Lives of the fellows

Donald Hamilton (Sir) Irvine

b.2 June 1935 d.19 November 2018
Kt(1994) CBE(1987) OBE(1979) MB BS Durham(1958) DObst(1960) MD Newcastle(1964) MRCGP(1965) FRCGP(1972) Hon FRCP(1997) Hon FRCP Edin(1997) Hon DSc Exeter(1997) DUniv York(1997) FMedSci(1998) Hon FPHM(1998) Hon DSc Leicester(1998) Hon FRCS(2000) Hon DSc Durham(2002) Hon DCL Newcastle(2002) Hon DCL Northumbria at Newcastle(2002) Hon DSc Warwick(2009)

Sir Donald Irvine was an outstanding general practitioner who throughout his career was at the heart of changing the relationship between the public and their doctors. He was the first, and so far only, general practitioner to become president of the General Medical Council (GMC). He was responsible for a seismic change in the philosophy of the GMC, from one of protecting doctors to that of protecting patients.

He was born in Newcastle upon Tyne, the son of Andrew Bell Hamilton Irvine, a general practitioner, and Dorothy Mary Irvine née Buckley, and grew up in Ashington, a mining town in Northumberland, in a house which was integral with the surgery. He therefore had early exposure to many aspects of medicine. He recalls in his memoir, Medical professionalism and the public interest, reflections on a life in medicine (London, Royal College of Practitioners Heritage Committee, 2018), that the practice was part of the family’s life and that everything fitted around the patients.

At the age of ten, he developed rheumatic fever whilst on holiday in Edinburgh and he spent many months 100 miles from home. He recalled years later that the one thing that stuck in his mind from this time was the trust that he had in the doctor looking after him, Charles McNeil [Munk’s Roll, Vol.V, p.261], because his manner and way of talking made him believe everything that was said.

He was educated at King Edward VI Grammar School in Morpeth and then Durham University, where he qualified in 1958. In spite of encouragement to specialise, he was determined to join his father in general practice in Ashington. He did not do National Service because of his history of rheumatic fever.

In the early years of the NHS general practice was very much the poor relation. Churchill’s doctor, Lord Moran [Munk’s Roll, Vol.VII, p.407], stated in 1958 that general practice was the place that doctors landed when they fell off the hospital ladder. This stung young Irvine. The recognition that standards needed to improve in general practice had been part of the stimulus for the formation of the College of General Practitioners in 1952 and his father was a founder member. At the age of 33, Irvine found himself as secretary to the College and from that time built a base from which he could fulfil his dream of making general practice an equal partner in the delivery of modern medicine.

In those post war years, which of course saw the beginning of the NHS, a young doctor could enter general practice after only a year of hospital posts and never need to undertake any further training or recertification until they retired. This was clearly not good enough. John Walker at Newcastle University Medical School had worked hard to establish general practice in the undergraduate medical curriculum and he then turned his hand to postgraduate education, working with Irvine. A three-year vocational training for general practice was led by what was by then the Royal College of General Practitioners (RCGP) and Irvine was at the forefront of this. It was organised on a regional basis and he led that in the North. Recognising that there were no standards for general practice, he led a major study harnessing most of the northern region GPs and hospital paediatricians. He showed that it was possible to set standards for the care of children.

He became chairman of the council of the RCGP and through that position was able to develop his ideas around improving professionalism, but it was on the wider stage of the GMC that he was to have most influence. Here he met the lawyer Sir Ian Kennedy, who had somewhat antagonised the medical profession with his 1980 Reith Lectures ‘Unmasking medicine’. Irvine had seen these lectures as a breath of fresh air, particularly their call to make the patient, rather than the doctor, the centre of care. Kennedy joined a small group with Irvine to revise the code of practice of doctors. Irvine’s vision was to change radically the GMC’s, and hence doctors’, approach to ethics.

