| Description | Dr BILL REITH interview at the Sir Duncan Rice Library, University of Aberdeen on Thursday January 12, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) WILLIAM REITH, born on 17th August 1950 (in North Berwick). Retired from clinical practice at end of January 2019 as a Principal in General Practice. No medics in his family; parents both born on 30th December 1925; father had been in the Navy till just after the war, mother in the Land Army, she was from Edinburgh, father from North Berwick. Mother managed to secure a prefab in North Berwick, where Bill and his older brother were born. Spent childhood in North Berwick, went to North Berwick High School, explains about the school and the town. Neither parent nor anyone in their families went to university; dad worked in the railways in an admin role, mum did variety of jobs. Bill’s older brother was the first in the family to go to university, and Bill followed him three years later. Bill applied and was accepted to study Medicine at both Edinburgh and Aberdeen universities, but Edinburgh had a better reputation at that time, so that was his choice. Bill did mostly science subjects at school, but was also involved with the Scouts and the local Red Cross. Did consider studying Science, but from about O-level exams on was thinking of Medicine; his brother did Classics. His interest in people and helping people contributed to his choice, again mentions the Scouts and the Red Cross, main drivers. (0:05:39) Talks in detail about his life as a medical undergraduate in Edinburgh from 1968. Quite regimented. During First Year, they were included with the dentists and the vets. In Second Year the Scottish students were joined by about 50 or 60 students from England, who had done A-levels and so could come into the course in Second Year. But at the end of Third Year the Scottish students had gained enough credits to graduate with a degree, so they all graduated with a Bachelor of Science degree in medical sciences. Did not see a patient till beginning of Fourth Year. Bill joined the university Judo Club. Talks about the pressure he felt under in the medical course. Talks about the clinical years, it was then a six-year course to do medicine, very old school, Edinburgh then was quite institutionalised, there was a medical hierarchy, explains, including significance of Edinburgh having the Royal colleges; some of their teachers were internationally known medically, which was great, but a bit daunting. (0:11:14) Recalls doing Fourth Year block in Medicine for eight weeks on the wards at the Royal Infirmary in Edinburgh; one of the consultants was Donald Batty, strict but caring towards students; very keen on the apprenticeship model, introducing yourself to the patient, checking the charts; gave running commentary to the other students on how the chosen student was doing; introduction to the professional side of medicine, rather than the academic. Also got on well with John Louden, consultant in Obstetrics and Gynaecology, who with his wife Nancy was very involved in family planning in Edinburgh; always seemed very interested in students. Also mentions Richard Scott, first professor of General Practice in the world; spoke to him about his career. (0:14:05) Already considering General Practice. Graduated in 1974, had to do single pre-registration year at that time; choose to do six months at Roodlands Hospital in Haddington, and six months at the Western General in Edinburgh. There were people in his year who went straight into General Practice after their House year, you could do that then. But Bill did not think he was ready, explains about vocational training programmes set up nationally. Decided he had been long enough in Edinburgh, so applied to Aberdeen and was appointed, explains nearly did not make it up because of the snow; also recalls Denis Durno, the regional adviser, phoning to check he was definitely coming. His only experience of Aberdeen before that was coming to a Scout camp at Haddo House (near Tarves in Aberdeenshire) in 1965. Came to Aberdeen in August 1975. Set rotation of posts; two years spent in various hospital posts, one year in General Practice. Started in Accident and Emergency at Woolmanhill Hospital, probably good post to start, explains. Thought Aberdeen city was attractive and buzzy because of the oil industry, explains. (0:19:48) Did A&E for six months, did the minor specialties of ENT (Ear, Nose & Throat), Eyes and Skin for two months each. Then six months in Obstetrics & Gynaecology, three months Paediatrics and three month elective in Geriatrics at Woodend, because knew increasing importance of looking after older people. Spent his trainee year at Calsayseat Road Surgery. Refers to events put on by Denis Durno, who was the first regional adviser for North-east Scotland, innovative thinker, explains. Trainer at Calsayseat Road was Fred Lynch, still alive and son Stephen has just retired as a GP in Aberdeen. Towards end of training, junior partner in his practice Colin Sinclair had a couple of friends who were looking for new partners; Peter Duffus and John Reid, went to see those two practices, chose John Reid’s in the city centre, explains about the practice. (0:23:13) Practice moved to new health centre at Foresterhill in 1979, explains in detail how this involved three practices, how they operated, and the advantages and disadvantages of moving from the city centre; health centre had a retail