20
December

Alastair Irvine

A tribute to Sir Donald Irvine from his son, Alastair.

Picker’s patron, Sir Donald Irvine, passed away on Monday 19th November 2018, aged 83 years old. His son, Alastair Irvine, spoke at his fathers’ funeral and has allowed us to share his moving speech from the day for those who were unable to attend the service:

It doesn’t need me to tell you Donald led a very busy and packed life. I’ve really struggled to condense it and yet still to capture the real essence of him. I apologise in advance if it’s a tad long, but today’s all about him, not us.

Donald was born on 2nd June 1935 in Newcastle and with his parents, Andrew and Dorothy and his younger sister Meg, lived at Lintonville, Ashington, the family home from which Grandpa ran his then single-handed medical practice in a very close-knit but thriving mining community. They were a very tight unit those four as the family photo albums reveal. He and Meg (and indeed later Amanda, Angus and I, his three children) attended Wansbeck Primary School. With Meg then being packed off to Harrogate Ladies’ College, Dad was destined for Glenalmond but, at the age of 10 on a trip to Edinburgh, he contracted severe rheumatic fever and, too ill to be moved, even as far as the Edinburgh Royal Infirmary, remained in convalescence there in the Churchill hotel, for a month. Under the care of Professor Charles McNeil, Professor of Child Health at Edinburgh University, he was struck that here was a kindly doctor looking after him, paying him close attention, who came to see him every single day to reassure him that all would be well. It created a lasting impression.

Only too well aware of the permanent cardiac damage which rheumatic fever could inflict, my grandparents decided to keep Donald at home and his education would continue locally at the excellent King Edward’s Grammar School here in Morpeth, to Meg’s lasting indignation! Achieving high academic success he had already long decided that medicine would be his profession (and Meg hers) and he took his medical degree from Durham. He qualified in 1958 and having completed his registration period and resisting the pressure to specialise, joined his father in practice in Ashington in 1960.

To most patients, Grandpa was Dr Irvine while Dad, whom many had known as a boy, was Dr Donald. At the insistence of my mother’s father, Frank McGuckin, an eminent ENT surgeon at Newcastle’s RVI, that he’d never be taken seriously in medicine unless he had an MD and preferably a gold medal, he took his doctorate which was awarded by Newcastle University, the medical school having been transferred from Durham in the meantime.

He married our mother, Margaret McGuckin, in 1960 and they moved to Redesdale, a good-sized house with a lovely, big garden on the very edge of Ashington where we three were brought up.

Work was nearly all-consuming, combining as it did not only full-time practice with its full panoply of surgeries, house visits, nights and weekends on rota, but also his wider commitments with the RCGP and other organisations. He was away regularly but also spent many late nights and very early mornings doing his writing before surgery. Nevertheless he took great care to make time for family and home.

On Saturdays and Sundays we frequently went with him on his visits, never into patients’ houses, of course, but we’d wait and muck about in the car. Often, returning from evening surgery, he’d take us up to Longhurst before supper to see the trains, or to Ulgham to play by the ford, at weekends for bike-rides, or drives up to Rothbury, or Druridge Bay. He loved having us sitting on his knee watching the telly and whatever else might be happening, Thursday evenings were reserved for his favourites, Top of the Pops and Tomorrow’s World, an unlikely BBC pairing if ever there was one! The Sunday ritual of lunch with my grandparents, always Granny’s soup, was unbreakable.

Summer holidays were spent largely at home with a week’s visit to see Meg and our cousins in Harrow-on-the Hill, which unfailingly included a visit to the RAF Museum, Hendon.

He taught all three of us to drive, unnerving given how much of the time when he was supposed to be the responsible adult supervising us, he was fast asleep in the passenger seat— and none of us will forget practising hill-starts with him on the inside curve of Bothal Bank—to those of you who don’t know it, I can take you there and you too can have a go. Good luck!

