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A traumatic day

Pound signs are at the forefront of our diarist’s mind as he does his duty doctor stint.

The story so far – Dr Peter Weaving is a GP and locality lead for Cumbria PCT, now regarded as a trailblazer for its ambitious integrated care plans. Today he is a duty doctor in a consortium…

I jumped athletically over the six-inch-high box hedge and struck a low hanging branch with the bridge of my nose. Looking in the mirror after shaving, I decided a small scab was better than a cartoon boxer’s sticking plaster for the duty doctor. And no ordinary duty doctor!

Today I was the duty doctor in the post-white paper world of GP commissioning. I am the last bastion of defence to stop the NHS going bust. Healthy alternatives to admission and referral ‘r’ us. One of the – I presume intended – consequences of the internal market is the awareness that my actions as a doctor equate to what I spend from my budget. Although the pricing of some transactions seems counter-intuitive (it costs more if a patient phones NHS Direct than if they have a face-to-face consultation with, and examination by, an experienced clinician such as me) others, such as admission to hospital, seem appropriately expensive. A bit like taking your BMW to the garage – it’s hard to get in and out without spending at least fifteen hundred quid.

Anyway, on with the day’s emergencies. First up we have James, a slightly sheepish, smiling young man who took an impulsive paracetamol overdose after a row with his girlfriend last night. He knows it was daft, he’s not depressed and his suicidal intent is zero. But he needs to be sorted and safe.

Old-school option: admit to medics, who would put him to bed, run bloods, administer antidote if needed, refer to psych for assessment and bill me £3,000 for the privilege of his being their guest for 16 hours. New school says: phone the primary care assessment service in the same trust’s A&E department and ask them to check the bloods for me and I’ll get him back to see me tomorrow for the psych review. Total cost – less than a phone call to NHS Direct. James is happy not being admitted to hospital.

My satisfaction is terminated by a distressed phone call from Fred’s son. Fred has just been discharged home after a stroke and his son had popped out to get milk. On returning, his son finds Dad has fallen and split his head open. I whizz round to be confronted with what looks like a tableau from TV’s Crime Scene Investigation. The Zimmer is on its side on the kitchen floor with blood sprayed on the wall and floor. Bloody handprints lead to the upstairs loo where Fred is sitting. The old-school approach would have had an ambulance on its way before you could look up the tariff for ‘head injury with complications’. But on closer inspection his wounds are limited to a small laceration on his forehead that can be sorted with Steri-strips and a firm dressing. Fred is already supported by our Short-Term Intervention team, so having patched him up, I agree to arrange a couple of days at the day hospital for additional rehabilitation. His son is happy with this arrangement.

And back to the surgery for the next round of walking wounded, which includes a wounded Afghan veteran, a 14-year-old requesting a pregnancy test, two cases of quinsy and a professor with horizontal nystagmus.

You couldn’t write this stuff.

The PBC Diaries