One of the internet’s enduring attractions is the way in which a search for a particular piece of information can often lead you off at a sharp tangent that ends up taking you somewhere fascinating yet wholly unanticipated. It was whilst following a particular thread of family history that I stumbled across this story which then took me off on just such a tangent. I hope the reader will forgive some of the personal stuff which, in reality, is germane to the issue that what I trust is an interesting story.

Most of my childhood and all of my teenage years were spent, apart from my time at boarding school, in the Huntingdonshire town of Ramsey which lies on the eastern edge of what will in the years to come be one of the most interesting nature reserves in the UK, the Great Fen (here and upon which I hope to blog in the near future). Ramsey was founded in 969 and grew on the back of one of the great monastic foundations of the Middle Ages, the great Benedictine Monastery of Ramsey Abbey, once so wealthy a foundation that it ranked, at the time of the Norman Conquest as the fourth richest in England. It had a magnificent library and at its height was home to eighty monks and the town of Ramsey was one of the wealthiest of those bordering on the edge of the great expanse of wetlands that made up The Fens.

Then came the dissolution of the monasteries. A picture of the Abbey gatehouse is above: all that remains of the old Abbey. Since Henry VIII’s time the town of Ramsey has undergone gentle decline and stagnation: the population today is much what it was thirty years ago and may even be less than it was before the draining of the great meres that lay around Ramsey and Whittlesey: Ramsey Mere, Ugg Mere, Whittlesey Mere, Trundle Mere and Benwick Mere, great repositories of wildfowl and fish and home to the legendary ‘Fen Tigers’, those men who led a Spartan and often solitary existence as wildfowlers and eel fishers.

My late father was one of the GPs at Ramsey, Huntingdonshire in the Fenland district south of Peterborough from c. 1955 to the early 1990s when he retired. When he first moved there it was as junior partner to a Dr. Staffurth who had been there for donkey’s years as both a pre- and nascent NHS GP. There was at that time one other Doctor in town then, a Dr. Hertzog (improbably an Afrikaner, the son of a pre-war Prime Minister of the Union of South Africa who was Field Marshal Jan Smuts’ immediate predecessor) who did not have a huge practice and had retired by the early -70s.

Dr. Staffurth retired in the late 1950s and my father then formed a partnership with a Dr. John Goodger circa 1958/9. The latter went off to be a company doctor in the early 60s and thereafter my father had a number of replacements. He became increasingly despondent at the NHS and by the late 60s he had resigned from it and went it alone thereafter as a Private GP. If I was to reduce his motives to a small bite it would be that he wanted to practice medicine not to be a form-filling bureaucrat. He was, I am sure, much happier outwith the NHS where he felt he could practise medicine, not bureaucracy

His cachement area as an NHS Doctor (which you will see from the map at the top) was as follows:

He and his partner served Ramsey and (a) to the south, the villages of Upwood, Bury, Wistow, Great and Little Raveley. In addition he had quite a few patients in Warboys which was also served by a Dr. Warbrick-Smith (to whom I used to go as a temporary patient in the school holidays). He had a few patients in Pidley and Somersham as well. (b) to the north they served Ramsey St. Mary’s, Ramsey Forty Foot and Ramsey Mereside. They had a few patients at Benwick and Holme and at the many farms, some quite isolated, dotted all over The Fen. (I remember one of them in particular as Dovehouse Farm, its interest being the site where Josef Jakobs, an Abwehr officer dropped by parachute in January 1941 to spy on the many RAF stations in the area: has was captured and, after being tried by court-martial, became the last person to be shot at the Tower of London on 15th. August 1941. [see here ]). In broad terms, however, the he, his partner and Dr. Wabrick-Smith served the parishes of Ramsey, Bury, Upwood & The Raveleys, Warboys, Wistow.

The approximate population of this cachement area was, in the mid 60s, about 10,000. My father had the best part of 3750 patients on his NHS books as I recall and his partner likewise and Dr. Warbrick-Smith and Dr. Hertzog accounted for the rest.

According to a document called “popest7104Hunts.xls” that I have downloaded from Cambridgeshire County Council (here) the population of the relevant parishes has increased from 10310 circa 1971 to 15530 in 2004, an increase of something like 50%.

On that basis that four doctors served this area at the end of the 1960s such an increase should provide the basis for the employment of two extra doctors to service the area’s increased population.

Whilst on my root around I came across the Huntingdonshire PCT website (here) which details the doctors practicing in Ramsey and Warboys. They are as appears below. I see that Dr. Haslam, who arrived in Ramsey just as I was going up to University, is now a Professor: a bit wasted on the Fens, but I suppose it depends upon what he professes.