Family was important to him and, whatever else was going on, even in the busiest and most pressured days at the GMC, he was always available for advice and practical help, particularly when Amanda’s husband died; when Angus was battling with his exams; and with my own family, when our own son, also called Angus, was having cardiac problems. And none of us will forget his diagnoses of any injury—he’d examine it closely, peer solicitously over his half moon specs and say, “oh dear, yes. Never mind, leave it alone, it’ll get better”.

He had a wide range of eclectic interests.

Aeroplanes! Kindled through Granny’s brother, Philip, who was an RAF officer and bomber pilot, he was an aviation enthusiast. Apart from rheumatic fever Dad’s closest shave with a premature end was an air experience flight in a Wellington, in which, parting the curtain from the front portion of the aircraft to explore the rear, our intrepid NCO Air Cadet discovered to his horror that some half-wit had left the floor emergency hatch behind and it was but one very short step to a very long drop. He loved air shows and we’d all go regularly to Duxford or Shuttleworth where he’d revel in the sight of Spitfires and the evocative sounds of lots of Merlin engines. We held a big family party for his 80th birthday at our house in Lincolnshire and arranged for a Spitfire to display, an event which left him (all of us, actually!) in tears.

He was a very keen modeller all through his life. Aircraft, flying and static; dolls’ houses; ships; they were all painstakingly made with fantastic attention to detail, beautifully finished. I remember a big balsawood glider, six foot wingspan, which took weeks to build. We took it to Douglas’s field for its maiden flight, attached it to 50 yards of launch line and he ran (not often you saw that) to propel it in to the air. Soaring up, it was supposed to release at the top of the curve, but instead it gracefully completed the full arc of the semi-circle, still hooked. The inevitable happened and the glider smacked at full tilt vertically in to the ground. I still vividly remember that plaintive “ahhhh!” as it hurtled down, then after the crash a heart-felt “bugger” as six weeks work splintered in front of us.

Gardening was his most enduring recreation. He found it very cathartic. He loved his regiments of roses at Redesdale and took great pleasure in designing, creating and nurturing the garden at Mole End, first with Sally, then with Cynthia, turning it from a field to the mature garden it is now, over 30 years. Anyone visiting would be invited “shall we have a wander round the garden?” Actually, that was more of a statement than an invitation.

He was a keen ornithologist from a small boy– in the days before it was illegal, he built up a sizeable egg collection. He particularly enjoyed bird watching at places such as Simonside, Ingram Valley, Budle Bay, Druridge, the Farnes and elsewhere, walking and observing.  Latterly he took great delight in the many species attracted to the feeder underneath the kitchen window. He had an acute ear, and whether it was listening to Merlin engines, or the distinctive high pitched hum of a two-stroke Deltic railway engine, his hearing was every bit as attuned to birds. Inheriting his interest from Grandpa, he had an encyclopaedic knowledge of bird-song and calls.

He was an avid reader of Autocar and Car Magazine and to say that he was interested in fast cars would be an understatement. We all agreed that the bright red Sunbeam Rapier coupe was much the coolest. We sunk to the ignominious low of a second-hand Simca but gradually finances improved and pride was restored with his first BMW323i , followed by several more enduring all the way to now. He enjoyed driving fast; well before the days of speed cameras, Amanda remembers him driving her from Ashington to Wren St in central London to begin her nursing career, in no more than four hours. 310 miles, including driving through London. You do the maths. Only a month ago, Angus took him out in the current BMW to turn it over and keep the battery up to charge. It being Dad’s pride and joy, Angus was somewhat tentative, but Dad had no such inhibitions and on the Pegswood road instructed, “Go on! Put your foot down!”

He might have been precious about cars but he too had his moments: returning to Ashington with a chum from a night’s carousing at the Medics’ Ball at the University, he crashed in to a lamp post. He managed to get home and Granny found him and his friend sewing each other up on the kitchen table. For the rest of his days, Dad had a permanent knotty scar under his chin and his chum had a jagged scar on his knee. Grandpa was indignant; leaving aside the walking wounded, he had to pay for the car and, to add insult to injury, pay for a new lamp-post.

