Late last week, the steel plate showing Dr Stephen Farley's name and qualifications - "DR S.E. FARLEY MA, MB, B Chir" - was still fixed to the wall of the village surgery in Leicestershire where he had worked as a GP for 25 years. Here, in Ibstock, people say that he was the village's favourite doctor, a kind, jovial man who was not just a GP, but a friend.
Below the nameplate lay some flowers, wrapped in yellow paper. A note pinned to them read: "For Doctor Farley, a wonderful doctor and a much-loved gentleman. We will miss you very much."
Less than a week earlier, in a tragedy that shocked the village, Dr Farley had been found hanged in an old barn behind his house, just a few moments' walk from the surgery. He was 52. Colleagues claim that he killed himself when depression set in after being hounded by NHS managers for referring too many patients to hospital. In the new, target-conscious, statistics-driven NHS, his referral rate was an "anomaly". It was making above-average demands on the system, its budget and its resources.
His death is the more poignant because patients describe him as an old-fashioned village GP , whose door was never closed to them, day or night. On the council estate on the edge of the village, mothers tell of taking poorly children to his house at midnight, knocking on the back door, and being warmly greeted by his wife Marion ("she always gave you a nice cup of tea, with plenty of sugar"). They recount how her husband would expertly examine these young patients, sometimes on his kitchen table, oblivious to the lateness of the hour. "He and his wife always made you welcome, whatever time it was," says Tina Lycett, 47. "He never turned you away, never."
As well as sadness and shock, there is an undercurrent of anger in the village. Julie Clarke, 36, a former spokesperson for the tenants' association on the Sunnyside estate, says: "I think [the NHS managers] should have asked the patients for their views of Dr Farley before it got to the point where he was driven to this. He would have had the support of the whole village - I know that for a fact. And then it wouldn't have got to this, would it? They should have given him more of a chance, and everyone else more of a chance to speak up for him. And they didn't. It's sick."
At the surgery in the High Street, where Dr Farley was one of five GPs, grief is mixed with other emotions. "This is a terrible tragedy - and one that I believe could have been avoided," says the practice manager, Charles Jones. "Dr Farley was a brilliant GP, and he was absolutely loved by all the patients and the team here. But the Primary Care Trust believed he was referring too many patients for hospital treatment.
"He had had nearly three years of this since it was first brought up, and the finger was always pointing at him - there was this continuing pressure. We felt they were hounding him, almost persecuting him.
"We were behind him in all his referrals, and even though I informed the trust that we would deal with it as a practice, they homed in on him. But he always had the patients' best interests at heart, and if he thought they needed treatment he would refer them."
Jones adds that the patients have been "completely devastated" by his sudden and unexpected death. "We've had them in here in floods of tears, signing the book of condolence." The book had only been placed in the surgery that morning, and by lunchtime there were 36 entries. "The last of the true family GPs," Melanie Allsopp had written. "You cared, and it cost you. Ibstock and the surgery will never be the same." Another patient, Karl Hicklin, had written: "Steve, thank you for saving my life 22 years ago. I will miss you greatly. God bless you, doctor and friend."
Even though the British Medical Association says that the old-style, open-all-hours village GP disappeared a decade ago, rendered extinct by NHS modernisation, Ibstock is just the sort of place you might have looked if you wanted to find one of the rare survivors.
Set in gently undulating Leicestershire farmland, its narrow main street winds between brick-built Victorian houses and small village shops. Down the lanes running off the High Street, you can see out across the fields. This and the scattered villages round about, where the practice's 9,500 patients live, was Dr Farley's world.
Graduating with distinction from Cambridge, he trained in the Hastings area, and moved to Ibstock 25 years ago, to a substantial Georgian house at one end of the High Street. At first, the surgery was in a colleague's house just across the road. By 1985, he and his fellow GPs had moved to a new surgery in the High Street, a couple of minutes' walk from his house.
Villagers recall a happy, jovial family man with two children, a regular church-goer, and a participant in almost every village event. With his mutton-chop whiskers, his country clothes and a big grin on his face, people say he looked more like a cheery Farmer Giles than a doctor. Apart from his job, his other passion was making home-brewed beers and wines. He was often out gathering nettles and berries for some new vintage. A generous man, he would usually give most of it away.
He was generous with his time, too - perhaps to a fault, as far as the modernised NHS was concerned. "He was never happier than when he was out there in the community doing his job. It was his life," Charles Jones says. "In modern practices nowadays, in line with national guidelines, we all have out-of-hours cover, and we pay for it. But there were instances when we'd say to Stephen, "What were you doing seeing patients at home at 1am?' And he'd say, 'Well, they couldn't get through to the on-call people...' That's the kind of man he was. The patients knew that he would never turn them away. And Marion was the same; she was a country GP's wife, and she expected that. It was as much her vocation as his."
It was almost three years ago that the local Primary Care Group first raised questions about the number and type of cases Dr Farley was referring for urgent admission to hospital. The issue dragged on. When the group became the Primary Care Trust (PCT) under further NHS reorganisation, moves to monitor Dr Farley's work began in earnest at the beginning of last year. It was proposed that Leicester University's Post-Graduate Deanery - an independent GP training organisation - should carry this out.
"They call it 'mentoring', and it was a topic that came up at a meeting with the PCT's clinical governance team in July," Jones says. "When a team from the Deanery came in November, they offered it again. The practice said, 'Fine, we don't have a problem with it, but if you do it for one you do it for all. We run a very efficient practice here, but if you're questioning how we're doing things, then question everybody.' We said that all five doctors would agree to mentoring, and if there was a problem we'd be more than happy to learn from it. But then the Deanery came back again, with, 'We have offered Dr Farley mentoring.'"
