The changing face of general practice

Having worked in general practice for over 30 years, College Fellow Dr Alastair Fraser recently reflected on his time working within primary healthcare, as part of his Audit of Medical Practice. 

Alastair completed his Bachelor of Medicine at the University of Otago in 1979, registered in 1980, and after three years of post-graduate training, left New Zealand on the traditional Kiwi overseas experience -  travelling and working as a GP in the United Kingdom.

When Alastair first arrived back in New Zealand, he spent nine months working in Hokitika. 

“Hokitika was a truly rural town in those days – the GP was never off duty, I’d be tracked down even when having a quiet beer in a local pub.”

Alastair says he enjoyed being part of a small community but it was quite lonely being a single professional there, so he set his sights on Taupō.

“The spring of 1985 is unforgettable - a milestone moment when my professional and personal life changed direction forever.

“I arrived in Taupō, back then a small tourist and popular retirement town, to take up a locum position in an expanding medical centre. There were few pavements, no cordless phones or personal computers, in fact few computers at all.”

In the 1980s Taupō had a small hospital and GPs looked after their own patients in that setting.

“I worked alongside five other GPs and we were completed by an experienced physician and general surgeon – it was a very good service.

“The work was varied and there was never a dull moment! I carried out obstetric requirements for my patients, was called out to emergencies by the ambulance service, as well as doing some work with the Police.”

Changes to GP scope

Alastair tells us the change in general practice has been incremental and everyone has adopted and adapted to new models of care. 

During Alastair’s first 10 years or so, GP services at Taupō Medical Centre were slowly replaced by Medical Officers and GP involvement was terminated permanently. 

“The evolution of advanced paramedics then took away the need for GP ambulance and helicopter work.  

“Police work was centralised to Rotorua doctors, and when Helen Clark signed the document allowing midwives to individually deliver babies, it eventually became unsafe for GP obstetricians to practice and our skill became redundant.”

Alastair explains that the workload didn’t diminish with these changes, but the scope of GP work narrowed and has resulted in an overall loss of cute medical surgical skills.

The rise of the mobile phone – “a godsend”

Alastair says there have been two significant changes during his time as a GP – computers and mobile phones.

“The first mobile phones arrived in the late 1980s – known as the ‘brick’ - and they were a godsend.

“Although the mobile phone range wasn’t large, having a brick gave us a new freedom and we were no longer tied to a landline at home or the surgery.”

New ways to cope with the workload

Alastair’s practice has recently introduced a phone triage system where patients can ring the practice and speak to a GP, who will then decide whether or not they need to be seen immediately or if they can wait.

“The rise of nurse practitioners is also another welcome change in general practice.

“We have two nurse practitioners who mentor and support our patients – they are important members of our practice.”

Memorable moments

“In the early 2000s I had a patient present with lower abdominal pain who unexpectedly delivered a baby at 28 weeks.

“Having not done obstetrics for 10 years, I had to trawl back to remember what to do.

“Amazingly, it all came back and we had a successful outcome – the Waikato Hospital neonatal unit also sent me a congratulations.”

The future 

Alastair is coming up to 65 and says that, health permitting, he plans to continue practicing medicine for as long as is practical. 

“I still love practicing as a GP – it’s challenging and rewarding. 

“Throughout my time in general practice, I’ve never stopped learning and I thoroughly enjoy the opportunities for continued professional development. I also enjoy teaching and imparting knowledge to medical students, junior doctors and nurse practitioners.”

Alastair’s theory is - work hard, play hard, keep learning, stay relevant, enjoy your family and friends, and have lots of fun along the way.