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Dinah finds out she's not first-class material, and discovers more hoops to jump through

Monday

No surgery today. Off to the Big Smoke for a conference with cheap 'First Advance' GNER ticket. Discover this doesn't allow entry into first-class lounge for free coffee at the station when I am ejected in front of a crowd of acute trust managers apparently filling the place (hope they aren't going to same meeting). They obviously have more money than they are letting on...

Chat to consultant dermatologist on train. Trying to work out design for community skin lesion service when he sees some hospital managers coming and rushes off to hide in toilet. His trust is one whose consultants are banned from speaking to GPs. Why do they put up with it?

Tuesday

Unscheduled care workshop. Everyone agrees – if only GPs could take over casualty we'd be saved. Urgent care and A&E must merge and we just need to ensure there are enough 'intermediate' services like end-of-life care and COPD support to divert to. Plus we need armies of IM&T experts to challenge 'up-coding' and alert us to imminent trim-point-violation (God knows what we'd do about it).

Exhausted, miss three calls from practice manager worried about new GPSI guidance and practice plans for community gynae service. Suddenly there are more hoops to jump through. Don't worry, we can manage without ultrasound for now, and I have new info on test kits for BNP and D-Dimer for other services. She's not convinced so agree to meet in pub later. Two missed calls from children too – it's GCSE drama performance; text PM (pub tomorrow instead) and rush off to school.

Friday

Surgery at last! First patient is full of hell – an 83-year-old discharged yesterday on insulin. Kicked out too early (isn't that what we asked for?), missed the self-injection training session and handbook 'how to manage your life on insulin'.

Illegible discharge note lists seven diagnoses: renal failure, heart failure, IDDM, CHD, OA, TIA and hypertension – just think of the bill! He just wants reassurance he's on the right drugs which unfortunately I can't give. No ECHO, no ECG, no CXR, no BP. What can I do? Not pay? It won't help him, it won't help me – but could the savings help women needing community gynae ultrasound? Best not mention that; let's check your BP and I'll write to the consultant – don't worry, you'll be fine.

Dr Dinah Roy is a GP in Spennymoor, chair of Sedgefield PBC group and co-PEC chair of County Durham PCT

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