Politics too was a big interest. He was an unapologetic Thatcherite but very definitely with the caring side. Health, defence, social policy and education were his preoccupations. Indeed seeing the shortcomings in the state education system in London where my sister lived at the time, he had no qualms about using his title to book a meeting with Michael Gove to give him the benefit of his wisdom and experience in medical education about not compromising on standards in primary and secondary education.

He had an intense interest in people, and many have said he had the knack when he was talking to you of making you feel that you were the most important person that mattered. He really did want to talk about you. He was always concerned about our lives, what was happening to his various grandchildren, how they were progressing. He did tend to give a strong bias towards academia or career progression as his measure of success, but he was happy with the result so long as you’d really tried. He himself always sought the highest standards, whether in practice, his writing, modelling, gardening, roasting a fillet, boiling peas, frying an egg (if he bust the yolk, he’d start again—seriously): it’s reflected in the motto on his arms, “Ad Excellentiam”, to excellence: if you aim for it, you might achieve it; if you don’t you almost certainly won’t. If he had a blind-spot it was sport; it was of absolutely zero interest to him, whoever was doing it.

He was also an aficionado of the finer things in life. To those of you who only knew him in the last 30 years for most of which time he was almost totally abstemious, you may not know that, alongside enjoying good food, he had a discerning palate for fine wines and brandy, he appreciated malt whisky long before it became fashionable, and had a strong penchant for Henry Upmann Havana cigars. Whisky, in moderation, cigarettes and cigars were his fuel during his long nights’ writing. We can all three of us remember the cloying smell of cigar smoke throughout the house in the mornings.

He wasn’t a vain man but he was always immaculately dressed and groomed. He had a shave every day including the day he died. He believed, like his father, that doctors should always look smart, even off duty. It was a suit most of the time, occasionally flannels and a linen jacket or blazer in the summer, always a tie to work. We did have a couple of aberrations, one when he returned from a trip to Hong Kong with the obligatory suit knocked up in a back street in 24 hours: I remember it well when he proudly wore it to show it off to us: a shiny blue silk creation with red flecks. It was execrable and on that occasion he needed saving from himself and it was never again seen in public. Jeans and a pair of trainers too made a mercifully short appearance, best forgotten.

I suspect with his cardiac history in mind, and early onset angina and the pressures of his various positions, he recognised the need to keep fit as best he was able, so he used to walk every day, a good distance at a vigorous pace, arms swinging, hands never in pockets, in the winter in his camel coat and galoshes. These walks were significant, not just for his wellbeing but because this was his uninterrupted time when he marshalled his thoughts.

Donald Irvine the doctor really had four centres of gravity in his professional career:

  • Lintonville, where he practised for 35 years, and which was the crucible for the development and practical implementation of ideas, particularly group working and vocational training and fund-holding;
  • the Royal College of General Practitioners where both as Honorary Secretary and later as Chairman of Council, he and other forward-thinking colleagues were at the very forefront of dragging General Practice out of the doldrums, driving up standards of clinical practice and the quality of care, developing vocational training and competence. They were determined to push General Practice away from the perception, whether right or wrong, that it was a sleepy backwater populated only by doctors who were unable to cut it in the hospital specialties. Why should General Practice not be able to field doctors every bit as excellent as their specialist counterparts, reinforced through a programme of continuous professional development and re-assessment demonstrating ongoing competence, albeit in a generalist role?
  • Newcastle University, not just his alma mater, provided the Department of Family and Community Medicine, a key unit in the research and development of vocational training;
  • lastly, the General Medical Council in Hallam St , the doctors’ self regulation body and the keeper of the medical register where in his election manifesto to be President he made it clear that, building upon the work done by the RCGP and in particular its strong Northern Regional Faculty, the GMC would be failing in its public duty were it not to be demonstrating that every patient is entitled to a “good doctor”; that meant not only competent when qualified, but demonstrably competent to provide care throughout their career.

