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Dinah finds she could easily be a woman of letters

Monday

Practice manager meeting: what's our policy on people who can't take their exams? Confused – does she mean the forthcoming hand--washing exams that all practice staff must pass? No – she means students who want a doctor's letter to explain underperformance. Oh, an excuse note! A GP has refused to do one for a student who says he's too stressed to study. I know the lad and feel sympathetic but there is nothing to back it up in the records.

I promise to think about the exam notes policy and we discuss the practice drinks machine (still waiting for delivery); should we include caffeinated drinks? Definitely. They will be useful for exam candidates.Surgery: a string of patients wanting sick notes, letters for council about rehousing, grants for cookers and gardening help; someone who knows you get free gym membership if referred through the GP. Get through whole surgery without writing a single prescription – good for the budget, but not my sanity. But who else is there for people to turn to for social support and empowerment? Must think again about community involvement in PBC.

Wednesday

PBC meeting: still trying to make sense of practices' performance against last year's PBC DES. Activity analysis looks like a phone book; flawed anyway as independent sector data excluded. Finance can't be updated until end of year accounts finished. As for any savings, they're all committed in next year's LDP already. Pity, I'd earmarked funds for a locality drinks machine scheme – business case at the ready, for patients with 'TATT', to save on path tests and GP time.

GP meeting at surgery – discuss hand-washing exam and PDPs. Start to worry – I have chronic neck pain, could it be caused by washing hands too often?Late home. Kids apparently have no homework. Odd.

Friday

Son asks for note for teacher – he'd forgotten homework book. Scribble something hurriedly about juvenile dementia. Late for PCT.

Eighteen-week target meeting: musculoskeletal pathways bother me. They look very logical but one thing is missing – no acknowledgement of social need and all the work involved for primary care. Meeting runs over time but I get up to leave – I'm sorry, I have to practise washing my hands for my exam next week. Here's an idea: should I get an excuse note from my neurosurgeon? On second thoughts, I don't think I can afford it.

Dr Dinah Roy is a GP in Spennymoor and chair of Sedgefield PBC group

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