When I was training to be a GP, my tutor showed me a painting by Sir Luke Fildes called “The Doctor”. Its significance was lost to me in those fun-filled days of team-building exercises and group learning, however I remembered it again recently when I was asked to fill out an insurance report for one of my elderly patients.
In it, the underwriter asked what she could do by herself; could she dress unaided? Could she walk unaided? Could she climb stairs? Did she have carers? I felt guilty when I realized that I just did not know. Whenever I had seen her, a family member had brought her into the practice, led her dutifully to my desk and back out when her allotted ten minutes had elapsed. Would I have known her better if I had visited her at home?
Believe it or not, there was a time when you could see a GP in the wild. Far from the reclusive species we know today, GPs would regularly visit a large proportion of their patients at home and would revel in the opportunities that the house call provided. Seeing the patient in their daily habitat gave them a picture of their constitution: their interests, their families, their habits and their current mood. At inception, circa 1948, the role of the general practitioner was one of twenty-four seven, three sixty-five care. When the doctors’ charter of 1966 came into effect, more emphasis was placed on facilities and staff within a practice and one could argue that the focus towards centralised care began here. However the model was unsurprisingly fraught with difficulty and, in effect, was unsustainable.