Membership of the Order of Australia for services to medicine
Dr Geoffrey Gates was the 15th president of the RACGP (1988–1990) and the third West Australian to hold that office. He presided over the finalisation of government acceptance of a new content-based schedule of general practice fees that were tied to vocational registration (ie the Fellowship of the RACGP [FRACGP]) and proof of continuing medical education.
Many GPs and the Australian Medical Association (AMA) were opposed to this initiative and it resulted in one of the most turbulent but significant periods in the history of the RACGP.
However, it did result in the recognition of general practice as a discipline in its own right.
Geoff was born in Liverpool to Kenneth and Jesse Gates (nee MacIntosh) in 1926. The family moved a lot as Kenneth was an Anglican minister and World War I chaplain. Geoff was an only child, but his father was the middle child among 13. Geoff’s grandfather, William Gates, was the chief electrician of the London Underground railway.
Being an only child and moving about meant that Geoff did not develop lasting friendships and perhaps became somewhat self-contained. He grew into a tall man, of solid build and a distinguished bearing. He had a happy childhood and he described his upbringing as being strict. He attended church regularly. He learned from his family to always give people a fair go and he had a strong sense of responsibility, especially to do his best for his fellow human beings.
Initially, Geoff attended school on the Isle of Man and later went to a prep school in Prestatyn, Northern Wales. At age nine, he would travel from the Isle of Man by ferry to Liverpool, then catch a train to school. After prep school he attended St John’s School in Leatherhead, Surrey. It was a school for the sons of Anglican clergy and was located 20 miles from London. His high school years occurred through World War II. Geoff had vivid memories of seeing fighter planes and bombers passing over the school. Despite his school being damaged amid the turmoil of the war, he graduated when the war was over.
Geoff had no idea what influenced him to study medicine but he never had any inclination to study any other profession. He gained entrance to both Guy’s Hospital and Manchester University Medical School, but chose Manchester because it enabled his family to avoid the cost of his living in London. During his final year he won the surgical prize and learned committee skills as the treasurer of the British Medical Students’ Association.
He qualified in 1950 and worked at the Manchester Royal Infirmary, the Crumpsall Hospital and the Oldham Royal Infirmary with an orientation towards a surgical career. In 1953, he was called up for national service. While waiting for departure to the ‘far east’ he married Moira Exley, a nutritionist he had met at a university union dance. He served in Hong Kong as a junior surgical officer for the 33rd general hospital with the rank of Captain in the RAMC.
When he was demobilised in 1955, he was torn between migrating to Australia or returning to the UK. As he and Moira still had parents in the UK he took up a post as resident surgical officer at Oldham Royal Infirmary. At the end of that year Geoff decided that ‘general practice would suit me better than doing surgery full time’.1
When he graduated there was no compulsory requirement for a year of post-graduate hospital experience. However with his hospital and army experience he had acquired considerable clinical skills. He found a position in a semi-rural general practice group in Immingham, Lincolnshire. There, under the guidance of Sydney Bedford, who was an excellent mentor, he furthered his knowledge of general practice. He joined the Royal College of General Practitioners (RCGP) in 1964.
One of the great influences on his professional life was the arrogant comment made by the blinkered elitist, Lord Moran, whose career included being the dean of St Mary’s Hospital Medical School, president of the Royal College of Physicians of London, and Winston Churchill’s wartime and post-war doctor. While giving evidence before a Royal Commission on doctors’ remuneration he stated that ‘A general practitioner is a doctor who has fallen off the ladder of specialist training’.2
This denigration spurred Geoff to see training for general practice properly organised and ending with some sort of assessment for doctors who wished to enter general practice.
Moving to Australia
In UK general practice Geoff missed using his surgical skills, and after almost 10 years at Immingham (1956–67) an opportunity emerged. He saw an advertisement in the British Medical Journal for a GP in Western Australia. Dr Derek Stevenson, FRCS was on holiday from his practice in Kellerberrin and was interviewing prospective candidates to replace a departing colleague, Dr Ken Nyman. Geoff was invited to join the Kellerberrin practice and in January 1967, Geoff and Moira immigrated to Western Australia with their two children, John and Jenny.
Kellerberrin is situated in the Central Wheatbelt, 200 km east of Perth. The town had a small hospital and Geoff and Derek lobbied hard to get the hospital enlarged, refurbished and upgraded to 32 beds, an operating theatre and a delivery room. They developed a highly regarded practice that became a de facto sub-regional centre, providing support to GPs in adjacent towns.
The work in rural Australia was very satisfying and demanding. Geoff was the anaesthetist to Derek’s surgery and practised as an all-round GP, doing what he called ‘womb to tomb’ medicine. This included midwifery, surgery such as caesarean sections, anaesthetics including dental anaesthetics, general and emergency medicine and the full range of ambulatory care. He also loved teaching and became involved as a medical student tutor, taking students in the latter part of their clinical training.
