The work of a GP in 2017 Britain is worlds away from how it was when Dr Peter Coleman started out in the early 1980s.
Amidst all the massive social and technological shifts in healthcare, his town and rural practice in Ventnor has managed to retain its strong focus on traditional values, with a close-knit community feeling that comes from having served the same local families for several generations.
In 2015, the Ventnor Medical Centre won a Practice of the Year Award.
We spoke to Dr Coleman about his 35 years at the front line of community health care on the Island.
If the young Peter Coleman had stuck to his schoolboy ambition, he might have spent his working life carrying handcuffs, rather than a stethoscope.
Like many young lads, he had fancied himself as a policeman – although it wasn’t an idea that went down well with family or friends.
“Nobody seemed very impressed with that choice” he recalls, “but when I started thinking about being a doctor, well, that certainly seemed to go down a lot better!”
Born in Leicester, Peter had moved to the Island at the age of six with his parents, Eric and Barbara, who started up an office supplies company in Newport.
He attended Nine Acres and Newport C of E and then progressed to Ryde School, where the idea of going into medicine began to grow on him.
It just so happened that a new medical school had been set up in his native city of Leicester, and after A-levels he was accepted there as one of only its second intake of students.
“It was all very new, so an exciting time to be studying there” he said. “We got an excellent medical education and a huge amount of experience”.
Initially, Peter had planned to specialise in obstetrics and gynaecology – but that was reckoning without the legendary lure of the Isle of Wight, which ended up drawing him back over the Solent.
He explained: “Returning by train from a weekend away, I found myself reading the BMJ (British Medical Journal) from cover to cover, and noticed an advert for a GP training scheme on the Island.”
By that time he had already started his ob-gyn training, so he was faced with a tough choice. Ultimately he decided he wanted to head back to the Isle of Wight.
The choice was made even tougher by the fact that his much-respected Professor of Ob-Gyn had found him a job at Leicester Royal Infirmary, and so was none too pleased.
“He didn’t speak to me again until the day I left the department” he recalls.
Prodigal’s return
Leicester’s loss proved to be the Island’s gain, when Peter began his three years of GP training in various junior doctor posts at the now-defunct Ryde Casualty Hospital and St Mary’s Newport, and then as a GP trainee in Ventnor.
“The attraction for me was being able to come back to the Island, and yet still have a great training opportunity”.
“It was a good medical community to work in” he says. “I did have a lot of responsibility for my grade, but we were very well supported, and that made a big difference”.
As he says, he and his fellow trainee doctors of the early to mid-1980s put in similarly long hours – sometimes 100 a week – to those of today’s hard-pressed junior doctors, but he added: “We were much better supported in those days than they are now”.
“We had the doctors’ mess where we could take a break and talk to each other, and hospital rooms that we could stay in after a shift.
“Nowadays that’s all gone, and exhausted young doctors have to face a journey home after a long shift, or stay in a bedsit”.
Another thing that was different was the fact that when Dr Coleman arrived on the Island in 1982, at 25 years old and, as he puts it, “young, free and single”, he was able to buy a house even on a trainee’s salary: something that would almost certainly be way out of the reach of today’s junior doctors.
He says he was helped by the fact that as a student in Leicester, he’d realised it was cheaper to buy a house than to rent one, and so effectively leapt on the property ladder while he was still at Uni!
After selling that property, it gave him the means to invest in a small house in Ryde as his first independent home on the Island.
Working GP
After a hectic three years as a trainee, Dr Coleman gained his GP Certificate and headed to the south side of the Island as assistant to Dr Norman Beisly in Ventnor.
After little more than a year, Dr Beisly retired, meaning that at the age of 30, Dr Coleman became a partner in the practice with the late Dr Alan Champion and Dr David Turner.
“It was very much about working in the community, and seeing whole families, so you built up strong relationships of trust with people over time, and really got to know people” he recalls.
“It’s satisfying to feel that you are helping families throughout their lives, and now, after more than 30 years, I must have seen four or more generations of the same family.
“For a GP that’s a great basis to work from, because you really get to know people and their history, which makes it easier to pick up on things they say or do that might be subtly different and may need your attention.
“Unfortunately it’s hard to measure any of these things in the way the Government would like us to measure them – it just comes from experience and knowledge of your patients.”
“Of course we have had to modernise and embrace all the modern methods, but we still do it here in a family-focused way.”
But as he points out, the pressures in the NHS now are steering things towards ever- larger medical practices.
“The general idea is that large is good” he says, “but you can lose the real effectiveness of a family GP if there’s no continuity or relationship with the practice.
With its roll of just over 5,200 patients, Ventnor would now count as a small medical practice – the average being over 12,000, and in the case of inner city practices, more like 30,000.
