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Richard Gee, 2008

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Richard Gee, 2008
 
 
Interview 98 Richard Gee

General Practitioner
Born in Wall Heath, Staffs in 1947.


Overview: Richard Gee has been a G.P. in Lower Gornal, on the edge of the Black Country, since 1972. During the 1980s, a diabetes consultant from Wordsley Hospital helped his practice, and other training practices in the area, to set up mini-clinics and make links with a Diabetes Resource Centre at the hospital. In Dr. Gee`s view, the Payment by Results system, introduced in 2004, encouraged hospitals to reverse the flow of patients from hospital to GP care - but in his area many patients have preferred to stay with their` GPs, supported by a strong diabetes community nursing team.

There is interview with another Black Country GP, from one generation earlier, Dr. Joe Needoff.

Please note that Overview relates to date of recording 22 April 2008

 Short samples

1 While he was a Senior House Officer at Wordsley Hospital, from 1971 to 1972, he first became aware that there were two types of diabetes, known then as ‘juvenile onset’ and ‘maturity onset’. ‘Maturity onset’ diabetes was regarded as less serious. [ 57 secs ]

2 In the thirty-eight years since Richard Gee arrived at the Lower Gornal practice, there have been many developments in the treatment of diabetes: he thinks that two of the most important are early screening and patient education. [ 58 secs ]

 
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01 Staffordshire village. Father factory accountant. Grammar school. Birmingham University, 1965-70, 3 years science, 2 years clinical.
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02 Last 2 years continuous assessment – unique. 1st house job – cardiology, Birmingham General Hospital. Surgical house job, Guest Hospital, Dudley. General medicine, Wordsley Hospital.
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03 2 weeks diabetes as student. Warned to avoid huge diabetes clinics at General Hospital. Needed more knowledge re diabetes in Dudley A & E. At Wordsley, 1971, learnt from nephrologist. Realised diabetes not best managed in hospital.
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04 At Wordsley, ‘juvenile onset` & ‘maturity onset` – all on strict diet. Exercise not mentioned. Sedentary hospital life no preparation for physical jobs. Maturity onset regarded as milder, but I saw it lead to severe complications.
Juvenile – Isophane, IZS. Maturity - Tolbutamide, Chlorpropamide.
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05 Had heard of ‘units`, but ignorant re diet.
Large outpatients, all conditions, no appointment system.
Converted workhouse, Nissen huts, diabetic diets on trolley.
Ward rounds. Little inter-consultant referral.
Learnt importance of early diagnosis & glycaemic control in home environment.
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06 Locum GP, Lower Gornal, 6 months – extended – stayed. Black Country – miners, steel workers, food suppliers. Interbreeding – much Type 2.
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07 Large practice & workload, on call to maternity unit, sleepless. Joined another practice - shared rota. 1974-78, set up preventative programme. 1978, split into 2 practices. Lower Gornal - prevention, computerised prescriptions. 1984, became training practice. Linked with diabetologist, Dr. Zalin, at Wordsley.
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08 Previously all diabetics treated at hospital. We began to manage Type 2. Urine-testing. Difficult to track patients…
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09 …developed individual lists for continuity. Proactive – screening.
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10 After became training practice, met with other training practices. 1985, Dr. Zalin trained us towards establishing own mini-clinics - register – paper-based – 6 monthly reviews.
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11 2 clinics monthly - practice nurse, dietitian, chiropodist. Dr. Zalin continued training. Patients saw nurse, then doctor.
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12 Dr. Zalin emphasised exercise. At first, thought it more important for Type 1, then realised importance for Type 2. Retired manual workers thought they deserved rest!
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13 Diabetes Resource Centre developed at Dudley – asked GPs to notify of all diabetics, early 90s. Developed retinopathy screening & specialist nursing. We began some Type insulin initiation. Dr Steve Parnell`s audit showed better care in mini-clinics than hospital outpatients.
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14 Disliked 1990 contract, but not much affected. Introduction of commissioning – nearly lost, 1997, then revived. Primary Care Groups – I became Chair of one – improved diabetes care. 2001, PMS standardised care. 2002, PCG became PCT. Development of community nurse specialists lessened iniquities of Payment by Results, 2004/5.
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15 PMS went well 2002-4. Payment by Results, 2004, damaged partnership between hospitals & GPs. From 2002, our PCT developed good community care - patients stayed with us after Payment by Results.
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16 New contract, 2000, & QOF, set diabetes targets, encouraged information collection & introduced Local Enhanced Services.
1972 - open all day, walk in, diabetes referred to hospital. Now – waiting more controlled, diabetes seen in mini-clinic, little hyperglycaemia, patients empowered.
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Transcript
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