pharmacy, attached staff, nurses and health visitors, in same building; university Dept of General Practice located on first floor. Helped develop the primary health care team. Later found that the practice was founded in 1896 by the first woman doctor in Aberdeen, Elizabeth Latto-Ewan, and included people like Laura Sandeman and Mary Esslemont. Celebrated centenary in 1996, and up to that time the senior partner had always been a woman; Bill broke that duck when he became senior partner later in 1996. Explains where the practice’s patients came from; had branch practice in Torry till the late 1990s. John Reid interested in the practice becoming a training practice again, had been that in the past with Bill’s predecessor Florence Stephen. Talks in detail about training standards at the time in hospitals and general practice; Denis Durno very good at ensuring that Aberdeen met all the national standards that came in at that time. (0:29:00) Mentions Joint Committee on Post-graduate Training for General Practice, explains in detail how this set national standard and how it operated, involved Bill. Talks about importance of legibility of records, and other issues that were looked at. Refers to controversy over which practices got to be training practices; seen as prized achievement to become a trainer in General Practice. Explains that when they first moved to the Foresterhill site they were known as "The Yellow Practice", but name subsequently changed to "Westburn Medical Group". One other practice had been at Elmbank, so they were "Elmbank Group Practice", and the third practice had been at Hamilton Place so were called "Hamilton". One of first developments they brought in was conversion to A4 records, explains this replaced the A5 "Lloyd George" system introduced in 1911. Talks about how this new record system was developed both in Scotland, and Aberdeen; matched a move in the hospitals, in Aberdeen led by Professor of Therapeutics Jim Petrie, who was doing problem orientated medical records in hospital. Explains what new record system enabled general practices to do re sorting out patients. (0:35:13) Up till that time practices had been very individual and insular, but when involved in training, started to speak to other doctors and visit other practices, explains. Says training practices throughout the UK, particularly in the North-east of Scotland, really did begin to drive progress, explains. Introduction of computers, driven by West of Scotland GP called David Fergusson, explains. Says they were going to buy one computer for all three practices, cost ten thousand pounds, and suggested would never need to buy another! GPASS stood for General Practice Administration System Scotland, explains in detail how this worked and what it allowed them to do; could put on limited clinical information; only later began to develop into a clinical system. Bill sees this as a paradigm shift for General Practice, explains in detail, contrasting record-keeping in hospital and in general practices at the time. (0:40:25) Allowed them to be pre-emptive with patients, rather than waiting for them to come to the practice. Computerisation then a huge benefit to patients. Contrasts it to situation now, IT (Information Technology) not up to it, explains systems don’t speak to each other. Explains how systems back then were developed in hospitals and general practice. Talks about how because not all patients had a Hospital Number that eventually system was brought in of the Community Health Index (CHI) number; but took a long time for it to become a unique indicator. (Summariser’s note: During the correction process for this summary, Bill added the following clarification) – ["CHI number introduced into general practice as unique numeric patient identifier; Hospitals continued to use own individual hospital patient identifier until Scottish government required CHI to be patient identifier throughout the country. Rest of UK use different systems."] Talks about vocational training for GPs being voluntary in those days, got extra money (in form of Vocational Training Allowance for first 7 years in practice); most who did it were encouraged to join the Royal College of General Practitioners (RCGP), explains it was professional recognition by your peers. Bill became involved with the RCGP, began to put him in touch with the greats of General Practice; Donald Irvine, still only GP who’s ever been President of the General Medical Council; GP called Julian Tudor-Hart, working in Wales, done internationally-renowned work on hypertension; Marshall Marinker; GP in South-east of England called John Fry, who wrote about differences in clinical presentations and conditions between hospital and general practice; all this revolutionised primary care and the way we delivered training. (0:45:06) Talks about taking a positive decision to become a GP trainer himself; saw the opportunities at Westburn for him to be involved and drive things forward, explains in detail; introduced an ante-natal clinic and a post-natal clinic; had an early interest in women’s health and contraception. Set up immunisation clinics and child development clinics. Explains about different philosophies of different practices; Laura Sandeman opened up the practice in Torry, particularly interested in providing care for women and children. Even now, with the pandemic, the practice is still seen as one where the continuity of care is seen as important. Some