My full-time NHS job in a small district general hospital involved being resident on-call at middle-grade at nights and weekends, as well as all the usual general paediatric workload. My first step towards ‘winding down’ was to stop doing resident nights, and later resident weekend days: this was ironic given that I was an early advocate for consultants being resident. Fortunately, my colleagues and the management agreed to this, thus setting a precedent (at least in my trust) for ceasing resident on-call after reaching one’s mid-50s.
This was about four years before my 60th birthday. About two years later I went part-time: this was possible through a sort of gentleman’s agreement (or Faustian pact) with the trust management: I could drop half my workload as long as I promised to retire completely at 60. Thus they could employ a part-time consultant as a long-term locum while keeping open the option of replacing both of us with a (cheaper) single full-timer. I continued to do some non-resident on-call, usually with a consultant colleague on-site, which wasn’t too demanding.
Knowing my exact date of retirement two years in advance enabled me to make long-term plans for my clinical work. My special interest clinics were gradually either transferred to colleagues or dropped. Long-term follow-up patients were either discharged to primary care, transferred to more appropriate clinics or transitioned to adult services. That left very few for me to hand over to my successor. The families all knew well in advance that this would happen.
I formally ‘retired’ on 28 April 2017, when I was overwhelmed by a surprise party, attended by many old friends and colleagues from way back in my career. However I already knew that my replacement wouldn’t be available to start for another three months. My trust required me to take a whole month off, effectively May 2017. I was then given a completely new contract, and filled the gap, doing daytime work only. After that I did a few sessions in late 2017 to clear waiting-lists in outpatients; and then in 2018 I did a maternity leave locum for a colleague for six months: again daytime only, two or three days a week, with no on-call. My last day functioning as a consultant paediatrician in my trust was 11 December 2018: some 19 months later than I had originally expected!
Being re-employed on a locum ‘bank’ contract was strange. The HR systems didn’t really cope with someone returning to their old job: my pass card didn’t work on any of the doors, and I had to be set up anew on all the computer systems. I also had to keep a strict timesheet and make a monthly claim in order to get paid: not something I ever had to do before. The terms were very loose and vague, nothing like a formal consultant contract.
I love teaching, and throughout this time, and afterwards, I tried to maintain regular teaching sessions with students and trainees. I chose not to claim for this time, as it was optional and too enjoyable to want to be paid for! As trainees moved on, fewer of them knew who I was, and so some may have been reluctant to attend sessions given by this strange old bloke they had never met before. So understandably, attendance dwindled.
I had been heavily involved with the College in various roles throughout my consultant career. Some of this ceased during my peri-retirement period, and some continued. I dropped MRCPCH examining just before, and I withdrew from the General Paediatrics CSAC. However, I continued to do Invited Reviews and consultant interview panels (AACs): for both of these my experience was some use, even when no longer clinically active. These also involved travelling to paediatric units around the country and interacting with colleagues, which I have always enjoyed. Recently, COVID and loss of my GMC licence have scuppered both of these activities.
My current role for the College will probably be my final one: with others, putting together an online resource specifically for paediatricians approaching or going through retirement.
I have continued my long-term involvement as an Associate Editor for Archives of Disease in Childhood, actively encouraged by my good friend and Editor-in-Chief Nick Brown. I do less now, and restrict myself to handling mostly non-clinical articles, such as historical pieces, and the odd weird article that Nick sends me.
I’ve always been interested in history, and had been a long-term but completely passive member of the British Society for the History of Paediatrics and Child Health (BSHPCH). After ‘retirement’ I have become more active, hosting meetings and joining the committee. This links in nicely with my Archives role. I have always thought that ‘history will always be there’, and so this interest took a back seat until I had more time and energy for it. Unsurprisingly, nearly all the attenders at BSHPCH meetings are retired.
I stopped being an educational supervisor a year before I retired, as I would not be able to see trainees through. However with a view to continuing to be involved in supporting trainees, I enrolled as a Case Manager for my Deanery’s Professional Support Unit (recently renamed Professional Support and Welfare, PSW) before my ‘retirement’. This involves taking on trainees in any specialty who have been referred because they are struggling, for a wide range of reasons. We talk to them, advise, and then refer on as necessary to others: coaching, counselling, communications skills, exam support, cultural integration support, etc.
As this doesn’t require a GMC licence, I have continued it until now, and found it very rewarding. However, I now worry that I am becoming too disconnected form the real world of medical practice to maintain my empathy, particularly in the era of COVID.
In 2020, a tiny packet of RNA wrapped in a spiky protein coat changed the world. Like many other people at various stages of retirement, I joined the rush to help in any way I could. It quickly became apparent that the virus largely spared children, and my paediatric colleagues at my old trust politely declined my offer to help them out. Because of my activities with the PSW, my trust’s Foundation Programme Director asked if I would take on a new role: supervising and supporting the final-year medical students who had volunteered to start their F1 year early, in May-June 2020, to help out on the wards – known as interim F1s, iF1s or ‘iffies’. As it turned out they didn’t need much support, as they were being somewhat cosseted by the trust and the regular trainees, so that role didn’t last.
