Graham Lockerbie, Dartmouth GP
I Am The Doctor - Dartmouth GP, DR Graham Lockerbie
When I met with Dr Graham Lockerbie, eminent Dartmouth GP and partner in the Dartmouth Medical Practice, I expected to have a highbrow discussion about the latest NHS reforms, so I did a bit of reading up to prepare myself.
I’d chatted to Graham lots of times before and knew I was interviewing a man held in high regard by the people of Dartmouth, passionate about his work and about getting the very best deal for patients.
What I wasn’t expecting was a lengthy and entertaining natter about the tussles of judo, and the perils of being a Glasgow boy who was actually born in (shhhh … England!)
“You can imagine how that went down growing up in Glasgow – the fact that I was born in Consett. My father was the manager of the Consett Ironworks at the time, but my parents went back to Scotland when I was still a baby.” He might have been born here and lived in England a long time since, but there’s no doubt who this popular doctor supports through the Six Nations.
Dr Lockerbie has been in Dartmouth for 26 years. As one of seven partners in the Dartmouth Medical Practice, he is proud of the unique set up honed by the Dartmouth GPs. This is a portfolio practice where each of the GPs fulfils a different role and brings with them their own particular expertise. Graham is the chairman of the local GP Commissioning Consortium and handles Primary Care Trust matters, liaising constantly with the health service. Another example is Dr Andrew Eynon-Lewis, who works extensively on GP education and the training of medical students, Dr Adam Morris is an expert in cardiology and Dr Anthony Anderson in ear, nose and throat. There is also expertise in dermatology and rheumatology – skin and joints to those untrained medics amongst us
The practice also employs a salaried doctor and a hard working team of nurses, health care assistants and receptionists. It is a hive of activity where everyone has learned to expect the unexpected.
All of this work, the skill set, the management and liaison with other authorities, stands Dartmouth in good stead when it comes to the coalition Government’s plans for NHS reform. Dr Lockerbie is taking it all in his stride, but that’s not to say he doesn’t applaud the next step for GPs.
“The Big Society could be good for us,” he said, commenting on the Government plans to get rid of the Primary Care Trusts and pass control of budgets to GPs.
“I’ve been through five major health reorganisations since I’ve been here – Family Practioner Committees, GP Fundholding, Health Authorities, PCGs and PCTs, now we are to have Strategic Health Authorities. The only constant throughout has been General Practice, which is very interesting. While the nature of the job has changed, the principle that if you feel poorly you go and see your GP is still there. The health service is completely free at the point of contact. GPs are the gatekeepers for the NHS. I think the new reforms just make that more obvious.”
News bulletins say GPs will hold the purse strings of the National Health Service, wielding new power. Dr Lockerbie said: “We will be making big decisions on funding public health.”
Surely we’ve been here before? Back in the 1970s Barbara Castle called for a shift away from hospital treatment towards more community based services. Throughout the 1980s and 90s the message was the same, but by now we had huge hospitals mopping up community health care. In the 1990s ministers gave GPs their own budgets (GP Fundholding) which was scrapped by the end of the decade, before practice-based commissioning was brought in by 2004. The ping pong has continued ever since. Is this latest move going to mean big changes?
“This is not fund holding all over again,” Graham explained. “Fund holding was limited in scope and GPs were only given 25 to 30 per cent of the budget to spend. It also wasn’t compulsory – this is. The change will start in a shadow form in April and kick in properly in 2013, when GPs become accountable for the money – long overdue in my opinion.
“For the whole time I’ve been in Devon, acute hospitals have been the focus of attention. There has been a steady increase in the number of consultants and the standard of care that they offer. They hoover up huge amounts of money, and the only way that we will be able to face the financial challenge of the next few years is to change the way we think and take some of the care delivered in hospitals out into the community.
“Big hospitals need to do what they do – if you need a heart bypass that’s where you go, but if you need some investigation, that could be delivered close to home. Another example is follow up appointments after small operations.
