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How genetics will transform CHD risk assessment

...practising in Tony Blair's backyard

This week our diarist Dr Dinah Roy, who juggles a singlehanded practice with life as PEC chair at Sedgefield PCT, reflects on how her role as a GP is changing ­ and wonders if Jamie Oliver may be able to help

Week ending April 10

·DNAs: 7 GP appointments plus 15 for nurse/HCA

·Sick notes signed: 23


08:30 Pop into PCT before surgery to check QMAS figures ­ hooray! Practice has performed well, as hoped. Phone practice manager Joyce, who has already booked night out for 'prize giving'. Most practices on patch have achieved well above aspiration ­ the usual story when GPs are given targets to hit. Still, I'm glad we weren't being measured on obesity management this time ­ lower lipid targets will be challenging enough.

09:00 Notice time; rush to surgery which turns out rather gynaecological, so relieved to see 'heartsink' who hasn't been for a while. She's agitated, having found an anonymous gunman in the garden; police, helicopters etc involved. Distressed, but also enjoying the drama, she surprises me with an invitation to her art class exhibition, having painted my portrait ('Doctor, you have such an interesting face!'). Distracted (was that a compliment or not?) I promise to go. Recover sufficiently to weigh her: BMI well over 30. Proposal to diet offends her so she ends 23-minute consultation. Wonder if dietitian could attend exhibition instead of me? Dictate referral to mental health link-worker for PTSD. Rest of surgery runs very late.

13:00 Leave for afternoon of meetings at PCT. Have to spend ages correcting PEC minutes.

19:00 Get take-away on way home. Remember I have to give a presentation on practice-based commissioning tomorrow. Panic and forget to go to Pilates.


07:00 Weigh myself. Bad mood for rest of day.

09:00 Surgery. 11-year-old and mum, sent by school ­ does he have ADHD? No he doesn't, he's bored. Plus who knows what's in those school dinners? Discuss his dad's death from alcohol-related cardiomyopathy a few years ago. Recommend Jamie Oliver and contact school nurse. Reflect on how job has changed ­ seem to spend my time these days telling people they aren't ill and trying to scare them into changing their lifestyle. The nurse sees chronic disease and the salaried GP sees acutes.

12:00 Close surgery for 'time out' ­ cover from neighbouring PCT. Go to PCT to collect practice-based commissioning presentation, get delayed by full inbox of e-mails. Rush to training centre but miss lunch: only chips left. Eat them anyway.

13:00 Attend workshop on MS. Worry about pins and needles in my hands. Probably can't justify MRI as practice exceeded quota for last year.

15:15 Run practice-based commissioning session. Most practices getting more interested, loads of new ideas for service changes ­ scrap outpatients, primary care in-reach to hospitals. But none of it will work unless activity information improves vastly ­ and we don't have good enough financial data yet.


09:30 Off to PHA conference in Gateshead. Session on community pharmacists providing public health services.

17:00 Walk back to Newcastle station in snow, reflecting contentedly on past week. Need to change art exhibition venue to local pharmacy. And book Jamie Oliver to run it.

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