Memories: Standing on the shoulders of giants

An inspirational event was held at 30 Euston Square on 22 February, as part of the celebrations of the 60th anniversary of the founding of the Royal College of General Practitioners. Those attending were privileged to hear six speakers — Sir Donald Irvine, Sir Denis Pereira Gray, Marshall Marinker, Mike Pringle, David Haslam, and Stuart Sutton — who each spoke about a decade in the College’s development.

Marshall Marinker quoted Tony Judt — ‘if you’ve lived through a period, you can’t write its history, you can only have memories’ — and indeed the speakers mostly focused on personal memories, a kaleidoscope of issues, moments, and people, although Denis Pereira Gray presented developments in the 1960s with the incisive, forensic clarity of a born historian.

Had the event been held a few months earlier, it would have been graced by John Horder, a great figure in the College’s evolution.1,2 But there are still a few links back to the first days of our College: Nigel Mathers, chairing the event, read out a letter from HP Cooper Harrison, now 97 years old, who was involved in the College from its foundation, presented a paper on the training of undergraduates by GPs in 1953 at John Hunt’s invitation, and was commended by Will Pickles for choosing Cum scientia caritas as the College’s motto and helping design the College’s coat of arms.

Memories: Mike Pringle recalls the SAS siege.

Donald Irvine,3 the only GP to have been GMC President, recalled that the College was formed as a protest movement about poor standards of care, unlike any of the other medical royal colleges. He described ‘what it was that made’ the College’s founders ‘get started: the fuel was the disaster.4 It was the determination that something had to be done about’ the poor standards in general practice, ‘and that only practitioners themselves could lift themselves out of the mess’. ’Something had to be done about establishing general practice as a discipline in its own right.’ Donald also spoke of how the College became a fast communication system for the people who were going to change practice, and how morale was improved.

Denis Pereira Gray, the only GP to have chaired the Academy of Medical Royal Colleges, identified some crucial advances in the 60s, which he called ‘the decade when general practice came in from the cold’. RMS McConaghey fought to keep the College’s journal, this journal, as a peer-reviewed, scientific publication, against much opposition, and was rewarded by its inclusion in Index Medicus in 1961 as the first scientific journal of general practice in the world.5 In 1962, Prince’s Gate was purchased. In 1963, Richard Scott was appointed as the first professor of general practice in the world. That same year, the Gillie Report6 was published, described by Denis as ‘the first publication I had ever seen that gave hope and encouragement for a future in general practice’. In 1965, the Membership examination was initiated as ‘the first objective examination of general practice in the world’, and the College argued the case for systematic training.7 John Horder’s ‘tremendous withstanding’ of interrogation by the Royal Commission on Medical Education led to the complete endorsement of that case by the Commission.8 The Report of the Commission, published in 1968, was ‘the transforming document that changed the way the whole of general practice developed and the whole of the College developed’. And when Annis Gillie was made a Dame, she was the first family doctor who had not been a GP to the Royal Family or to a Prime Minister or Chair of Council of the BMA to receive a high honour; another breakthrough for academic general practice.

Denis remembered ‘how small that Council was and how brilliant its leadership was. We really are looking at a historical story of professional leadership of the very highest order’. ‘We were very fortunate we had them at that time.’

Marshall Marinker remembered the vibrancy of the Faculties; Julian Tudor Hart’s iconic essay on the inverse care law;9 the enormous and radical influence, nationally and internationally, of The Future General Practitioner,10 written under the chairmanship of John Horder; setting up the London Teachers’ Workshop; the ‘marvellous diversity’ of training; the introduction of the Vocational Training Regulations;11 and how he and Bill Styles had in 1979 written a paper proposing the introduction of democracy to the College.

Mike Pringle described the introduction of audit, led by Donald Irvine, and how as part of that move to reflective practice he had been the first GP to undertake Fellowship by Assessment. He mentioned the establishment of the internal market and fundholding, the imposition of the 1990 GP contract, and the importance of computerisation. Mike remembered the SAS siege of the Iranian Embassy as ‘the most important thing that happened to the College’ in the 1980s, describing how the SAS drilled a hole in the wall and started feeding in a microphone. ‘It was only then that someone had the courage to say there was another bit’ of the building ‘between us and the Embassy.’

David Haslam, the only doctor to have been President of both the College and the BMA, echoed what all the speakers had emphasised, ‘the importance of individual inspiration’. He identified the cyclicity of policy-making: many Government policies of the 1990s were still being proposed, as if newly minted, 20 years or so later. He talked of the stimulation and excitement of being a College examiner, and told how devising modified essay questions for the MRCGP examination taught him that ‘you can have an opinion about anything with zero knowledge. Dear God, as Chair of Council that was useful’. He concluded his own memories by stating ‘the secret to an enjoyable and successful career is to mix with enthusiasts, and for me, that’s just what the College has done’.

Stuart Sutton, former Chair of the College’s Associates in Training Committee, talked of the strength of the College’s female leadership; how trainees’ voice was at the heart of the College; how Associates in Training now formed a quarter of the membership; the replacement of summative assessment by the introduction of the new MRCGP examination in 2007; and the curriculum.12 Looking to the future, he hoped to see longer training and a larger GP workforce.

Listening to Memories was a tremendously positive experience, a concentrated hour of magic, and heartening confirmation of the importance and influence of our College. But as well as celebration, it was also about the enjoyment of storytelling and oral history. Donald Irvine remembered annual doctors’ pilgrimages to Will Pickles’ practice in Aysgarth to see epidemiology firsthand,13 and described his father-in-law’s attitudes as those of an ‘old goat’. Marshall Marinker described the early Chief Executives as ‘from casting for Downton Abbey’, and told of how, when he was the first doctor ever to sleep in a double bed at Prince’s Gate, the staff had made him an apple-pie bed strewn with fresh rose petals. David Haslam recalled how the Prince of Wales’s bust had worn a policeman’s helmet at his daughter’s wedding reception.

David Haslam rightly mentioned the importance of patients. We can be justly proud that we were the first Royal College to set up a patient group, leading the way with our Patient Partnership Group in 1983. In setting standards and defining quality, we strive to deliver the best possible care to our patients. The progress we have made was exemplified throughout the Memories event.

• © British Journal of General Practice 2013