Last Monday, Sylvia and I drove up to Camberley, to take a couple of saws to Slava Rode. He had agreed to fit some new handles.

Sylvia had given me a pair of Pax saws for Christmas. Pax saws are the flagship brand produced in Sheffield by Thomas Flinn & Co (www.flinn-garlick-saws.co.uk). They are very fine saws, but I found the handles a little large. Perhaps I am spoilt, having handled so many of Slava’s restored and new saws. Anyhow, thanks to Slava, I have discovered that a well-fitting saw handle makes all the difference to how a saw handles.

Slava took measurements of my right hand, and we tried out some of his saw handles. I chose the wood, and Slava promised: “I’ll have them ready for you by February.”

True to his word, we returned yesterday to collect the re-handled saws. The handles have a traditional open grip with horns that lie snugly against my hand, and they are shaped specially for right-handed use.

They fit my hand perfectly. It is surprising how saws which had felt heavy, awkward, and unstable, now feel lighter, balanced and ready for work.

I left Slava with a bottle of wine this time (!), and my thanks for a fantastic job. We went and celebrated with lunch at The Brickmakers in Windlesham – it came highly recommended by Slava and his wife. The food was super, so if you’re in that area, near Sunningdale – for the golf, or a visit to HRH Prince Andrew and Fergie perhaps – The Brickmakers comes highly recommended by us too!

From his modest workshop in Camberley, Slava Rode restores, refurbishes and sharpens vintage saws. He also has his own brand of saws that he produces himself, largely by hand. I’m not sure if would call himself a saw doctor, but why let terminology get in the way of a good blog title?

I visited Slava on Friday and spend a most enjoyable couple of hours at his home where he restores hand saws and makes his own brand of Greyhound saws. He sells on eBay, under the name mapputta, and his website is: www.greyhoundtoolworks.com

I had sought some information on one of his eBay items, and he kindly invited me to visit “even if you don’t end up buying anything.” So, I put a bottle of wine in the car, in case that happened, but – of course – I bought a saw instead … and later, at home,Sylvia and I drank the wine. To celebrate!

I took my collection of inherited rusted saws, donated saws, and Christmas present saws, and was surprised to find just how many there were! Slava looked over them carefully, pointing out the better saws, and finished by saying: “You’ve got all the saws you need.” Of course, fellow tool lovers will know that you can never have too many tools. I looked at dozens of vintage saws and a few of Slava’s beautiful hand-made saws. Spoilt for choice, what I liked most of all was the ability to try them in my hand, to find a tool that fits “like a glove.” A real treat. In the end, after trying out a few selected saws, I bought one of Slava’s lightweight dovetail saws. It will be super for really fine joinery work and, while I know that vintage saws made before the early 20th Century have far greater quality than the mass produced saws that followed, there is a certain pleasure in supporting modern artisan toolmakers, who take such pride and care in their work, and produce high quality tools as a result.

Slava generously showed me how he restores the vintage saws he buys, and the equipment he uses in his small workshop. I was really impressed, and inspired to get started on cleaning up my saws ready for work in Boathouse 4, and in my own workshop at home.

So, this weekend has been partly spent cleaning up a small steel-backed saw, and I am pleased with the results. Sandpaper and elbow grease for the plate; scraper, sandpaper, Deks Olje D1, and furniture wax for the handle.

It just needs sharpening now and, even though I am not yet ready to try, I’d like to learn the skill, and to become a Saw Refurbisher and Sharpener – even if I am not to destined to become a Saw Doctor!

Another year older and a lovely day, spending time together, and with family and friends. A birthday not spent at work, and somehow more enjoyable than usual – perhaps because of how it was spent, perhaps because of the turning tide of life.

We had brunch with our biker buddies, fellow veterans of two Harley Davidson-riding tours in the USA; and an evening meal with our children, their other halves and our grandson; good food, great company, and lots of laughter.

I received many gifts, and they followed two common themes: alcohol and woodworking. The tools included a Joseph Marples bevel gauge, Thomas Flinn saws and a chisel hammer.

Most new tools require a little finishing or, I think the term is, fettling, and I have already fettled the hammer, shaping the handle for comfort and changing the finish from a shiny thin varnish to BLO (boiled linseed oil) with wax to follow. This process, is not a chore – there is real satisfaction in honing a factory finished edge, reshaping a handle … of making a tool “mine.” I hope it reflects my aspiring craftsmanship.