people see back then as the Golden Age of General Practice, explains; lot of prejudice against General Practice in the NHS, still is, explains. (0:51:02) Explains about state of GP education before his time and how it changed. Possible to go into General Practice with no training apart from the pre-registration year. Before the NHS pretty much all doctors were GPs, explains. In Scotland where health has always been devolved, through discussion with the BMA (British Medical Association), the Scottish Home and Health Dept set up a one-year Trainee Assistant post. When Bill joined the practice Evelyn Macleod, the senior partner, had done the one-year trainee assistant post, which was run by the university, which did have a Dept of General Practice by then. She showed him the training programme, explains in detail what it involved. Refers to the Royal College of GPs, founded in secret in 1952 because the other medical colleges were so resistant to it; it began to promote change. Refers to the GP Charter in 1966, improved conditions for GPs. RCGP envisaged five-year training course for GPs, similar to training for other medical specialties. (0:55:26) Partly politics, partly financial, the government of the day agreed to a three-year training programme; one year in General Practice and two years in various hospital specialties. Then the vocational training schemes were set up with the regional adviser ensuring they were all of decent quality. As a 1974 graduate Bill could have become a GP in 1975 without any further training. It was only in 1991 that it became compulsory to have done a year’s training in General Practice and other posts relevant to General Practice, explains. Lot of tension at the time with people in the profession who didn’t see the need for an exam in General Practice. It wasn’t till 2003 that the government set up a body called the Post-graduate Medical Education and Training Board (PMETB). Up till then each speciality medical college was responsible for approving training posts, explains in detail about difficulties this caused for hospitals and the government. Dept of Health wanted to change this. Bill involved with Royal College of GPs in pushing for the college exam to be the standard, explains. Mentions the Summit of Assessment, previously introduced by the Joint Committee on Post-graduate Training, which everyone had to pass if they wanted to go into General Practice. When that was being introduced in the 1990s the RCGP proposed its exam as the Summative Assessment, but there was still quite a lot of resistance in the GP community, the union BMA side. (1:00:03) Eventually through the training board, they required every specialty including General Practice to have a curriculum, and also to set the qualifying examination. So from about 2008-9 the RCGP was the first specialty to have its curriculum fully approved, explains. Other key thing they introduced was when the PMETB met up it was to be representative of the profession, explains. Through work the College had done, Donald Irvine and Marshall Marinker had been amongst authors of a key book called "The Future General Practitioner", hugely influential, explains; again mentions PMETB. All now done by the General Medical Council, again; continue to be big issues, explains why in detail. Thinks the politicians who set up the PMETB did not appreciate the complexity of Medicine. There are something like 65 medical specialties, all with their own training and curriculum. Explains difference that in any other medical specialty it is possible to work in another capacity, though not become a consultant, if you fail your exams; but not in General Practice. So those who fail GP exams have to do something else back in hospital, somewhat perverse, explains. First department of General Practice set up in Edinburgh, second one in Aberdeen; mentions Ian Richardson, very influential in setting up the vocational training scheme when he was Professor of General Practice; John Howie; John Bain, who went to Southampton and then Dundee. Post-graduate department set up separately to the Undergraduate department. Bill became regional adviser in 1993, and given honorary university title, explains. Fell under remit of the post-graduate Dean, funded through the Scottish Council for Post-graduate Medical Education; subsequently changed into NHS Education for Scotland. In the 1970s and 80s not very much investment in training for health professionals except for doctors. Dentistry set up vocational training schemes a few years after General Practice. (1:07:44) Explains what his role as an Honorary Clinical Senior Lecturer in the Dept of General Practice and Primary Care actually involved. [Bill later clarified - "Role that I had was that of regional adviser; as result, given honorary university senior lecturer role. Tried to maintain good links with undergraduate department but no active role in its teaching or other activities."] Responsibilities to oversee the post-graduate training of GPs. Ian Richardson went on to become Dean of the Medical School, at the time the university had to make swinging cuts, explains. He resigned the Chair of General Practice in 1984, but there was outrage from GPs when university announced that Chair was to be frozen, explains. Eventually re-established the Chair in 1992, Bill got his honorary university appointment around then [later clarified as in 1996]; not unusual, explains; but still some discrimination