The crucial insight was to talk about what the ‘good doctor’ should do. At a stroke this shifted a cultural approach, which had been geared to telling doctors what they should NOT do, to one which emphasised what they should do. The result was the guideline Good medical practice (www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice), which, with regular revisions, continues to guide the practice of all doctors working in the UK.

The GMC at that time had around 110 members, most of whom were elected, and only 11 non-doctors. The British Medical Association, the doctors’ trade union, had a large influence in those who were elected. It is not surprising therefore that there was considerable hostility to these changes. That there was any change was down to Irvine’s commitment to do good by patients, his toughness and a deal of charm.

His cause was helped by several high profile medical scandals, including errant practice by doctors such as the gynaecologists Rodney Ledward and Richard Neale, the case of the serial killer Harold Shipman, and ‘Bristol’. It became known through a whistle blower that the results for children’s heart surgery in Bristol were substantially worse than they should have been. Three of the doctors involved were suspended and referred to the GMC. Irvine himself chaired the disciplinary panel, which found the doctors guilty and two were struck off the register.

There was considerable media and public attention, which led to an inquiry led by Sir Ian Kennedy. Irvine gave evidence, not about the specific issues thrown up by Bristol, but about the prevailing paternalistic culture amongst the medical profession and what changes might be called for. Kennedy recalls that his sense was that Irvine was weighed down by the burden of what Bristol was exposing regarding a ‘club’ culture, the stifling of unwelcome views, the bullying and oppressive management, all of which he felt personally both responsible for and affronted by. His strongly expressed ideas were very influential in the direction that the Kennedy report took about education and training of doctors, and the need for patients to be at the centre.

The Bristol report also gave Irvine external validation of the need to press ahead with change. The GMC council, however, remained hostile, but the appointment of a new chief executive, and political threats that if the GMC did not reform it would be abolished, were sufficient to precipitate reform of the composition and modus operandi of the organisation. His tenure as chairman was a bruising time and he had to survive a vote of no confidence and challenge to his leadership. He left seven months earlier than he might have done. His presidency was an unhappy period and not the obvious pinnacle of his career that it should have been.

His book The doctors’ tale: professionalism and public trust (Abingdon, Radcliffe Medical), published in 2003, records this period of his life. He remembers 2000 as an annus horribilis for the GMC, a year which included high profile conduct proceedings, tensions within and between medical tribes, and significant pressure from government. Not surprisingly, his book received a mixed reception from the medical profession, but was received more favourably by the public.

The overall result was a move to an independent GMC, which still exists but now with a clear focus on protecting patients as well as the education and training of doctors. It was slimmed down, with more lay representation and much strengthened conduct procedures. A move to revalidation, with doctors having to undergo revalidation, is also a result of the change of culture started by Irvine.

Loie Hanscomb, of the US Picker Institute, recalls that as a doctor Irvine had a deep understanding of the importance of the human relationship between patient and physician. He was a pioneer, not only in the UK but in the US, through his work with the Picker Institute. In 2017, the American Board of Medical Specialties awarded him the prestigious Health Care Quality and Safety award, which recognises extraordinary achievement, with a particular focus on physician performance and professionalism. He made an indelible mark on the patient-centred care movement.

He was tall, always immaculately dressed, unceasingly polite and described as a true gentleman. His hobbies included gardening (where he would wear kid leather gloves), birdwatching and walking in the Northumberland countryside. He had two sons and one daughter by his first wife, Margaret McGuckin, whom he married in 1960. They divorced in 1983. His second marriage to Sally Fountain was in 1986. They divorced in 2004 and he married his third wife Cynthia Rickitt in 2007. His last two years were marred by ill health with cardiac and renal failure. Cynthia, a nurse, managed his home dialysis and looked after him with immense dedication and devotion.

Alan Craft

[Picker 26 November 2018 News Obituary of our Patron, Sir Donald Irvine www.picker.org/news/obituary-of-our-patron-sir-donald-irvine/ – accessed 23 January 2019]

(Volume XII, page web)

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