Alcohol came in the form of a gin-making kit (no, HMRC, I am not setting up an illicit distillery), whisky and a box of Badger beers. The latter include a bottle of well-named Tanglefoot ale. Seeing it, I was reminded of a training event I attended in 1989. This was a three day course in paediatrics, giving training to undertake six-week baby checks. It was based in Dorchester, and we were living in Southampton, so I stayed in a B&B in a nearby village. The village pub sold the local Badger brewery ales, and a couple of pints of this said brew did indeed tangle my feet on my walk back, and have the room spinning when I fell into bed!

It is a moot point whether Practice nurses and Nurse Practitioners can, with a two day course and some mentoring, take over the six-week baby checks. I have my doubts: hip examination is one thing, but listening for heart murmurs, checking femoral pulses, and examining eyes for a “red reflex” can be difficult for even experienced doctors. We need to be careful, lest the GP shortage leads to inappropriate delegation of work that requires a GP’s experience and clinical judgment. Delegation should only be made to those who have been fully trained and thoroughly assessed and who have the necessary background experience – for safety, diagnostic and medico-legal reasons. Maybe I am a grumpy old Luddite …

… indeed, I received a jar of ‘Grumpy Old Man’s Mustard’ from James and Steph. I hope that this gift will prove to be less well-named, or at least less appropriately-named. I have not been the most relaxed of husbands and Dads, nor the happiest doctor of late at work. However, I dare to hope that I will be a lot less grumpy than hitherto, as I step off the treadmill that General Practice has become in recent years, and turn to learning to work wood with my hands. I am really looking forward to putting to use my expanding collection of tools, both newly gifted and those that I have inherited or have been passed on to me from friends and patients.

The wittiest card award goes to my brother Darryl …

…. and the funniest present award, to Siobhan – “No,” I assured Sylvia, “I would not trade you for all the woodworking tools in the world!”

It feels as if I have passed a milestone.   Since I made the decision to retire, the 31st of January – my last working day in the Practice – has seemed like a distant horizon.  

Monday brought the realisation that I had this week and then next week, before I am off for Christmas – my first Christmas week off since I qualified in 1986!  Then, it’s just four weeks before I work my last day in the Practice.  Suddenly, that day feels tangibly close.

With Christmas approaching, cards and gifts are arriving from my patients, as is traditional for this time of year.  This year, many contain good wishes for my retirement and plans, and thanks for all the care I have given over the years.  

My first Senior Partner used to instruct the Receptionists: “If anyone asks what I drink, tell them gin – Gordon’s Gin!”  Alcohol is still the commonest gift, with whisky a frequent choice, for which I have thereby developed a taste. However, Mrs W’s traditional gift is a Christmas cake, well “fed” with rum, that’s always delicious.  

Not surprisingly, the full-time Partners usually do best from this spirit of giving – or giving of spirit!  Several years ago, miffed by this, one of the part-time Partners suggested that we pool all the gifts and then divide them out “fairly.” The then Senior Partner, John’s reply was swift and firm: “Well, that’s not going to happen.”    Funny how we measure our value and worth.

Wanting to be well-liked is, I think, a strong part of a GP’s psyche.  I will miss that show of affection and gratitude … much more than I will miss not having to buy my own whisky!

There is a tide in the affairs of men.
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries.
On such a full sea are we now afloat,
And we must take the current when it serves,
Or lose our ventures.

W Shakespeare. Julius Caesar Act 4, scene 3, 218–224

My situation is hardly that of the civil war here being fought by Brutus and Cassius, nor is it likely that omitting to seize this tide would mean that  the rest of my life will be “bound in shallows and in miseries.” Nevertheless, I feel that the time – or tide – is now set for me to seize the opportunity to make a change in my life.

Two days ago, I handed in my formal letter of resignation from the Practice.  In it I wrote:

As I think you are aware, I have very mixed emotions about my decision to retire nearly two years before I had previously intended.  I am deeply saddened by the realisation that I cannot continue working in the Practice, and I feel guilty about leaving at such a difficult time for my colleagues, the Practice, and the profession.  However, I am daring to start to feel excited about my plans to make this change in my life from GP to novice boatbuilder; from ‘scopes to saws, pens to planes and computers to chisels; from reports and scripts and tasks and referral pathways to paper plans, laying-up drawings, and a pencil behind my ear; and from the medicine I have enjoyed practicing for 32 years, to building and restoring wooden boats.