against GPs, explains. Describes what the department was like in those days; Ian Richardson as head, John Howie, John Berkeley and John Bain as clinical senior lecturers, and Ross Taylor as a lecturer. When Ian retired, Roy Weir, Chair of Public Health, became acting head of department, but Ross ran the show. By then John Howie had got a Chair in Edinburgh; John Berkeley, dual-qualified in Public Health, did variety of things including two years in Bhutan, then became Clinical Director of Roxburghe House; John Bain went to the Chair in Southampton and then Dundee; Ross became head of department, but never got a professorial title, explains why. (1:12:49) Does not think he was even interviewed for the post when Lewis Ritchie was appointed; reveals there was no external GP on the assessment panel, Robin Fraser was to be the external assessor on the panel, but he advised university he could not make the date given, panel went ahead anyway, Bill suspects internal university politics. University made a good appointment, Lewis able to regenerate the department; previous diminution down to lack of support from the university, explains. Recalls time when Donald Irvine, who had just become GMC President, was coming up to Aberdeen for a formal visit. Bill was regional adviser, and he and Donald were at a dinner hosted by the University Principal; Lewis Ritchie had just got five star research rating for the Dept of General Practice; Bill asked the principal what the university was doing to support continuation of the department; says there wasn’t a plan. Dept has issues now because Lewis has become very influential at a national level, been on secondment to the Scottish Government for considerable time; great for him and the country, but not sure what’s happening in the university department now. (1:16:19) Suspects lack of support is from both the university and the Medical Faculty, explains. Tells about sitting on a panel to appoint a new chair when David Reid was head of the School; gives example about difference in training for MD; four years as senior registrar for other specialities in addition to specialty training, Bill got only one year in total in general practice training as a GP. Aberdeen seems to come out well in student surveys, but do hear stories of General Practice being talked down by other specialties, explains consequences; lack of opportunity to get research funding; length of training is still an issue, explains. Talks about Marshall Marinker again; lecturing about the generalist and the specialist, explains the differences. Now realisation that even within specialist hospital-based medicine, you need generalists, explains; multi-morbidity of patients. (1:21:22) Bill explains his key roles at Scottish and UK levels. Became Honorary Secretary of Council for the Royal College of General Practitioners in 1994, explains in detail how this worked, contrasts with what would happen to a specialist consultant in similar role. Joint Committee on Post-graduate Training, responsible for setting standards for GP training nationally; joint between the Royal College of GPs and the BMA, explains resistance from the BMA. Explains responsibilities of the Honorary Secretary, quite a lot of politicking, trying to ensure better standards for GPs; for Bill an interesting and exciting time, explains; benefits of his role to Aberdeen and North-east. (1:26:09) Addresses his achievements; refers to doing MSD (Merck, Sharp and Dohme) Foundation Leadership Course. Learned you may facilitate things. Talks of the Prince of Wales, when he had been their President for a year, allowing them to set up RCGP Commission on Primary Care; looking for individuals to take on a fellowship for perhaps one day week in some of the "Cinderella specialties", explains. Example of Epilepsy, GP called Henry Smithson had been doing the job, said lot of people seemed to die after having an epileptic fit, no one knew why. Bill brought this up at tripartite meeting when Ken Calman was the Chief Medical Officer; Dept of Health set up confidential inquiry into sudden death in epilepsy; Bill thinks that was a good achievement. (Summariser’s note: During the correction process for this text Bill added - "I made mention of a couple of things I was proud to have facilitated - but didn’t mention the second! I promoted the idea of an All Party Parliamentary Group on general practice/primary care. When the first All Party Parliamentary Group on Primary Care and Public Health was set up in 1998 I was invited to be its Joint Administrative Secretary.") Talks of developments at the College, increasing numbers, Bill helped steady the ship, explains. He also went on to chair the College’s Post-graduate Training Board, explains. (1:31:35) Explains the mention in his CV that "the formation of the Post-graduate Medical Education Training Board heralded the most significant change to post-graduate medical education in the UK"; Bill contributed to that, very professionally rewarding. Explains his promotion of the concept of "Quality in General Practice"; when he was chair of Scottish Council for the College, three-year post, more based in Edinburgh, mentions Prof Elizabeth Russell being involved in various initiatives, explains; Scottish Inter-collegiate Guidelines Network (SIGN), and Confidentiality and Security Advisory Group for Scotland, explains. Bill having regular meetings with the education leads of the other Royal colleges, mutually