In 1976 he became a general practice supervisor in the newly formed Family Medicine Program (FMP), a program introduced to train doctors for independent general practice. FMP was run by The Royal Australian College of General Practitioners (RACGP) and funded by the Federal Government. General practice registrars would come for six or 12-month placements and learn the art and skills of general practice. He related well to the students and registrars, who would stay with him and Moira to learn firsthand about the life of a country GP – the phone calls and being called out at all hours. He continued to take an interest in these students and registrars as they progressed though their careers.
The practice provided a comprehensive service doing three consulting sessions per day. The doctor doing the evening surgery was on-call overnight and the cover extended 24 hours a day, seven days a week. While one doctor did the consulting the other did a ward round, X-rays and minor surgery. They did their own X-rays up to and including intravenous pyelograms. The operations they performed included gall bladders, hysterectomies, hernias, vasectomies, reduction of closed fractures, breast lumps, tonsils and adenoidectomies. These were the days before CTs, ultrasounds, epidurals and laparoscopies. There was no pathology service within the hospital and specimens were sent to the laboratory at Merredin Hospital.
When Geoff began to practise in Kellerberrin, he would often anaesthetise the patient, then get the matron (director of nursing) to bag the patient so that he could scrub up and do the operation. After he completed the surgery, he would degown, take over from the matron and wake the patient. The Health Department eventually outlawed this practise and towns in the Wheatbelt with a single doctor would call a colleague, like Geoff or Derek, to come and assist. There was an Aboriginal reserve outside the town, and all were treated equally. One wonders if having a minister as a father, gave Geoff a model of availability and devotion to a calling. This may have helped him to commit so wholly to general practice and achieve such a high standard of care.
He took a number of additional roles in his time in Kellerberrin. These included being the medical officer for the St John’s Ambulance Brigade, a member and president of the management committee for the Iris Litis Hostel of the Slow Learners Childrens Group of Western Australia, and medical advisor and member of the management committee for the Dryandra Frail Aged Hostel. For a while he was also president of the Kellerberrin Pony Club.
General practice registrars were given a lot of responsibility and fully shared in the regular clinical work. They were able to admit their own patients and discuss them at the ward round each day. Geoff’s style was very much as a supportive colleague. As a registrar, one always felt supported and able to discuss difficult cases or express any uncertainty.
One registrar, Barry Fatovich (later to become state director of the RACGP FMP in 1990), described his time in Kellerberrin:
In 1977 I did my first FMP general practice registrar term in Kellerberrin. Each day involved a ward round and this was followed by booked sessions in the practice that had been built in the grounds of the hospital. Geoff was available and supportive. He was a broadly experienced and well-rounded rural doctor. I had done a three-month term of hospital anaesthetics and in Kellerberrin was given the opportunity to do anaesthetics and less complex surgery. I also learned to give a dental anaesthetic. Overall I had an extraordinary learning experience. As a young doctor one could grow in clinical understanding, and working in a small town gave a good understanding of context, [which is] so important in general practice. I was immersed in the local community and took part in a variety of local activities, both medical and non-medical – for example, I gave a course of lectures on first aid for St John Ambulance volunteers. At the end of my six months, they did not have a registrar to take my place and Geoff asked me to stay for another six months, which I did willingly.
Geoff was well regarded, his style was understated and business-like. He never made a fuss and just got on with what needed to be done. He had a wide network of Perth specialists whom he was on a first name basis with, and would ring for advice or help.
Moira was Geoff’s partner in all their activities. She had a detailed knowledge of the people in the area; she knew who was married to who and what was happening in the broader community. She also developed an interest in abstract oil paintings that she used to decorate the walls of their house.
Geoff’s friend, Ken Nyman, was a member of the RACGP WA Faculty Board and persuaded him to join. He transferred his membership from the RCGP to the Australian college with a letter from Lord Hunt, then secretary of the English college, sent to Dr Howard Saxby, then honorary secretary-general of the RACGP.
Geoff completed the college examination for Fellowship in 1973 and was made a Fellow in 1974. At first, he found some of the more intellectual members of the board intimidating, but their deliberations reinforced his belief that general practice could only become a discipline in its own right when it had a formal training program, with a final examination as its end point, coupled with continuing education and quality assurance that was formally recognised by the Federal Government and by specialist colleagues (see below information on Paul Fitzgerald). That belief drove Geoff to drive 400 km to Perth and back for each faculty board meeting.
He was surprised when he was asked to become the WA faculty representative on the RACGP Council in 1977. He found himself in the company of able and experienced people who felt the same way about general practice as he did. He was elected chair of the council in 1978. This gave him a detailed insight into the internal workings of the college. He also developed important friendships that helped him shape the future of general practice in Australia. Geoff’s main aim was to nurture the professionalism of the various RACGP committees. He was a consensus chair who maintained the council’s respect until his term expired in 1981.
After 1981 Geoff remained on the WA faculty board but had little contact with the national office in Sydney.