I have struggled emotionally with various issues, particularly the change of culture, moving from a small family-like Practice to the corporate structure and its ways of working; and with the breaking up and re-forming of teams which has been the necessary result of merging four Practices into one.  I will not miss the workload, and the pressure of work, which I have found at times overwhelming.  But, I will miss the medicine; the patients I know well, some for 28 years; and my colleagues, particularly those I have known and worked with for many years, who have become good friends.

I would like to take this opportunity to express my sincere gratitude to the Trust for having the vision of integrated care, and for taking the risk to take on my Practice, and others, securing the future of primary care in Gosport for the patients and all of us in post.  I am very grateful to the Practice Managers, who have taken on the huge challenge of merging four Practices, and forging a new Practice with SHFT (Southern Health NHS Foundation Trust).  They have worked so very hard on this project, and there have been some real successes. 

With just eight weeks to go before my last day in the Practice, letters, gifts and good wishes continue on a daily basis – all very humbling.  The theme is always the same: “I am so sorry that you are leaving, you will be really missed ….” only to be immediately followed by “… but I understand why you are going” or “… you’re doing the right thing for you.”   I find it hard to answer the recurring anxious question that frequently follows from my longstanding patients: “Who will I see when you are gone?”  I point to my remaining longstanding Partners, and praise their abilities and commitment.  However, I know that they are already struggling with the workload and its pressures, and the numbers of complex patients that they see.  The Practice continues to advertise for new doctors, but there have until recently been no responses.  Our Research sessions are to be filled by a locum for the next few months.  The backfill for the three doctors leaving this month is also with locums.  The good news is that someone is interested in replacing the Lead GP post that I vacated two months ago, but an outsider will find it difficult to take on a leadership role with long-established Partners.  It is sad but telling that none of the current Limited Partners are prepared to take it on.

With the majority of GPs planning to retire before they reach 60 (www.pulsetoday.co.uk/news/gp-topics/employment/majority-of-gps-intend-to-retire-before-the-age-of-60/20037119.article) the news today is that an RCGP survey reports that 30% of GPs are planning to retire in the next five years  

I feel sad and sorry to be adding to this ‘brain drain’ but the time has come for me to move on, and I must catch the tide, to gain fortune – of a non-financial nature – or surely succumb again to the workload and pressure which made me ill eight months ago.

I have recently joined the Hampshire Woodturners Association (HWA).

One of the machines that I inherited from my Dad was a wood turning lathe and, not having done any wood turning since my mid teens at school, I decided that I would make use of the lathe and do some turning.  Happily, a retired patient of mine, who I have known for many years, is a very keen and accomplished amateur wood turner.  Richard has taken me under his wing, keen to get me started with wood turning, and we have done a few projects together, most notably a housing for the brass porthole in my office door.

At a recent HWA meeting, I won a couple of beech ‘blanks’ in the raffle and, having bought some tool sharpening tools, dust extraction and other protective gear, I have now turned them up into a couple of bowls. Aficionados will spot not only the progression of technique/?ability from my first solo bowl to the second but will no doubt, have some useful criticism to make.  Anyhow, I am pleased with my efforts, and glad to have started this new craft and skill.  It feels like another step in moving forward … moving on.  I must say, that when I am at the wood lathe, making shavings and sawdust, everything else goes out of my mind … it’s really therapeutic.

This first, a highly figured, bowl, is turned from spalted beech, where fungus has infiltrated the grain – https://www.thewoodplace.com/wood-types/spalted-beech.

The second bowl, is also beech, but this one not spalted.

Patience please … it’s too early for commissions!  Anyway, I hope you like the attached photos.

Tomorrow is the November HWA monthly meeting, and I will take these first two solo efforts, to see what the experts think, and to learn what I can do to improve.

Yesterday, the 1^st of November, was a significant date, and its being so came to mind while we were out for a meal with friends, talking about my future plans and how long I had left in the Practice.