beneficial. SIGN developed guidelines for patient care, explains; but importantly also gave patients an idea of what they could expect in the way of care from their doctor. Speaks about confidentiality of medical information, and computerisation; group set up to look at how to share information, but also with whom; Elizabeth Russell and Bill very involved with that. Speaks about training and non-training practices; evidence that the former gave better care, explains. The colleges developing criteria, initially called "What sort of doctor?", then developed to Quality Practice Award, explains; peer-reviewed process, to get people to improve themselves. Continued for some years. Notes that some years ago there was major negotiation of the contract between the BMA and the government; brought in the Quality and Outcomes Framework, explains; unfortunately majored even more on what’s measurable, rather than what’s desirable, explains. Now increasing evidence of importance of continuity of care, explains. (1:38:50) Explains in detail what he thinks makes a good GP practice, with reference to his own practice; and with reference to problems affecting GP practices, including patients complaining about not seeing the same person. Speaks about moves in recent years to deal with more patients remotely, rather than face to face, using computer technology; COVID changed all that, no face to face consultations in general practice, explains this caused huge problems for practices and patients. Refers to shortages of GPs and nurses and other groups; was warning politicians 25 years ago we were heading for shortage of GPs, made no difference, explains. Now something of a crisis, explains. (1:44:20) Emphasis pre-COVID on hospital care, explains in details the consequences for general practice; different generation with different work-life balance; recalls when he started his first House job he worked 120 hours a week, just expected. With being told not to see patients, some practices have struggled to cope, partly because we seem to have medicalised life now, explains in context of COVID; lockdown for everybody, and for so long, probably wasn’t the best idea, explains about the things that weren’t happening. Not back yet to what we want to do, explains in detail; reassurance of face to face. All the public services being hit; lack of appreciation by politicians, and senior managers in the health service, explains. Gives example of politicians talking about Primary Care, his medical speciality is General Practice, working in the context of Primary Care; [clarified later during correction process that there is no medical specialty known as Primary Care]; politicians and senior managers have for some time tried to conflate the two, explains; what the public want is to see a GP; that may need to change, but public will need persuaded. Criticises what happens when a GP practice closes; General Practice at a very crucial stage at the moment, explains. (1:52:21) Talks in detail about the issue of Fund Holding for GP practices. Came in in the late 1980s to 90s, explains how it worked. Huge interest in North-east Scotland, from small number of GPs initially, about the possibilities fund holding offered, explains; mentions GP Fund Holding Association, employed staff to do the work. Meant hospitals had to cost every procedure, gives examples. In bigger cities different hospitals might give slightly different prices, GP practices could then save money to be spent on some other form of service. Explains referral procedures for GP practices back then; also use of laboratories. Financial gains less important than that GPs began to influence things, explains; great resistance nationally for a few years by the BMA. An interesting experiment, got GPs and hospital specialists talking to one another about standards and frequency of care, explains. Refers also to what he feels was the start of the local health board taking their eye off the ball of General Practice locally. (1:59:11) Talks in detail about what he hopes the future of General Practice will be; substantially GP-led; if General Practice fails, the NHS fails. Need to sort out IT, now woefully inadequate, explains. Need to look at access, the pandemic has just destroyed it, explains. Continuity of care. Integration of Social Work. Role of the Pharmacist; pays tribute to the pharmacist working in his own practice. Move to larger practices. Plea for honesty from politicians. And for GPs and General Practice being able to influence the system. (2:06:31) Explains in detail about his involvement in the Shipman Inquiry in 2003-2004; Bill was asked to represent the RCGP in the phase of the inquiry about re-certification, or re-validation as it is now called. This generated a whole industry, and a lot of work for doctors, explains. (2:13:02) Outcome of the inquiry; politicians thought some form of re-validation would have caught Shipman, Bill has yet to come across a GP who thinks that. Sums up the achievements of his career; first and foremost to be a good GP; hopes he provided continuity of care for a lot of patients; through the College helped influence the training of doctors wanting to do General Practice; contributed to everyone having to pass a professionally-set assessment; educating some politicians and managers. Finishes by explaining his achievement in 1973 in gaining a First Dan Black Belt in Judo. (ENDS 2:17:44)
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