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In those days a rep would drop in with the good news. “He’s on the jar again. The wife won’t stick it. She says she’ll walk if he doesn’t hand over the list, and she will, if the Council don’t close him down first.” If you kept in with the reps it was like conducting an online job search, if you were in the market for a job.
Most assistants and locums did want a full-time GP job. The list was not only a livelihood; it was a badge of respectability. In the mafia of medicine you became a made man and bank managers, patients, and fathers-in-law-to-be looked on you differently. Lists were graded in size, like potatoes. I seem to remember that the ideal size was about 850 medical card patients, which was big enough to run on your own without employing another doctor. If the health board threw in a rural practice allowance, dispensing rights, and a health board premises you would be set up for life. As a rule of thumb, the more benighted the spot, the better the perks were. If you were fortunate to land a job in a seaside spot with sporting clubs, restaurants, good schools, and a thriving private practice, you did not need much in the way of inducements to stay. If you got your list in a backward windswept spot peopled with sheep and elderly men carrying hay bales on bicycles, then the health board would do all they could to keep you there. The same jobs would come up every couple of years in the back pages of the medical papers as another incumbent moved on, having served their time in the sticks.
I sometimes wonder if the teachers and older relatives who enthusiastically steered school kids towards medicine realised what an uncertain and precarious career it could be. It was all too easy to get it wrong; to work for years as an assistant and then get stabbed in the back when the nephew in the RCSI who nobody had told you about showed up ready for work. Then words were inevitably said and there you were, without a reference and your name blackened. So the rep would tell you about the job coming up, and when you saw the miserable hole where the soon to be forcibly retired GP worked a one-in-two, you could see why he drank.
A GP list was like a title. The man (it was usually a man) from Toureendohennybeg was the current baron; he was bound to the place, and only got away for the Galway races. He usually stayed until he became completely decrepit and then was replaced, like the queen in a hive. Like a queen he would sometimes take a few dedicated followers and open up around the side of the house, while the new incumbent worked from the hive and wrecked his eyesight trying to work out the old boy’s handwriting.
When a list came up it was a big deal. A hundred GPs would apply for a job in north Donegal or inner city Limerick and a GP would be expected to do dozens of interviews before getting a job.
Life should be easier now. Things are changing. You don’t have to live in the area where your list is situated any more. The ideal distance to put your home is 15 miles away, where you have just enough of a drive to clear the head and your children won’t get beaten up at school by the kids of those to whom you refused benzos. Out-of-hours co-ops have spread across the country like Japanese Knotweed, so you don’t have to sit by the phone at the mercy of everyone in the district who wants a chat about their indigestion. It is possible to share a list and rumour has it that the necessity to be responsible for patients 24/7 is under scrutiny. The rural practice allowance has made the most sensational comeback since the Connaught rugby team, so all should be well. But many a list that put three kids through boarding school and kept two beamers in the drive is lying vacant.
There are many reasons why a list is no longer a prize valued above all others, but it mainly comes down to the fact that the mangers don’t manage. The old health board staff who knew their areas intimately got out and were replaced by people who never managed anything except to tell the workers on the ground how to do their jobs. They are obsessed with getting high rents and setting up primary care centres. The Primary Care Strategy, which has been staggering pitifully along since the millennium, needs a radical rethink and reinvention and until they make a general practice job worth having again it will never succeed.