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.