Healthcare for the Local Community, 1966-1990
Dr G Kennedy
The practice in which I worked was based in Tranent and Ormiston in a partnership with four doctors in 1951, enlarging to nine doctors by 1990. By 1966 due to the GP’s Charter we were able to build custom-built surgeries with the help of interest-free loans. We were able to employ staff – a secretary and four part-time receptionists in Tranent, and a secretary in Ormiston. The other single-handed practitioner in Tranent joined our group, reducing night work and weekend duties considerably, but the on-call doctor was very busy.
Maternity work in the practice had almost ceased due to the closure of Haddington and Musselburgh Maternity hospitals. We continued antenatal and postnatal supervision but all deliveries were in hospital.
Our diagnostic facilities increased considerably with the purchase of E.C.Gs, laboratory vans collecting samples twice daily, and direct access to the X-ray Department in Roodlands Hospital. We also had an excellent relationship with the medical and surgical consultants in Roodlands.
Tranent and Ormiston were mining towns when I started in practice, but by the late 1960s the mines were closing down and both towns were changing in character. Tranent in particular was becoming a dormitory town for Edinburgh and enlarging due to a large amount of private building around the periphery of the town. The custom-built surgeries soon became too small. A new larger surgery was built in Ormiston and by the late 1970s a Health Centre was built in Tranent. By the time the Health Centre was opened the partnership had increased to eight and we required a Practice Administrator, a secretary, a practice nurse and six receptionists. There was also accommodation for Health Visitors, district nurses, a physiotherapist and a chiropodist. By 1990 the Health Centre had to be extended when the partnership was increased to nine: we were by then a training practice with a trainee attached to us for a year to complete his training to become a principal in a practice. The trainee did consultations on his own but was on-call with a partner. He also had one or two tutorials per week from one of the partners. The Ormiston end of the practice was run by two partners, and staff increased to a secretary, two receptionists, and a visiting district nurse when required.
In the Health Centre the practice nurse gradually became much more involved taking blood, syringing ears, and assisting in minor surgical procedures. By the 1980s she was running an asthma clinic, obesity clinic and interviewing new patients. The Health Visitors, chiropodist and physiotherapist ran their own clinics.
Computers were introduced in the 1980s improving record keeping and to help the receptionists arranging appointments. They also had a direct link to the local chemists for patients on repeat prescriptions to save them coming to the Health Centre. They could phone the Health Centre with their order and pick up the drugs at the chemist of their choice. This also allowed us to check if they were due for a consultation, and an appointment could be given by the chemist!
Regular practice meetings were held on Fridays at lunchtime including nursing staff and one of the local chemists. They were used to discuss any problems that had arisen during the week. If there were no problems management and treatments of various illnesses were discussed and with the aid of the chemist drug costs were kept down.
Infectious diseases had virtually disappeared by 1966 due to immunisation clinics. Bacterial infections were being controlled with the ever-widening range of antibiotics. It is possible that these antibiotics were used too freely and this probably was in part responsible for the increasing number of resistant strains today.
Childhood ailments were rarely serious but as years went by asthmatic problems seemed to increase and eventually we started an asthma clinic run by the practice nurse. There were occasionally more serious problems in children such as leukaemia and congenital heart problems but by the 1980s chemotherapy and advanced surgical techniques were dealing with many of these serious illnesses.
Eye problems were dealt with by the Royal Infirmary but as years went by patients had longer to wait for appointments and surgery. This was probably due to increasing and improving surgical techniques, and increasing demand with no increase in hospital staff or facilities. Also opticians were examining patients in more depth and picking up conditions such as incipient glaucoma and retinal problems.
Most mentally ill patients were dealt with at Herdmanflat Hospital in Haddington where we had an excellent relationship with the psychiatrists. Anxiety states and depression were in the main dealt with in the practice, both conditions requiring time and a sympathetic ear and in the case of depression assisted by the use of antidepressants.
By the 1970s the elderly in the practice were increasing and when they became dependant they were not as readily looked after by the family as they had been in my early days in practice. ‘Old Folks Homes’ [part IV accommodation] were built to help the situation. Some of these homes specialised in looking after demented elderly but most had a mixture of demented and incapacitated due to illness or accident. The homes in our area took elderly from East and Midlothian and were visited by us regularly. Every new inmate was examined and therapy reviewed. The former occasionally revealed pathology and the latter usually modified considerably.
Cigarette smoking in the 1960s was still socially acceptable, but by the next decade due to the increasing evidence of the pathology it reduced gradually becoming socially unacceptable. There were already many chest problems in the mining community such as pneumoconiosis and cigarette smoking added to these problems. We had a large number of patients with bronchitis, emphysema and bronchial carcinoma. Fortunately T.B. was no longer a problem at this time due to the improved antibiotic therapy. During the 1970s and 1980s bronchial carcinoma was occurring in the female population, which co-related with their increasing tobacco smoking. By the 1980s there was help available for nicotine addiction in the form of counselling and therapy, but this does not appear to have reduced cigarette smoking overall.
Alcohol consumption was high in mining areas particularly at weekends and this inevitably produced a number of alcoholic and liver problems. The weekend binges often led to fights and resultant trauma requiring suturing or referral for X-rays. We fortunately had excellent support from the local branch of Alcoholics Anonymous.
With regard to other drug addictions I have very little experience. Before I retired in 1990 I had two patients who attended regularly for methadone. Most addicts attended Jordanburn Hospital in Edinburgh usually referring themselves direct.
Record keeping improved considerably with the introduction of hospital folders in the late 1960s. By the 1980s we also had computers on which records were kept as well as the written records in the folder. Each patient also had a summary of his conditions and drugs in his folder, which was kept updated by the computer. As mentioned previously the computer was a great help with repeat prescriptions due to the direct link to the chemists. They were also valuable in general practice research projects. We did not have computers in the consulting rooms!!
From 1966-1990 the improvements in general practice can be summarised as follows – improved accommodation with all primary care staff under one roof, excellent diagnostic facilities, computerisation, and the tremendous increase in therapeutic agents.