Sylvia has been keeping an eye on the number of months, then weeks, and now working days that are left before my upcoming retirement, but when people ask me if I am counting the days, my reply is along these lines: I remember when, as I child, the more I looked forward to Christmas, the longer it seemed to take to arrive; so, no, I am not counting the days!

Time is indeed a funny thing.  When we are looking forward to some future event, time seems to slow, but when we are dreading an event, time speeds up.  When work is busy, time rushes by; when work is (rarely) quiet, or the time to switch the phones to the out-of-hours service is drawing near, then time drags oh so slow.

As we get older, time seems to speed up. ‘Hasn’t this year gone quickly?’ we say.   Andy Rooney, the American radio and TV writer and broadcaster, once said: “I’ve learned that life is like a roll of toilet paper. The closer it gets to the end, the faster it goes.”

We mark time in many ways, and one of these is the taking note of anniversaries.  We gather more and more of these through our lives, as additions to the family increase the number of birthdays and wedding anniversaries; and the loss of loved ones add anniversaries of their death to those of their birth.  From personal, family and professional experience, I have seen how, following the death of a close loved one, the first anniversary of their birthday, their death, the first Christmas, are especially poignant, though these dates will be marked by the bereaved for many, many years.  Some happy anniversaries, particularly birthdays and wedding anniversaries are somehow increased in their importance by reaching a significant number – so a 50^th wedding anniversary is inordinately more notable than the 49^th!  Thus, when Haslar Immigration Removal Centre closed in 2015, I felt cheated by it closing just nine months before I would have celebrated 25 years of service there.

Yesterday, was the 28^thanniversary of my joining the Practice, and snippets of memory of those earliest days came back to me.  Of being introduced to patients by the Senior Partner … of finding my feet in a new job … of the welcome and kindness I received … of people telling me I looked far too young!  I had hoped and planned to reach 30 years – a nice round number – but staying on to reach that arbitrary figure is not a realistic proposition and, surely, 28 years of work is not devalued by being two short of thirty.  Rather, I count myself lucky to have enjoyed so much of my career, to have worked with some really super people, and to have looked after and got to know my patients for such a long period of time.  Yes, I fully agree with one of the superb aphorisms in Margaret McCartney’s recent ‘A Summary of four and a half years of columns in one column’ https://www.bmj.com/content/362/bmj.k3745 “Medicine is an absolutely brilliant job, and having long term relationships with patients and families is one of the most joyous and fulfilling aspects of work.”

Tidying up some papers, I came across an article I had torn from the April 2016 edition of the BMJ:  https://www.bmj.com/content/353/bmj.i2207

I had meant to show it to our son, James who, three months earlier, had entered Britannia Royal Naval College as an Officer Cadet.  Reading it now, it seems to be more pertinent to myself and my colleagues, than to James who, happily, is thoroughly enjoying his career.

Under-investment, ever-increasing workload, increasing rates of mental illness and burnout  … these fuel the recruitment and retention crisis, that in turn increases the workload  of the remaining GPs …

… it’s a vicious circle.

No wonder then, that morale in General Practice is very low:

https://www.independent.co.uk/news/health/gps-nhs-two-in-five-plan-to-quite-survey-exeter-south-west-crisis-haemorrhaging-doctors-a7679166.html

Richard Jones’ article describes how life aboard a Royal Navy warship places the morale of its crew at the heart of all that is done: the decisions that are made; and how leadership, communication, caring for people, safety, training, and a clear sense of mission all play into the morale of the crew.

I recently agreed to relinquish my Lead GP role, now that my retirement is only a few months away.  For me, the most important aspects of leadership are communication and engaging with all members of the team.  So, I spent my Lead GP session getting to know and support the doctors, nurses and ancillary staff in the three other surgeries that had merged with Brune Medical Centre, to form The Willow Group.  Mindful of the contagion of negativism, cynicism and demoralisation within an organisation, and that “…a leader with low mood can have a negative effect,” I just hope that any benefit from my leadership approach has not been negated by my time off with work-related stress.

Recognition of the inextricable link between morale, performance and safety, is the hallmark and focus of leadership in the Royal Navy.   Richard Jones asks: “Would a healthcare manager ever consider morale when making a decision?”  The NHS has certainly espoused leadership development, but its leaders and managers can still learn a thing to two from a Navy warship in giving equal weight to morale and operational capability when making decisions that affect the workforce.

