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At the heart of general practice since 1960

Dinah's got a bit of a nail biter on her hands – which doesn't help when she has a prang

Tuesday

Half-term. Short surgeries, trying to work from home all week (mainly doing laundry). Most evenings spent struggling with emails. Same as usual actually.

Last patient: Mrs G, mid-70s, hobbles in with her second foot injury from attempted toenail cutting. She can't reach her feet since her stroke and manages by hacking at toes from a distance with pointed scissors, feet waving in the air. Usually a matter of luck if she gets a nail, this time it was almost a whole toe. Needs antibiotics and dressing; I suggest a referral to podiatry. No! Vehement refusal. Last time she was sent to the 'foot health technician', a new, cheaper service introduced as podiatrists are too costly to cut nails. (Okay – GPs had been consulted and agreed.) What we didn't know is that the service apparently consists entirely of patients sitting through a long and disgusting Powerpoint presentation on infected ulcers and bunions, probably designed to put them off cutting for ever.Over to nurse; gritted teeth, cleaned, dressed, swabbed and cut nails...Meanwhile looked at emails but interrupted by call from kids; dishwasher smells of burning. Rush home to prevent a fire (more importantly, resuscitate dishwasher). In my haste, reverse into other GP's car – it shoots down the street as the handbrake is loose! Mrs G is watching, killing herself laughing. Great service! Holistic foot care plus entertainment!

Thursday

PBC meeting. Discuss musculoskeletal pathways and 18-week referral to treatment targets. Incredulous discussion about clock starts and stops (yet another new mini-industry is spawned).

Never mind, we will prevent patients getting on to pathways unnecessarily, get us more physio, occupational therapy, podiatry (ha) and we will sort it.

Friday

Surgery: Mrs G again. She's brought a gift – a rear view mirror extension (Thank you! Most helpful); found it while getting herself a mirror for remote toenail care. Healthcare assistant has taught her how to file and she'll show us her feet at BP/stroke clinic every few months.

Drive home (carefully) musing; Mrs G hopefully won't end up in hospital again but how much money can we prove we've saved and how can we get our hands on it to reinvest? This is just simple stuff. God only knows how we will ever do anything complex. Give up, phone ahead: thoughtful kids have already got wine out of fridge. Lovely!

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

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