Profile: Dr Simon Bonnington
Role: Family physician
Location: Annapolis, Nova Scotia
Career: A former GP in Somerset and vice-chair of Somerset LMC; emigrated to Canada in 2010
The deep-throated gunning of an engine and a flash of amber lights penetrate my slumber. My subconscious recalls the 4am clatter of the highways snowplough.
By the time I leave the house, the night’s four-inch snowfall has been cleared from our drive by Eric, our 77-year-old neighbour, with his plough. Like so many of my youthful elderly patients, he stretches his pension with small jobs. The warm midwinter sun greets my face. We’re on the same latitude as Turin and much of the snow will be gone by late afternoon.
My drive to work takes six minutes as I cross the causeway, pass the hydro- electric plant, halt at our only traffic-lights, then stop for the school bus.
The brick and concrete health centre offers a stark contrast to the elegant 19th-century houses in the town. I ask the nurses about our four inpatients. The patient with diverticulitis is still pyrexial, her white cell count not settled, but she was comfortable through the night.
I walk along to our practice offices and start the computers. Letters wait on my desk for signatures. Electronic lab and X-ray reports lurk in the Nightingale inbox – our equivalent to EMIS.
We meet for our daily multidisciplinary morning rounds. I review the patient with diverticulitis. Phoning the hospital, I speak directly to the consultant surgeon on call, then to the radiologist to arrange the CT. A nurse organises the ambulance. We’ll have an answer by lunchtime.
My morning clinic of 15-minute appointments runs until 12pm, with time set aside to review our two registrars. My $300,000 retainer contract (approximately £180,000) covers 40 hours for 46 weeks, plus 19 weekend days a year, including 1:6 emergency department coverage, and overnight inpatient responsibility. Our practice is more chambers than partnership, with rent, staff and overheads provided by the health authority at cost. They employ our nurse practitioner and practice nurse, at no charge to us. No list size to worry about, no visits, no LES, NES, DES, no commissioning and no federations. Incorporation offsets my tax liability to 30%.
I have better hours, more money and less stress than in the NHS I left in 2010. What’s not to like?
Our unionised reception staff must have an hour’s break for lunch, so the shutters and phones go down. It’s just $4 (£2.40) for a freshly cooked lunch from the canteen.
Clinic until 5pm. A patient with COPD comes in, breathing badly. He hadn’t liked to call an ambulance because of the cost and couldn’t afford the prescription for the inhalers. I take him straight over to our small emergency department where point-of-care blood count, electrolytes and chest X-ray are available. We admit him for nebulisers, steroids and antibiotics. This is his second exacerbation, so I reassure him he’ll get coverage from the Government.
A collective collegiate environment encourages doctors to seek advice from each other several times a day. I’m the go-to for chronic pain.
Home in time for supper with my wife and children. The kids head off to their skating lessons at our local rink, while I head to the high school gym for soccer.
The kids are in bed. My wife and I relax with a glass of home-brewed wine to enjoy the latest episode of Murdoch Mysteries, a popular TV detective drama in Canada.