The recently-retired were all encouraged by the government to apply through the NHS England Bring Back Staff campaign. I did this, which involved much tedious form-filling, document-finding and an online interview. Like many others, I found the experience frustrating and overly bureaucratic: in a crisis we were being treated much like new recruits out of college wanting to work for the NHS for the first time. Ironically I later found that I was still technically employed by my trust on a Bank contract, unknown to me, because they had forgotten to end it. Thus much of this process was unnecessary. I was granted a six month extension to my GMC licence without a further revalidation.
This Bring Back Staff process did not lead to any useful clinical work of itself, but separately the RCPCH President put out a call for experienced paediatricians to help with a new initiative: working remotely as frontline clinicians for NHS 111. There is more on this in articles written by me and Vivienne van Someren in Milestones summer 2022 edition. I signed up, was allocated to the London Ambulance Service’s NHS 111 system, and asked to co-lead the small group of paediatricians also allocated to them. I had to endure a repeat of the tedious HR processes already done for the Bring Back Staff campaign, as they don’t seem to communicate with each other. Also, as part of the required ‘onboarding’ process, I had to complete a whole series of online learning packages, most of which were largely irrelevant to the work. Then we had to get set up on their remote-working IT systems. It took until August 2020, long after the first wave had passed its peak, for me to actually start work.
I was delighted to be working as a children’s doctor again, albeit in a very different way to how I had worked before. I withdrew from this when the pilot project ended in December 2020.
End of GMC licence
At the end of 2020 I had to make a decision about maintaining my licence to practice. For this I would have needed to undergo a formal appraisal, and obtain patient and colleague feedback, etc. The only clinical work I was doing by then was for NHS 111, and it proved difficult to find anyone suitable within that organisation to appraise me. My old trust had previously refused to do any sort of appraisal or supervision, as I was no longer working for them, and was unlikely to do so in the future. So somewhat reluctantly I took the decision to ‘de-doctor’ myself, allow my licence to lapse, but to maintain my registration. This was straightforward, and registration does not require any sort of appraisal. I could continue functioning in a clinical environment as long as I did not do ‘doctor-specific’ things like prescribing.
A shot in the arm
In January 2021, the vaccine roll-out began. Having previously volunteered to help, I was contacted directly by HR at my old trust and I immediately agreed. Initially they were uncertain whether I could function clinically with registration but no licence, but eventually found that I could: this must have applied to many returning doctors. So I was recruited as a band 5 vaccinator, a generic health professional role which could be done by a wide variety of people: nurses, midwives, dieticians, physios, as well as doctors.
This time the recruitment process was slightly less painful, and some of the irrelevant nonsense from first time around had been dropped. However, I still had to do a lot of tedious and repetitive online modules around vaccination and COVID, and update my adult resus training. This was all completed by February and I then heard nothing. On 2 March I attended my local NHS vaccine hub to receive my own first Astra Zeneca jab, and while there mentioned that I wanted to work there. I chatted to the site manager. Possibly a coincidence, but within two weeks I had been invited to attend an induction and had done my first shift.
I did shifts intermittently from March through to December 2021, depending on demand. Most of the time I was ‘consenting’, ie sitting at a computer, taking people’s details, asking a few highly targeted questions and explaining briefly about the vaccine’s side-effects. It was repetitive, but it was strangely rewarding to be actually going to ‘work’ to do a shift, and doing something obviously worthwhile. Social interaction with others working or volunteering there was enjoyable, and I met a number of former colleagues from the old days. I wasn’t functioning as a doctor, and certainly not as a paediatrician at first.
I quite liked dealing with the old folks - with the middle-aged less so - but it got more interesting when we started on young adults. I felt I could help with authoritative reassurance around fertility, pregnancy and breastfeeding. I offered my services as a paediatrician when, in September 2021, the roll-out extended to children: this could have included training, advice on consent and safeguarding, and making the vaccine centre more child-friendly. However my offer wasn’t taken up. They obviously had other people to advise, and to be fair, have been doing a good job with children. Perhaps it’s an illustration of the transition we all have to face after retirement. When you are no longer officially a consultant paediatrician, even though you still have all your faculties and vast experience, people don’t see you in quite the same light.
So I just continued as a generic band 5 vaccinator, occasionally advising fellow vaccinators confronted with children with unusual diagnoses, and, once or twice, being recognised by parents of my former patients!
For about 15 years I have been acting as a general paediatric ‘expert’, providing reports to lawyers in cases where there have been allegations of negligence involving paediatricians. This is something I always intended to continue after retirement: not so much for financial reasons, but more because I find it stimulating and interesting. Until now I have been continuing with this, and actually have had more time to do it than before retirement, but I have now decided to gradually wind this down.
The GMC limits what legal work I can do without a licence: I am not allowed to see and examine patients/clients, or to do ‘condition and prognosis’ reports. I can still do retrospective reports based on the records, but I feel that I shouldn’t be commenting on incidents that happened after I ceased clinical work, and so it will naturally fizzle out. I’m aware that other paediatricians continue to do legal work for many years after clinical retirement, particularly in longstanding cases of adverse neurological outcomes, but that’s not for me.