The roots of his beliefs were instilled early at Lintonville, both as a boy growing up in the practice environment and later in partnership with his father who had a profound sense of selfless duty. In that close knit community, this was real front-line family doctoring. You got to know the whole family from delivery to dispatch, every member, all their foibles, interrelationships and family politics. Regularly in and out of patients’ houses, the doctor could often spot something amiss even before it had been brought to his attention. And of course it was a position based on mutual respect and trust, certainly not paternalism. Patients instinctively knew which doctors were good and which were poor and the local grapevine made sure everyone else knew too.

It was against this background that he inherited the unshakable belief that medicine was a vocation, not a job. Taking ‘vocation’ in its literal sense from the Latin verb, vocare, to call, he sincerely believed that either you had a calling, or you didn’t. Not long ago, addressing a meeting of doctors on Teesside on the subject of medical professionalism, he was reinforcing his core belief (“banging on” as some of his critics used to describe it); he was asked by one of the audience, “but what about our work-life balance?”, to which he replied flatly, “oh, well, if that’s what you’re worried about you’re better off sticking to golf”. There was no malice; it got a good laugh, even from the questioner. Dad made his point: the unwritten contract with the primary care patient was unconditional and non-negotiable; it was a 24 hour-a-day, 365-day a year commitment, manageable via duty rotas with colleagues and local cooperatives but not something to be delegated to unknown third parties such as deputising services. From which it followed naturally that patients rather than doctors are the pre-occupation of the medical profession, that medicine exists and thrives because of its patients not despite them.

The successful development of standard setting and reassessment of clinical and vocational competence was at the centre of his work at the College and the University, putting what he preached in to practice at Lintonville. It seems invidious to mention individuals because many were involved, but Michael McKendrick and Marshall Marinker were profoundly influential. But it was at the GMC, where he was President between 1995 and 2002 that the battle was fought on a much broader front, encompassing the whole profession as well as involving central government. His position as the first and last GP ever to be president of the GMC will remain unique, now that the reformed Council has replaced President with Chairman. With strong support but certainly not unopposed he was elected on a reforming ticket explicitly to expunge the perception that the GMC was there to protect doctors, and instead should focus on protecting patients.

That his Presidency would be dominated by dealing with the fall-out from the well publicised scandals; Shipman, the Bristol Heart Babies, Alder Hey to name but three, only added to the pressure of the three-way battle between the competing forces of the reformers, of whom Pa was a leading influence, the conservatives in the profession who were reluctant to confront reality, indignant anyone should be questioning their professional competence, and the new Labour government who, as the employer, made it very clear that the prevailing status quo of self regulation was not an option. If the GMC didn’t reform itself, Labour would take steps to abolish it anyway. It was a bruising fight; it split the profession down the middle; it became very personal with accusations of letting the side down, of going native with patients; but it was one Dad and his supporters knew had to be fought and won, not only for patients but the long-term self-esteem of the profession itself.

The scandal cases were therefore a watershed and, building on the work done at the RCGP and elsewhere over the previous 25 years, so the process of profession-wide revalidation was formulated and developed. But it took all his negotiating skill, persuasion, charm and a bit of good-old fashioned arm-twisting to get revalidation close to where it needed to be. Council having voted to extend his original five year term by another two to the maximum permissible seven, the slow pace of implementation in the face of strong resistance, as well as having to see off two direct challenges to his leadership, made him recognise six months before his compulsory departure date that revalidation could quite possibly stall unless the baton was passed to others equally committed to seeing it through but not constrained by his own time-limited term. Early in 2002, he stepped down. To say he was underwhelmed that revalidation was subsequently in danger of being de-railed would be an understatement and it bemused him that it would take the censure of the GMC’s lack of will by a high court judge, Dame Janet Smith (a strong admirer of Pa’s) in her public inquiry in to Shipman, to get it back on track.