The biggest change Dr Coleman says he’s witnessed during his years as a GP is the “intensity and depth” of the conditions that family doctors now routinely treat.
“What I see in the surgery now is as specalised as I used to see in outpatients during my hospital training” he explains.
“There’s a lot more responsibility on the GP in managing chronic conditions, such as heart disease and diabetes, and while that is good in many ways for the patient, it does increase pressure on the service.
“It certainly means you can forget that old stereotype of the GP who treats a few coughs and colds in the morning and then spends the afternoon on the golf course!” he jokes.
Even when patients have to be referred to hospital, it’s only after some good GP detective work and then diagnosis, to ensure that they get to the correct specialist for the job.
And if the GP’s job has got more complex, it has also become more demanding in terms of hours, and patient expectations.
“A 10-hour day for me would be a good day” he says. “12 hours is a not-so-good day.”
He stopped doing out of hours calls some years ago, after suffering a serious thigh muscle rupture in a fall, which put him out of action for months.
“When I came back it was to the day job, and I made the decision at that point to stop doing out-of-hours” he says. “It certainly made family life easier to manage.”
At that stage, his wife Rebecca – who had previously been a full-time GP partner in Newark – was a part-time partner at the Ventnor practice, and their children Emma and Edward were in their teens. Emma, now 26, has followed in her parents’ footsteps and is a junior doctor in London, while Edward, 24 is a trainee solicitor in the Capital.
Doctor as patient
In fact, both Dr Coleman and his wife have experienced the health service from the other side of the consulting desk. Rebecca was ultimately forced to retire early because of a recurring spinal problem, while Peter ended up in full leg plaster for three months after his fall.
He recalls his experience as a patient as frustrating, and his recovery took longer than anticipated: “I got so bored at home that I came in just to do some admin work – but then I ended up developing pneumonia, which really set me back again”.
He added: “I was trying to do as I was told, but I found it very difficult being a patient!
A medical training doesn’t make you feel any less powerless…”
Meanwhile Rebecca has undergone two episodes of back surgery and lives with chronic pain.
She retired from the practice after “making an enormous contribution to its development” says Dr Coleman, but continues to put in many volunteer hours as Chair of the Friends of Quarr Abbey, as well as being a member of the St John Ambulance County Priory Group, and area president for the Ryde unit of St John Ambulance.
She also has a diploma in interior design, which she’s used to the full in tastefully restoring their character Victorian home and 4.5-acre gardens in Ryde – described as a “Forth Road Bridge task” by her husband.
Dr Coleman says he especially loves the gardens as a place of retreat and relaxation – and, in particular, the pond that is home to his collection of Koi carp.
He inherited the fish from a late friend, and says they’ve provided the perfect way to wind down after a shift at the surgery: “I can just sit and look at them for hours” he says.
He and Rebecca also enjoy their holidays abroad – although they have learnt never to disclose what they do for a living.
“I made that mistake once in Cyprus” he laughs. “I was lazing by the pool and ended up with a row of people with skin rashes, all queueing up by my sunbed!”
There was one occasion, though, when he was happy to step up – on a Kuwait Air flight back from a holiday in Thailand. A passenger in First Class had gone into anaphylactic shock after eating caviar, and the call went out for a doctor on board.
Dr Coleman injected him with adrenaline and effectively saved his life. Afterwards, he was invited for a free holiday at the grateful man’s home in Malaysia – although he never took up the offer.
As he anticipates a well-earned retirement, Dr Coleman says he is planning to “deliberately do nothing” for a while, whilst slowly deciding how to spend the next phase of his life.
Having also held various demanding advisory roles with the Health Authority since 1993, including being a founder member in 2012 of the Island’s Clinical Commissioning Group, his working life has certainly been full-on.
He says he couldn’t have managed it without the huge contribution made by Rebecca both in the development of the practice and supporting him in his extended role.
“I’ve found that level of involvement very rewarding” he says, “and it’s been an important part of what I can give, to support that side of the Health Service”.
But his main source of fulfilment has clearly come from the day-to-day interaction with patients at his Ventnor practice.
“Yes, it is a good feeling to have so many people who appreciate the service I’ve given for over 30 years in Ventnor” he says. “It’s been rewarding for me, and has worked well for patients.
“Unfortunately, being a locally-based GP seems to be much less fashionable for young doctors qualifying now – but to me it has always been a great thing to do. Really getting to know people in depth, earning their respect and respecting them in turn, is not something you can suddenly do – it takes decades of practice.
“This basic philosophy remains the same, and it means the doctor has a full and varied career, while the patient can expect to receive a good level of all-round care.”