What else to do?
Some people wake up on the first day of their retirement and think: what shall I do now? Not me. As well as all the professional-related stuff mentioned above, I wanted to do activities that were unrelated to medicine, but which were mentally stimulating and rewarding. As a paediatrician I naturally enjoy working with children, so I also wanted to continue this in some form. With my own children long-since grown up, and no grandchildren, I found that I missed this aspect of work more than I expected.
So before retirement I looked around at what might be available. I’m fortunate in that I live near a major heritage site that has many child visitors, and organises structured visits by primary schoolchildren, largely run by volunteers. Thus I enthusiastically entered the world of volunteering. Now, once or twice a week during term-time I welcome classes of 7-10-year-olds, along with two or three other volunteers, and optimistically hope to inspire them with a passion for history and heritage. There’s a huge difference between handling one or two kids in a consulting room and 30 in a classroom or outdoors, but some professional skills come in handy: specifically how to talk to children. Naturally as a paediatrician I can’t help making spot diagnoses amongst the children who attend: that one’s an ex-prem, that one’s autistic, and the one with ADHD hasn’t taken his Ritalin! I’m currently discussing how we can improve the experience for children with special needs, autism and disabilities.
I’m thoroughly enjoying volunteering, not least because of the company of my fellow volunteers, who are mostly retired professionals with a very similar outlook on life to me. However I have encountered some issues common to the experience of other retired professionals: the organisation’s management, although always polite and grateful for our work, are not prepared to take advice from volunteers, even when we know far more than they do. A good example is COVID precautions: when the site re-opened after lockdown, there were some frankly unnecessary restrictions which showed a basic misunderstanding of the nature of viral transmission. My suggestions of how we could manage it better were ignored. Volunteering for a large and inflexible heritage organisation has resonances of working for a similarly large and inflexible organisation, the NHS.
As well as this, I am a trustee for the very active community centre in my village (a beautifully converted church). I help arrange social events, visiting speakers and film screenings. As everyone in this small organisation knows me well, they do actually listen to my advice on things medical or child-related.
Recently I have volunteered to help out at my local primary school (the one my kids attended many years ago): I will be going in for an hour or two a week to read with children who are having literacy problems.
When working full-time, exercise was crammed into necessarily brief bursts: gym workout, short runs and bike-rides. I have always enjoyed long walks, and retirement allows me the luxury of spreading my exercise over longer periods. When I went part-time, I started walking regularly on weekdays with some similarly semi-retired friends.
We enjoyed the smug feeling of being out in the countryside when everyone else was working, and the pubs were quiet. We’ve continued, almost every week, into full retirement, lockdowns notwithstanding. We usually cover at least 10 miles, but sometimes up to 20. I feel more walking-fit now than I ever have.
Reflections on retirement
When I tell non-medical friends about what I’m doing, as listed above, their reaction is often: you must be so busy! My response is: not really. It seems a lot, but actually, compared to a full-time consultant job, it feels fairly relaxed.
Everything I do now is because I want to, not because I have to. That, perhaps, is the best thing about retirement. I could stop it all at short notice and it wouldn’t matter: it wouldn’t result in gaps in the rota, letting down patients, or any financial problems.
Parkinson’s Law states that "work expands to fill the time available for its completion". This is particularly apposite to retirement. Simple commitments such as a 20-minute call can seem to occupy a whole morning. While working full-time, every minute seemed to be precious, and none ever wasted. Now a new mindset is required: it doesn’t matter if I don’t do much in a whole day. That said, there have not been many days when I have had absolutely nothing to do, even during lockdown, and I have so far managed to stave off boredom.
Being able to go away with my wife midweek during term-time, and at short notice, is a major bonus. Hotels, restaurants and attractions are so much quieter, and cheaper: inevitably, though, we are surrounded by other ‘old’ people, when it would be more lively if there were kids around.
The change in status, to being ‘no longer a doctor’ was gradual for me, but even so I felt it more than I expected. It’s a choice I made, and it was the right one, but there is a downside to relinquishing the GMC licence.
My personal journey of retirement has extended over almost a decade: from full-time resident on-call to non-resident, to part-time, to returning for locums, to COVID-related clinical work, to now, reducing professional involvement. I was fortunate in that I could gradually drop professional activities over the years - examining, some college work, clinical commitments, and education and support – while taking on some new, and increasingly non-professional, roles. Some things that I had no time for before retirement, I can now indulge. Life is undoubtedly less stressful. Everything I do now is because I want to, not because I have to. However there are downsides: the necessary loss of status with losing my Licence to Practice, missing the intellectual challenge of medical practice, missing the collegiality of working in a friendly department, and missing contact with children.
Finding things to do which are both enjoyable and stimulating was, for me, the most important means of adjusting to a new way of life. I would recommend volunteering in any of a whole range of activities, as well studying new fields of knowledge, as the best way to make the transition.