Interview: 'I was the first single-handed GP in Liverpool to employ a practice nurse'

Dr Shiv Pande is one of more than 10,000 South Asian doctors who came to work in the UK in the decades that followed the second world war. He speaks to GPonline about his experiences and his hopes for the future of the NHS.

‘I came to the UK from central India,' says Dr Pande, 'where I worked as a professor after completing a masters in surgery, in 1971 in order to get additional training.'

‘When I first arrived I did six months in A&E at the Royal Albert Infirmary in Wigan. It was a good start - I think everybody starting out in medicine should do some work in A&E because that is where you see a variety of patients and a variety of people. I then worked another six months as a registrar at the London Chest Hospital, during which time my wife came over from India to join me. I was then headhunted via contacts to work as a registrar in Liverpool.’

Dr Pande decided to forgo his job in India to stay on and work in the UK. Against the advice of some potential employers, he made up his mind to work in general practice.

GP shortage

‘I decided to go into general practice and I wanted to do this in the UK as my children had settled into secondary school here and there was a shortage of GPs. I went into general practice because it was a different direction. You were in charge, and I felt that a good GP could really make a huge difference for his patients.'

A book on the contribution South Asian doctors including Dr Pande made to the NHS - celebrated in an exhibition that opened this week at the RCGP - explains that many British GPs at that time were choosing to work abroad.

Thousands of doctors who arrived from Pakistan, India, Bangladesh and Sri Lanka to fill the yawning gap in the NHS workforce settled in, and played a fundamental role in making UK general practice what it is today, the book - Migrants who made the NHS - explains.

Dr Pande says: ‘At the time, there were different areas in which to practice: "restricted" areas, which included places like Surrey, and "designated" areas, which included a lot of very working class towns and cities like Liverpool, Manchester and St Helens.’

Innovation

Staying in Liverpool, Dr Pande completed his vocational training, which at the time took one year instead of three. This ‘gave me a tremendous insight into general practice and reassured me that my life was going in the right direction’, he says.

Upon completing training, he rang round practices in the area to let them know he was available. After initially working as a locum he joined as partner with another Asian GP who had suffered a heart attack. Dr Pande took over his practice, then in 1981 took over another practice where he became the first-single handed doctor in Liverpool to employ a practice nurse.

‘There was a lot of ingenuity, lateral thinking [and] experimentation that came with the job… We were looking after patients 24/7, 365 days a year. It was hard work. The locum service was there, and they could cover, but it was costly.

‘It became clear that a practice nurse was needed. I was a male doctor, and many of the ladies coming to my surgery - especially from the Asian community - did not want to talk to me about their issues. So, because I was able to appoint and had the freedom to make these decisions, I appointed a nurse to take blood pressure, weight and urine samples.’

After that, Dr Pande became more and more involved in community life. He started co-presenting a citizens' rights programme called Aap Kaa Hak - a Granada TV show based on the English-language show This is Your Right - where he would answer questions about health and welfare in Urdu and Hindi.

Community role

‘I was thinking: "What about those people who, like me, were not born here, not brought up here, who may find the language difficult but are nevertheless working here?" So I went to the studio and they started doing the programme in Hindi.’

‘I was speaking to all sorts of people [for the show] - dieticians, social workers… And I started thinking "why don’t I invite these people to come to my surgery?" So that’s what I did - 20 years or so before it became the norm, I had a nurse, a social worker, a dietician - all sorts of health workers - in my surgery, and that was all because you could decide what you wanted for your patient. As the need came, I was happy to provide.’

In the years that followed, Dr Pande’s practice also started providing children’s health checks, vaccinations and family planning clinics. ‘I was doing everything,’ he says. ‘I was like an octopus with tentacles all over the place!’

Although Dr Pande’s busy schedule meant that he was away from his family a lot  (‘My eldest son, who was really keen to become a doctor, saw that I was leaving the dinner table and rushing out to see patients late at night and decided not to go into medicine’) his two younger children both went on to become second-generation South Asian doctors in the UK.

Future of the NHS

Today, as the government seeks to recruit thousands of overseas GPs to tackle the workforce crisis and the NHS approaches its 70th anniversary, what does Dr Pande think the future holds for our healthcare system?

‘The future is worrying me - especially the fragmentation… But the NHS can’t be a bottomless pit. Everyone has a budget and we have to be realistic. We have to provide the needy people with the services they require, but we must also balance our books.

‘The fact that we have made it this far is a great credit to my profession and fellow GPs who are the gatekeepers of the NHS. We are at the forefront, the first NHS "buffer" people come to and our general clinical knowledge is the only defence.

‘Although I do have my worries for the future, I believe that if the government works with the profession then we can survive for another 70 years or more.’

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