Liam Farrell: One last home visit shows the challenges facing the NHS

The day I retired, I was passing Joe's house, and thought I'd call in to check up on him.

He and I have been growing old together, and our relationship is deeper than mere sex; I know his naked body like the back of my hand (though Joe is so hairy it can be hard to tell if he is naked or still wearing his string vest).

Joe and I were both born ten years after the launch of the NHS, and have spent all our lives in it’s ample bosom, though while I was working for it Joe was exploiting it mercilessly.

Future historians may look back at the NHS and say that there was time in the twentieth century when people actually gave a f**k about each other. It has always been there for us, a source of security we take for granted, where treatment for ill-heath doesn’t depend on what you can afford nor lead to financial ruin, something precious we must be prepared to fight for.

As it happened, Joe had some American visitors that day, relatives, I think, or maybe blackmail victims, who were amazed that a doctor could just, like, call.

‘In the States a house call would cost a million bucks,’ they said (or some equivalent mind-boggling sum); which would be quite alright with me, of course.

Home visits have always been a cornerstone of general practice; information to be gleaned, trust to be nurtured. But they are an example of how the NHS will have to change; we just don’t have that kind of time anymore. I can see six patients in the surgery, with all it’s diagnostic and therapeutic facilities, in the time it would take to visit Joe and wait for him to get naked again.

How can we adapt to the ever-increasing demands and yet maintain the doctor-patient relationship? It’s nobody’s fault; an ageing population with more associated morbidity, increased expectations, the inexorable advance of (expensive) medical science; as di Lampedusa said: ‘If things are to stay the way they are, things will have to change.’

To paraphrase Churchill, the NHS is not a good system of health care, until you compare it with all the rest. But yet again, perfect is the enemy of good; the NHS can’t do everything for everybody, and hard and unpalatable choices will have to be made. We need a mature conversation, but whether our political parties possess that maturity is very doubtful.

As I left, Joe shook my hand one last time.

‘Thanks for all your care over the years, doc,’ he said, as I counted my fingers and checked my rings were still attached. ’It’s been an honour.'

And then, for one final fling.

‘Before you go,’ he said, ‘I’ve an awful cough, can I have an antibiotic?’

The more things change, the more they stay the same.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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