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Independents' Day


Dr Nigel Stollery passes on his tips gained from many years' experience as a GP with a special interest in dermatology ­ he practises in Kibworth, Leicestershire

Dr Nigel Stollery passes on his tips gained from many years' experience as a GP with a special interest in dermatology ­ he practises in Kibworth, Leicestershire

...practising in Tony Blair's backyard

In the last of her

pre-election diaries,

Dr Dinah Roy, a singlehanded GP and PEC chair of Sedgefield PCT, mulls over a puzzling patient complaint and overexerts during a stress-busting run

Week ending April 24

·36 referrals

·19 to hospital consultants

·17 to other services


07:00 Polling card arrives, put it on mantelpiece.

09:00 Surgery. Morning of 'long cases' ­ 20-minute appointment each. There are three GPs (all part-time, making 1.2 FTE) with interests in gynaecology; mental health; and (me) ­ 'people who seem to have lots of things wrong with them who need to discuss everything at length'. We also have a new medical student who whisks people away for a good going-over while I work out what to do next and catch up on coffee.

Mr B was well until he found himself in hospital with an MI over New Year and surfaced with PVD precipitated by ?-blockers and an allergy to streptokinase. They weren't sure if it was the ACE inhibitor or the statin so stopped everything (except aspirin which hadn't been started) and sent him home. Now happily back on all meds and miraculously still alive, he needs referral to vascular surgeons following doppler studies. Med student surprised at hospital discharge summary: 'Diagnosis: MI; Action ­ skin biopsy.' She decides to become a GP (hooray!).

12:30 Catch up on reports (and coffee) before fleeing to PCT.


07:30 Opt for benefits of exercise and set off on run through woods. Bluebells delightful but breathlessness awful. Go home to lie down for half an hour. Too embarrassed to phone GP.

09:00 Arrive at surgery, tachycardic. ECG machine in use, practice nurse makes toast instead. Give up coffee.

I have received a complaint ­ a severely depressed patient, previously a diazepam addict, alleging I've ruined her life, in particular insulting her by suggesting sectioning in 1997.

Check records: I wrote 'severe denial' but didn't admit her; she was already under psychiatrists. How to approach this one, I wonder?

In fact I've never sectioned a patient. I've tried twice; the first time the patient arrested having injected herself with an insulin overdose and the second time the patient also collapsed, with alcohol withdrawal fits. Amazing what people will do to get out of sticky situations. Since then have always managed to admit patients voluntarily, thank goodness ­ even when threatened with razor blades in the out-of-hours centre.

09:30 Dictate letter then plough through surgery.

Thursday (PCT all day for meetings)

09:00 Management team ­ long discussion about role of PEC and clinical leadership. PECs becoming unfashionable ­ anxieties about finance and cynicism about whether they 'deliver'. But have they been allowed to? If practice-based commissioning is going to 'deliver' then PCTs will really have to let go to clinicians.

12:00 Deal with Freedom of Information requests from several sources for QOF figures for individual practices. How have we all performed, and what is the bill?

Locally payouts are higher than originally budgeted because practices have scored highly and have above-average prevalence in almost all areas.

18:00 Drive home, practising Spanish verbs in preparation for planned holiday. Note ­ will not need hotel with fitness facilities.

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