The nurse down the corridor: what today’s NHS is trying to rediscover - Pulse Today
Upon finding a lecture written by his GP grandfather in 1968, Dr Alex Charkin reflects on what today’s neighbourhood health plans are really trying to rebuild in the NHS
I recently rediscovered something my grandfather left behind, and the timing could hardly have been better. Dated 1968, it is a talk he gave to district nurses: Responsibilities in Relation to General Practitioner and Hospital. The original – two sides of pink foolscap, letters faint where the typewriter ribbon was tiring – is signed J. Loudon, General Practitioner.
That same week, Pulse ran a story where Sir John Oldham warned that the Government’s neighbourhood plans risk failing for reasons that felt oh so familiar. Reading the pink pages more than half a century on, the strangest thing is how little of it I would change.
My grandfather wrote: ‘It is the person who is being treated and not the illness.’ We say that today as if we coined it; but he wrote it in passing – too obvious to argue against. It reminded me how often the NHS repackages the same handful of ideas under fresh acronyms. But the document shows something more interesting. The NHS does change, but it just has a habit of circling back to ideas it once abandoned.
Describing a reform of his own era, he continued: ‘Now that nurses are attached, there is a tendency amongst patients to assess the doctor and nurse as a unit.’ For the NHS’s first two decades, district nurses were organised by geography – not practice. A nurse worked a patch, with instructions relayed through a central office rather than a doctor directly. A doctor and nurse could care for the same patient for years and scarcely know one another.
Dr Charkin’s grandfather’s lecture notes
The 1966 Family Doctors Charter helped break that open, financing health centres to house GPs and district nurses under one roof. Now, a doctor could simply turn and speak to their colleague – working as a ‘unit’. This was the moment that the system started treating healthcare professionals as a team.
I know what that unit looked like because I remember it. My grandfather worked with a nurse, Dorothy James. As a district nurse and qualified midwife, she held both ends of a person’s life at once – cradle to grave, working alongside a doctor who knew the same families. Dorothy and my grandfather worked so closely that I remember her as a part of our extended family.
I caught the tail end of that world when I started practising in 2010. We worked in the same building as our district nurses. You could put your head round a door and say, ‘While you’re with Mrs So-and-so, have a look at her legs,’ and hear back later that afternoon while passing in the corridor.
That has changed, but I don’t think there was a moment where anyone actually chose to give it up. Nurses moved out to a central location, and their room became clinical space we needed. Now, I reach the district nursing service by email, or a shared inbox. Nobody decided the corridor conversation mattered less; it simply stopped being something anyone measured.
None of these changes happened because people cared less. They happened because every decision solved a real problem while quietly creating another. More clinical space was real. Wider caseloads and flexible staffing mattered. The nurses my patients see today are skilled, and the care they provide is excellent.
But what gets lost in this kind of trade is rarely the task itself, but something quieter: the tacit handover between two people who know the same patient and can catch each other’s eye. You cannot put ‘I’m not happy with her, I can’t say why’ into a referral field. Email is a superb medium for facts, but a poor one for unease.
That is why we now spend a great deal of money on integrated neighbourhood teams, PCNs and ‘wrapping services around patients.’ Strip away the language and the acronyms and what remains is surprisingly simple: a doctor and a nurse who can talk to one another easily. My grandfather had that. We are now trying to design our way back to it, at some expense, having spent the intervening decades trading it away one reasonable decision at a time.
Sir Oldham’s words echoed this as he said that current neighbourhood health plans risk becoming the latest in 15 years of attempts to move care out of hospitals. He was concerned that the plans put geography and contracts ahead of the needs of the people we serve.
His warning reads like a description of a tired cycle: build the relationship, trade it away piece by piece for something else worth having, then rediscover (at cost) why the relationship mattered in the first place.
I know how real that cycle can get, because of how my grandfather’s career ended. When Dorothy retired, he still had many working years ahead of him. Instead, he retired too. He believed he could no longer practise in the way his patients deserved without her. It wasn’t a complaint about the system; just his honest accounting of what that partnership was worth.
Values survive because we keep restating them. It’s the assumptions we never trouble to defend, that quietly get traded away while we’re weighing something else entirely. My grandfather assumed the unit and continuity. Two generations later, we are rediscovering both under new names, at real expense, and calling it innovation.
The nurse down the corridor is not coming back, whatever the next strategy document calls the attempt to summon them. The challenge is not to recreate 1968. It’s to remember why that conversation down the corridor mattered before we redesign it all over again.
Dr Alex Charkin is a GP partner in Winchester