Back in the early 90s, a large number of our patients were the wives and children of men in the Navy.  Indeed, the local Rowner Estate had been built in the 1960s by the MOD for these young Naval families.  With their husbands away at sea, and their families far away, the ‘Navy wives’ had little or no family support with their children, though there was often support from their peers.  We were very aware of this lack of support for the young mums from their own mothers, and accepted that there was a lower threshold for calling on us as a result.

I was reminded of this by a recent letter in The Times:

Fri 12th October, Letters to the Editor:
GRANDMA TRIAGE
Sir, There may be an even more radical solution than asking nurses to fill in for GPs (letters, Oct 10 & 11). When faced with a similar dilemma in hospital, I often quote a paper from 20 years ago showing that, in families, the involvement of a grandmother significantly reduced the likelihood of attendance for minor problems. The clear inference being that a grandmother’s common sense and experience were all that was required much of the time.

A kindly grandmother sitting at the triage desk could undoubtedly manage many of the patients, and there might even be enough doctors and nurses to look after the rest.
Anthony Cohn
Consultant paediatrician, Watford General Hospital

Here is the original paper from the BMJ:

https://core.ac.uk/download/pdf/1670636.pdf

So, could Grandma save the NHS?   I fear that the Grandmas of today are somewhat different to those of the 1990’s, who were born and raised before the NHS was founded. They and their parents were a product of a time when access to healthcare was at a cost, and self-reliance therefore a necessity.  The attitude “Don’t bother the Doctor” was the norm.  No-one can deny the huge benefits of ‘free healthcare at the point of access’ – the mantra of the NHS, which has made the NHS the most valued institution in the UK.  However, one unforeseen consequence of such free access, is a progressive deskilling of successive generations.

Over the last two decades, successive governments have prioritised access, and fostered – if not encouraged – a consumerist approach.  They have used access targets in primary and secondary care, waiting time targets in A&E, Gordon Brown’s Extended Hours, and now the latest expansion of GP services: GPEA (GP Extended Access).   Already stretched services are expected to stretch even further.

“I don’t want to bother the Doctor” is a rarely-heard refrain now, and restricted to the very elderly.  Thankfully, “It’s my right” is also rarely said (though perhaps more often thought), but there is no denying that patient/public expectations have increased hugely over the last two decades.

Grandmas of today, both individually and collectively, have such an important role in their families and society.  Despite what I have said about the change in experience and expectations, and the deskilling of more recent generations in the management of minor illness, some could certainly provide an effective triage service for minor illness.

So, there you are Messrs. Hunt and Hancock: with a little smoke and mirrors, you can hide the unrealistic promise of 5000 more GPs by 2020, and build a workforce of Grandmas to ‘man’ 111, Same Day Access Services, and A&E Triage …

… sorted!

As far back as I can remember, way back to my very earliest memories, I can recall my Father’s workshop, housed as it was in a room in our house.  Fixed to the bench, was his metalworking vise, and the sound of the ring of steel against steel as the handle dropped through its housing, is a sound that brings back memories to my being allowed into his inner sanctum, and to turning that handle as a boy aged four or five.

For the last three years, that same vise has sat unbolted on my own bench, bearing the marks of time with rust and splashes of paint, but with the same ring as the handle drops to its stop.  As I start to gather tools for my future life and work, I felt a need to refurbish this old friend.  So, I dismantled it, cleaned off the rogue paint, the dirt-ridden grease, and wire-brushed the rust.  Then, I sprayed on coats of red primer and red paint to the non-moving surfaces.

It is a real heavyweight, weighing in at 63lbs, and with 6in jaws.  On its side is the lettering DAWN and 6”SP.  Thanks to Google, I discover that this vise was manufactured in Melbourne, by DAWN Industrial Tools – just a few miles from where my Father lived.  He had bought this vise in the 1950s, and brought it with him when he came to England in 1962 with his wife, who was carrying me.

Re-painted, re-greased, and  reassembled, the vise is not as good as new, but it’s as good as it should be for its sixty odd years.   It is now ready to be bolted to my bench, and to be put to use once more.  I like to think that Dad would be proud to see the value I place in it, and glad to see the use to which it will be put.