This week marks my 25 year anniversary of joining my GP practice as a partner. It has resulted in me reflecting on how much has changed in that time, and so much has changed! I trained as a GP in Bradford and after completing my training I undertook some long term and ad hoc locums whilst deciding where I wanted to work. The practices varied greatly from well organised training practices to very run down, probably dangerous single handed practices. It gave me a good grounding and an idea of what I did and didn’t want from a practice. I remember working at one practice as a locum where the receptionist would open the door and throw the next patients notes into the room. When one patient left the room the next would automatically come in leaving you little if no time to finish writing up your notes or familiarise yourself with the next patient. In most practices you would leave your room to personally call the patient from the waiting room. Nowadays we use an automated call system. The old way at least had the advantage of getting you on your feet and moving! So in 1995 I started work in a four doctor GP practice in Huddersfield. I think we had around 10,000 patients. He were co-located in a community health centre with three other practices, sharing administrative and waiting room space. Back in those days notes were handwritten on cards, the “Lloyd George” notes. The entries in the notes were usually extremely brief and often illegible! Hospital letters were stamped on arrival into the practice and folded up into the same packet. Some were organised in date order but many were not. Our hospital letters and results now come electronically and are filed into the patient records automatically. The appointments were only 7.5 minutes long and surgeries were usually 2 hours of back to back patients done morning and evening. Any home visits were undertaken between the 2 surgeries. It usually left time to have a break over lunch which is a rarity now. Appointments are now every 10 minutes with a 2 hour surgery three times a day with time in-between for paperwork, referrals or home visits if needed. We used to take calls overnight too although were rarely called and when we were it was usually an emergency. When the out of hours calls became more frequent we were able to opt out of the overnight on call as it was recognised how tiring it was work all day and be disturbed during the night. It was then that the local doctors cooperative was started and following on from this the national service 111 and dedicated out of hours service. Gradually computerisation came into our working lives and mobile phones - who can imagine a life without them now! On the odd occasion that the whole computer system crashes we are practically paralysed until it is fixed. However, patients seemed far less complex then, they usually came with one problem and when they received their prescription they left the room. I don’t remember there being as many patients with so many coexisting conditions. Diabetes and cancer were much less frequently diagnosed and there certainly were not as many patients with chronic pain and lethargy. As the health centre was extremely out of date we worked through as they refurbished it around us but ultimately we moved out to a purpose built building on the land next door. Over the years the practice grew both in numbers and patients but also in doctors, advanced nurse practitioners, nurses and health care assistants. At our maximum we had 10 doctors and a list size of around 18,000 patients. I have grown up with a system which provided continuity of care to my patients. I have seen individuals have a family and grow older and treated their children and grandchildren. I have supported families through all the stages in their lives. This has been a privilege and a pleasure. I am now having to adjust to a system in which continuity is increasingly less common, my patients struggle to book an appointment with me or anyone due to the huge demand. Even more changes have come along very quickly affecting the way we work, due to the Coronavirus pandemic. These changes would have previously taken a long time to put in place. General Practice was struggling to cope with the inexhaustible demand prior to the pandemic. The phone lines were jammed, the administrative staff having to cope with a queue of patients at the desk and angry people on the phone as they didn’t have the appointments to offer. The new way of working using e consultations, telephone and video calls has taken the pressure off the phones somewhat and using other ways of performing the consultations we are saving time for both patients and clinicians. It is only a minority of patients we are seeing face to face. The technology has also meant that colleagues who are shielding for medical reasons can work from home. However, I’m an “old school” GP and part of what I love is the face to face in person contact with patients. It remains to be seen whether or not I will feel the same job satisfaction with consultations by video or telephone. It seems strange that over the last 25 years with all the advances in health care, we have seen, that the population is less healthy, more likely to be living with at least one chronic disease and taking regular medications. It often feels like we are running a National Illness Service rather than promoting Health. I would love to see a movement towards using Lifestyle Medicine routinely in the NHS. Lifestyle Medicine as all about creating a good foundation for health on which to build. It includes ensuring good sleep, regular movement/exercise, good nutrition, having regular ways to counteract the effects of stress and support from family, friends, colleagues or community. My hope is that some good comes out of this pandemic, in that people have had a chance to stop and consider what is really important in their lives. More time is being spent together as families, exercising, communities have come together to support each other especially the lonely and vulnerable. I feel extremely privileged to have worked with an amazing bunch of doctors, nurse practitioners, nurses, health care assistants and administrative staff. Anyway I’m not done with General Practice just yet ….