longer."

"When I started we had more of an extended primary health care team working with health visitors, district nurses, midwives and psychiatric nurses. Because of reorganisations and how fragmented health services have become a lot of this has become lost and is more distant from primary care now. This is one of the reasons why we have launched our ‘neighbourhoods’ way of working as it will help us rebuild our teams, as well as addressing the increase in workload.

"The single biggest innovation in my time as a GP is the computer which has changed everything we do in primary care including patient records, prescribing and contractual arrangements such as how we are paid. All of this now depends on IT.

"Also when I first started, practice management was in its infancy. Now it’s essential to have a good practice manager as they oversee everything from running the practice, preparing us for Care Quality Commission inspections to employment law.

"For most people the GP practice is their first port of call, and this has always been the same. It’s a well-established, trusted model that patients like and rely on and it has been a great success in Sheffield. It’s now important that we build on and invest in this.

"Finally, there’s a much greater awareness now of the cost of care to the tax payer. It’s not just doctors and nurses who are aware but patients too. Even though there is more money going into the NHS now than when I started, compared to the increase in need and the additional services we provide, there is just not enough to go round. Because of this we have to keep examining how we spend the money and we have to make sure we spend it in the most effective way."

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