Patients travel all the way back to Torbay or Derriford hospitals to be asked how they feel and told they don’t need to be seen again. Each appointment costs the health service £140. In theory if we save that money by carrying out that service here, we can reinvest it for the benefit of local patients.”
Dartmouth’s portfolio practice and its thriving community, including the hospital, make it a perfect fit for the reforms, in Dr Lockerbie’s opinion: “We will be commissioning the hospital’s services, ie buying the services that it provides. We already work closely with the hospital, but I think to make it work better for the community it needs fewer beds, used more intensively. A lot of the care currently given in the hospital could be shifted into patients’ homes and GP care. That is the big untapped service – keeping people in their own homes for as long as possible.”
If organising Dartmouth’s health care at a local level appeals to Dr Lockerbie and his colleagues, do they support the mumblings that the surgery would be better placed at the top of the town?
“One of my life ambitions is to move the practice to the top of the town,” Graham said. “I have been trying for 10 years, and we have been ready to go for the last four. We were on the cusp of moving when the PCTs in Devon were merged and suddenly Dartmouth was no longer a priority. It went completely off the radar. Maybe the Big Society can help. Almost all the health care need is in Townstal, which is one of the most deprived areas in Devon. More than 50 per cent of our population lives there, and the majority of our health care need is there too.”
Graham’s not keen on opening a branch surgery there, but acknowledges it could work if the new surgery became the most popular, and the Victoria Road building became the branch.
Here is a man who fights for what he believes in and doesn’t like to lose – which brings us back to judo and the revelation that this Dundee University educated medical professional, who’s worked in Shrewsbury, Lanarkshire, Oldham, Wales and Barnstaple before coming to Dartmouth, is a brown belt in judo, and regrets not accepting a black.
“My sons Will and Jamie were keen to learn so I took them along to judo club and the instructor said I would have to get on the mat as well. I was pretty reluctant but found I quickly learned what I had to do, and by the end of the session I was hooked.”
The boys (Graham and his wife Sue, who live in Dartmouth, have six children between them) lost their enthusiasm for the sport as teenagers, but Graham fought at competition level – even against the Russian Army: “I was in Ilfracombe and was taken on by a pretty young woman who turned out to be a coach for the Russian National Army. She completely ripped the arm off my jacket then looked at me in disgust and spat on the floor.”
The British Judo Council offered him a black belt at teaching level. Too proud to accept a belt that was not at fighting level, Graham turned it down. “I wish now that I had it!” he said.
This Glasgow boy always wanted to be a doctor, and admits his ambition probably came from early episodes of Doctor In The House on television. “I thought it was great but it gave me completely the wrong impression!” There are no other medics in the family – his great great grandfather was a miner, his grandfather worked in the shipyards and his father flew Lancaster bombers in the War before heading to Strathclyde University and becoming a steel works manager, at one time managing the biggest in the country, at Ravenscraig.
Graham hasn’t done judo for a while but still enjoys five-a-side football and a round of golf. In the past he’s played football for Stoke Fleming and Dittisham.
This doctor loves his job as a GP. He recognises the profession is changing, but for the better: “The difficult thing is that General Practice has not expanded here in the same way that consultancy has. There are way more consultants than GPs in Devon – but the number of GPs remains the same as it was when I first came here.
“Thankfully there are huge amounts of GPs in the pipeline. The job is changing and so are the GPs – 60 per cent of those coming through now are female. Lots want to work part time because they want to balance work and family life commitments. A lot of GPs are realising that this is a job they can do well part time – maybe working as a GP for part of the week and doing something else the rest of the time. We’re seeing a dramatic change – when I started there were only men, working full time the way they always had, and patients were happy to sit and wait for as long as it took their doctor to be ready to see them.
“Now, quite rightly, patients’ expectations are higher, and for us to respond and adapt we need an increase in resources. In theory then we can reinvest more money into local health care, in the way we want to, and our community needs.”
First Published March 2011 By The Dart