Jones says that this would have meant someone sitting with him in his surgery, overseeing his work. At 52, and with some 25 years' experience, Dr Farley found this prospect humiliating. Demoralised by nearly three years of his professional competence being called into question, he became increasingly depressed. With hindsight, Jones remembers that in the run-up to Christmas, Dr Farley was subdued. "He seemed quiet, which was not Stephen. So, yes, there was a change. But I suppose we're the last to see it among ourselves. And nobody," he adds, "saw this coming."
On 15 December, a Monday, Dr Farley didn't come to work. Instead he went to see his own GP, and was referred for help with his depression. After about five weeks off, he was advised to make a gentle return to duty by coming in each day just to do some paperwork. His first day back at the surgery was two weeks ago. At the end of that first week - Friday 23 January - he came in as usual at around 9am.
No one saw him leave. But at 1pm that day, Jones took a desperate phone call from one of Dr Farley's neighbours, who had found him hanging in the roof space of the barn behind his house. A former paramedic, Jones raced down the road with a nurse and a resuscitation kit. They found there was no point in using it; Dr Farley had been dead for more than an hour.
Among the tributes that flowed into the surgery last week, one was especially significant. It was from a consultant to whom Dr Farley had referred many patients over the years. The consultant told Charles Jones that in all the patients Dr Farley had ever sent to him, he had never once found the GP to have made an incorrect diagnosis. "He had never known Stephen to be wrong," Jones says. "Coming from a consultant, that's quite a statement."
There are many stories of Dr Farley repeatedly referring patients back to hospital until his diagnoses - which had been dismissed - were eventually proved correct. One patient he referred three times, sure that something was seriously wrong. Only on the third visit was cancer diagnosed. A local councillor told Jones that Dr Farley had saved his life twice last year by insisting that he be re-admitted to hospital. Life-threatening blood clots were found. All around Ibstock, villagers tell of his dedication in treating their ailments, great and small.
Former school dinner-lady Barbara Hicklin, 81, recalls how Dr Farley once gave her ointment for an infection on her leg. "A few days later he came to the house to see if it was improving," she says. "I didn't ask him to come. He came because he cared. He was a lovely man, and I feel terribly sad about what's happened. If he'd known how much we all cared about him, I wonder whether he might have changed his mind about doing what he did. But it's too late now, isn't it?"
In Julie Clarke's living room on the Sunnyside estate, friends and relatives drift in and out, offering their own tributes. Her partner Jonathan Lycett, 19, tells how Dr Farley had once examined him on his kitchen table after a football injury, and sent him to hospital. He was discharged with "bruising". Dr Farley referred him again. It was a broken collarbone.
Clarke's brother Ian tells how the GP diagnosed his 15-year-old daughter Emma as having meningitis, merely from the fact that she was being sick and had a headache. "The symptoms hadn't fully appeared, but he knew," Ian says. "Emma loved him because he probably saved her life."
Clarke's sister-in-law Sarah Hines recalls the doctor's kindness to her two-year-old son Tommy-Lee, born with a cleft palate and prone to repeated infections. "Every time I took Tommy down he'd say, 'How's my little lad?' He were brilliant with him," says Hines. "If it was late and Tommy was poorly, I used to take him down his house, going on midnight sometimes. And he was always there, and ever so nice to you."
The Charnwood & North West Leicestershire Primary Care Trust issued a statement saying that it was duty bound to take action in cases of high referral rates. Offering his deepest sympathies to Dr Farley's family, friends and colleagues, the trust's chief executive, Andrew Clarke, said: "I can confirm that the PCT had identified significantly higher emergency referrals and admissions from this practice compared to all other practices in the area. This was so extreme that we felt it was important to carry out one of our key NHS responsibilities: to review and understand any GP activity that appears to be extreme in nature."
He said that the PCT had asked the Post-Graduate Deanery to carry out a "review based on their access to best clinical practice". He insisted that this was "neither a disciplinary process nor a cost-saving exercise". The doctors were not "under investigation". At Andrew Clarke's request, the area's Strategic Health Authority has agreed to launch an independent, external review - in effect an inquiry - into the dealings between the practice, the PCT and the Deanery.
It probably won't make much difference to Karl Hicklin. It was he who wrote in the condolence book about Dr Farley saving his life 22 years ago. The incident was a motorcycle accident, after a driver had pulled out in front of Hicklin's bike at a junction in Ibstock. Hicklin, then 19, was trapped under the car with a smashed leg and ruptured kidney, spleen and liver. Telephoned by a passer-by, Dr Farley was first on the scene. Typically, it was his day off.
"He injected me and kept me alive, kept me talking, and he came in the ambulance to hospital with me. And he looked after me ever since," says Hicklin, now 41. In later years, the GP was the first to realise that Hicklin had developed a mild form of schizophrenia, and later angina - which he had been told by another doctor was just indigestion.
"On his days off, if he was passing he'd nip in to see how I was. I think he was hounded to do what he did - and why they were hounding him I don't know, because he was only doing his job and putting his patients first. He was an absolutely brilliant man - and I'll miss him terribly," Hicklin says. "He had more time for his patients than he had for himself."
In the days after Dr Farley's death, the secretary of the local medical committee, which represents GPs, was reported as saying that Dr Farley was "an old-style doctor who was operating in the new-style, Blairite system. Nowadays," he added, "they run a few computer programmes and decide what's wrong, which is completely at odds with the old-style, holistic approach."
Perhaps Dr Farley's problem was that he was just too conscientious. Perhaps he cared about his patients too much. It's hard to measure such things on a spreadsheet.Reuse content