He never for one minute regretted his time as President of the GMC but I don’t think it’s a period on which he looked back with great fondness or satisfaction and while he was left frustrated, it was an obvious relief to hand on. If you had to ask my opinion, I’d say that his time at the helm of the RCGP and when he was still in practice was the period he found most enjoyable and professionally fulfilling.

Retirement in 2002 certainly wasn’t the end of his interest in the doctor/patient relationship: that was too embedded. With the strong encouragement of his friend Harvey Picker, an American philanthropist with an interest in patient welfare, he became European Chairman of Picker Institute, a charity dedicated to enhancing patient experiences and outcomes. He was also Patron of both the Patients’ Association and Age UK (Northumberland). And of course he was in demand to give lectures on medical professionalism, especially in the US and Canada.

Married to Margaret for 23 years, and Sally for another 18, as that second marital chapter closed in 2004, so the third opened and flourished soon after, when he re-met Cynthia. They were married in 2007 and it’s no exaggeration to say that this was the perfect illustration of two people, not only well-matched, but soul-mates, utterly devoted to each other, inseparable and profoundly in love. Although his health started to decline about four or five years ago, they still had the opportunity to travel widely and enjoy life. As what he called his co-morbidities but particularly his renal failure accelerated, and he moved on to home dialysis two years ago so it became debilitating and he undoubtedly found the restriction irksome and the equipment disruptive. But it bought him extra time and Cy’s devotion to him has never wavered, on the contrary, if it’s possible it strengthened further.  A bout of pneumonia 12 months ago and nearly four weeks in the Freeman hospital really knocked the stuffing out of him and he never really recovered though with some effort, he did manage the trip to Lincolnshire in July for our mother’s 80th, the last time as a family we were all together when he was alive. But despite the excellent care, the experience a year ago reinforced his determination, and with Cy’s strong and unconditional backing, that come the time, he wanted her to nurse him and that he wanted to die at home.

Cy, your support and care for him have been inspirational; for all you have done, from all of us, the words seem inadequate but a heart-felt thank you. The care he received from Lintonville, from doctors Andy Bell, Rakesh Chopra, Lindsay Gilfillan was exemplary, as it was from the Lintonville and Morpeth District nursing teams and the MacMillan palliative care nurses. He had many visitors, in particular his great friend and former Lintonville partner, John Gedney and his wife. He loved seeing all of them. Amanda, Angus and I spent a good part of his last three weeks with Dad and Cy and all four of us were with him at the end. We had many tears but there were lighter moments too. Alison, the vicar, unwittingly provided one when arriving to give Dad and Cy communion, she accidentally left the handbrake off her car and it rolled down the drive, stoving in the garage door to within a gnat’s crotchet of his prized BMW. After bread and wine, he demanded photographic evidence that that car was still in one bit. On days when he was out of sorts, sleepy or near unconscious, “not so good today”, suddenly he’d magically wake up when any of the nurses appeared and wave a hand and say, “oh, good evening, and you’re looking so bonny today!”. Shameless! As Cy was moved to remark on one particularly difficult day, “hey, laddie, you’re swinging the lead!”

And to bring the story full circle, one of the MacMillan nurses said to us, “Your Granddad was my Mam’s doctor. Your Dad was mine; he told me I was pregnant with my first child. And now here I am nursing him”. That tells you everything that matters. At the heart of it all is Lintonville: his boyhood home, his practice and principal place of work, remaining there to the end as a patient. Alpha, omega, cradle to grave.

You’ve all known him in different capacities and in different circumstances and you’ll all cherish different memories. But whatever his great achievements on the public stage and for all his honours and awards, we simply loved him as a kind, supportive, generous, affectionate and very gentle man, in every sense.

ACHI.

3rd December 2018.   

See Also:

Six steps to effective medical professionalism in the 21st Century

Our Patron, Sir Donald Irvine CBE MD FRCGP FMedSci, is a longstanding advocate of person centred healthcare. Formerly President of the General Medical Council (GMC), he is currently a Vice-President of The Patients Association and Patron of Age UK Northumbria. His opinion on clinical accountability and care improvement processes in…

22 June, 2016

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