Health Centre – Ramsey

Professor D. Haslam, Dr. S. King, Dr L Twelves, Dr P Byrne, Dr M Glover & Dr S Brown

Rainbow Surgery – Ramsey

Dr A Aggarwal, Dr R Aggarwal, Dr J Richmond & Dr S Nashef

The Moat House Surgery – Warboys

Dr D Warbrick-Smith, Dr J James, Dr H M Mackay, Dr R Sutcliffe, Dr J M Wilcock & Dr Joanna Minnis

This revealed that instead of the six doctors that might reasonably have been expected to be there with the population increase I have noted, there are now SIXTEEN doctors serving the area.

I can only say that I was quite stunned by this information and I have been over both the population figures and these pages quite carefully but I always end up with sixteen doctors doing the work my late father and three others (plus two notional new partners) used to manage to do. I would accept that one of the reasons he left the NHS was the increasing burden of bureaucracy but looking back on his day it was not all that bad really. His day then was surgery from 8.30 to about 11.00, then home visits from 11 to 1.00 pm. He would always come home for a cooked lunch from 1 to about 2.15 and he would then do about three more visits in the afternoon. He would then have an evening surgery from 5 to about 6.30. He would be on call for his practice for one third of the working week nights in a month and one weekend in three. I reckon I work much longer hours at The Bar than he did. The point I make is that the denizens of the Fens were ill but not that ill that he never came home.

If I think about his support staff, I recall that he had a secretary/receptionist and a nurse who did duty as a dispenser as well. There was also the District Nurse, an amazing lady who worked all hours (her father had served before the mast in clipper ships in the last decade of the 19th. Century and was still alive in the late 60s, the very epitome of ‘an old sea dog’! But I digress.)

If one adds to the sixteen GPs now working this area all the support staff that these modern GPs seem to have (practice managers, nurses, dispensary staff, clerical staff etc.) then I dread to think what the annual cost to the NHS these sixteen doctors create.

Of course it is right to say that the nature of GPs work has changed significantly. Much more screening work is done these days which might account for some of the increase in duties. Some doctors may not be full time, especially those female doctors in their 20s and 30s who are having families. But most GPs have offloaded their night and weekend work to a variety of fill-in services so there is a significant ‘swings and roundabouts’ element of extra work taken on and work offloaded.

So, in 2007, the government (and therefore the taxpayer) is shelling out (if the papers are to be believed) some £1.6 million in contractual fees to Ramsey’s and Warboys’ GPs whereas if work had continued at the rate of the late 1960s the figure would be a mere £0.6m. Extrapolated all over the UK (and I bet the Scots have an ever better ratio thanks to the Barnett formula) it does not take long to see why Gordon Brown has to loot everything in sight. Factor in also all the extra staff to serve all the extra doctors and the bill goes into orbit.

Have I missed something here or have we not in fact gone quite barking mad? Is this example wholly atypical? Is the level of illness really so great now that we need more than twice as many doctors to look after us?

If this has happened across the NHS then it comes as no surprise that Chancellors of the Exchequer are faced with a bottomless pit for the taxpayer to try and fill.

If it is a typical example, however, what has happened in the intervening thirty years to justify so many GPs on the strength? I cannot believe we are sicker than we were then, so the mind boggles at what these people actually do…. I suppose a huge chunk of time goes on filling in forms to prove they have fulfilled Gordon Brown’s Five Year Plan, or whatever

I must admit to being dumbfounded, open-mouthed and struck dumb at this scenario. If someone had come up to me and informed me thirty-five years ago that the small Fenland town and village of Ramsey and Warboys would one day need to be served by sixteen doctors, I would have immediately looked round for the white-coated minders whilst making polite conversation in case my interlocutor was dangerous.

I cannot, with any of the three main political parties, envisage anyone actually addressing the nuts and bolts of how the NHS works and I assume that the number of GPs will go on growing and growing, whatever happens to our population and the NHS pit will simply get ever more bottomless. In the last twenty years I seldom recall any real debate about how to make the NHS more efficient, rather it has been about how much they can get away with in taxation and just spend, spend, spend and see if that makes it all better. There must surely come a point at which something gives. We cannot, surely, go on for ever paying for an ever-expanding NHS workforce.

I stand to be corrected, of course, by someone who might explain why this area needs on the face of it a veritable army of GPs to serve it compared with the modest battalions of the past. But whatever explanation it proferred is going to have to be very very convincing.