In 1986 he and Moira moved to Perth, where he took up a post at Edith Cowan University providing medical services to students and staff. He particularly enjoyed treating the students and staff at the Western Australian Academy of Performing Arts (WAAPA). In part, this reflected his interest in the arts, especially music and ballet. His role enabled him to get a closer insight into their world. He also worked part-time at the University of WA General Practice at Lockridge. There he continued with broad based general practice and did vasectomies under local anaesthetic.
The then college president, Eric Fisher, reasoned that Geoff now had time to devote to college affairs and asked him to consider standing for the presidency.
In 1988 Geoff stood and received 75% of the votes that were cast. He was a good listener who neither dominated discussion nor pushed his own ideas. He had the insight to know that he was not assertive enough to be a good face-to-face negotiator, so he assembled around him a number of members with good negotiating skills whom he could trust.
For the previous six years the college had been pressing for vocational registration for general practice. It had received advice early in 1988 from Paul Fitzgerald, a GP with knowledge of administration and politics, that the best way to implement vocational registration was federally, by tying it to an increase in the Medicare rebate. At the same time the college wanted to change the descriptors for service to more accurately reflect what was done in a general practice consultation. The Health Minister Neal Blewett accepted both these college proposals in the first days of Geoff’s presidency.
The question of vocational registration went before a senate select committee on two occasions. Presentations to the committee involved considerable expenditure of both time and money by the college and its members who appeared before the committee. The overall strategy was directed by Geoffrey Gates and the chief negotiators were Graeme Miller and Michael Bollen. Vocational registration became law in late 1989.
Finally the college had established for general practice, a nexus between standards and remuneration. This set the stage for the distribution of healthcare funds for training and quality in general practice. Here Geoff had achieved his dream of the recognition that training and quality assurance would be the basis for future general practice. In his valedictory speech, Geoff paid tribute to the efforts of his predecessors who had prepared much of the ground for this success. At the end of his speech he was given an extraordinarily long standing ovation.3
Geoff summed up those years in his autobiography:
‘My overall summary of my college experience would be that it dominated my life for 25 years. It enabled me not only to see, but to help the process of vocational training leading to vocational registration, together with ongoing high quality education. Above all, it gave me a great interest in, and great satisfaction from the achievement of helping move the general practitioner to equality with the rest of the medical profession.’1
Post RACGP and retirement
After his presidency Geoff withdrew from national committees but continued his involvement with the WA faculty board until 2007. He served as treasurer and honorary archivist for 10 years, was provost on two occasions (1988–89 and 1997–98) and was an examiner for nearly 20 years. In 1998 he was honoured by the Geoffrey Gates Award, that was established by the WA faculty board for members who met the criteria of having provided ‘long and meritorious service’. It is customary to give the first struck medal to the person after whom it is named. Geoff would have been a most worthy recipient since he served on the board from 1976–2007.
Other honours were a Membership of the Order of Australia in 1989 for services to medicine. In 2008, the RACGP awarded him its highest honour, Life Fellowship.
Geoff was well regarded in the medical community and was invited to be involved in various committees, that included the Ministerial Inquiry into the Recruitment and Retention of Country Doctors in Western Australia (1986–87), the Vocational Registration Appeals Committee (1989 – 1995), and as a member of the committee to review the Medical Act in WA (1992–93).
In 1993, his wife Moira, was diagnosed with leukaemia. She initially responded to treatment but eventually succumbed in 1998. This was a difficult time in what should have been a period of settling into retirement. Geoff and Moira were swept along by the necessity of receiving care for a major illness. Friends rallied to provide support but this did not change the sadness of what was happening.
Geoff found it difficult being on his own even though he had more contact with his son John and his grandchildren, Cody and Georgina. He became vice-president of the Friends of the Western Australian Academy of Performing Arts that was a faculty of the Mount Lawley campus of Edith Cowan University, and devoted much of his time to it.
A year after Moira died, Geoff decided to make a farewell visit to England to catch up with friends and family. There he met up with Patricia Creaser, who had known Moira. Their relationship grew and Pat moved to join him in Perth. They married in 2000 with an intimate, in-house ceremony.
In retirement he had time to soak up his interests in music, travel and keeping up contact with colleagues and friends in Perth and the eastern states.
He had a strong family history of bowel cancer and despite regular monitoring still developed bowel cancer. He underwent major surgery but succumbed to postoperative complications. He passed away with family by his side. A service was held at St George’s Cathedral with over 200 people attending. He was given glowing eulogies that reflected the regard and respect with which he was held. A memorial plaque has been placed at the cathedral to commemorate his contribution to society.
He is survived by his widow Patricia, son John, daughter Jennifer, grandson Cody and granddaughter Georgina.
The future of general practice. Full report of Geoffrey Gates’ valedictory presidential address at the RACGP AGM, Perth, 1990. Medical Observer. 12 October 1990: 22; 26 October 1990: 28–29.
Patricia and Jenny Gates, personal communication with Eric Fisher and Barry Fatovich.
This biography has drawn heavily on the obituary written by Eric Fisher on 3 December 2009.
Eric Fisher, Barry Fatovich, Cody Gates, Max Kamien.