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					hoolet 56 AUTUMN 2008
                                                                                                                                                                                                                                                  hoolet 56 - AUTUMN 2008




                                                                                                                                  W
                                                                                                                                  Who needs GPs any more?                                                                                      ISSUE 56
                                                                                                                                               ho needs GPs any more? Not the UK governments it would seem. Apart the very
                                                                                                                                                                                                                                              CONTENTS
                                                                                                                                               visible and concerted attack on GPs in the media, there is a more subtle but more
                                                                                                                                               worrying attack from the Departments of Health. GPs are slowly being phased
                                                                                                                                                                                                                                       2   Helping Patients Back to Work

                                                                                                                                  out of primary care altogether.                                                                      3   Editorial

    GP Pathways Back to Work                                                                                                        I became a GP in 1987, towards the end of the golden age for GPs in Britain. When the
                                                                                                                                  NHS was formed most GPs worked singly out of poor surgeries, often parts of their own
                                                                                                                                  homes, with their wives for receptionists. By the mid-fifties things were not much better and
                                                                                                                                                                                                                                       4
                                                                                                                                                                                                                                       5
                                                                                                                                                                                                                                           Alex Thain's Flight Takes Off
                                                                                                                                                                                                                                           Hamish McLaren Forgets to
                                                                                                                                  General Practice was slated in a government report. The RCGP was formed and slowly things                Remember
Working Together For a Healthier Scotland                                                                                         got better. In the early Sixties funding for practices was markedly changed, money was made
                                                                                                                                  available for new surgeries and GPs were encouraged financially to work in group practices
                                                                                                                                                                                                                                       6   Pierre Fouin Reveals All
                                                                                                                                  and practice nurses began rearing their heads. In the seventies training became de rigeur and        7   Ken Lawton Keeps Busy
                                                                                                                                  then compulsory. Practices had District Nurses and Health Visitors attached and the Primary
A review of published evidence “Is Work Good for your Health” (G. Waddell, A.K. Burton, TSO, 2006) demonstrated that
                                                                                                                                  Health Care Team became king.
there are very strong links between being in work and positive health outcomes. This report from the University of Bleeding                                                                                                            8   Coeliac UK
                                                                                                                                    PHCTs, with GPs at their head, have led to a revolution in primary care in the past 30 years
Obvious tells GPs what they already knew. However the benefit trap and lack of confidence for those on long term benefits                                                                                                              9   QPA, P3, and the OC
                                                                                                                                  and British general practice has truly been the envy of the world. Despite all our moaning, we
made it very difficult for patients to get back into work. Our practice in Paisley took part in a pilot to help patients return
                                                                                                                                  have never had it so good. As always it could have been better, but our nation’s low health
to work. We were the first practice in Britain to have Jobcentre Plus advisers and NHS Condition Management practitioners                                                                                                              10 What Do Faculties Do?
in our surgery. The pathways project gives people physical and mental help in adapting back to work. Importantly it includes      costs and impressive health outcomes have been due to the dominance of GPs in the NHS,               10 Retiring Suzanne Clark
a benefit review and has two distinct advantages over previous initiatives. One was that it promised anyone going back            their gate-keeping role and impressive clinical skills, especially in dealing with uncertainty.
                                                                                                                                  Other countries have copied and built on our vision from the late sixties onwards. Some may
                                                                                                                                                                                                                                       11 Ian McKee Tells It Like It Is
into work at least £40 a week better for a year on top of pay if earning less than £15000 per year and if the return to
work failed they returned to their previous benefit level, rather than starting again at Job Seekers Allowance. Having the        have overtaken us, but the importance of GPs in treating people as humans, not illnesses,            12 Josie Inwood Goes to the Flicks
advisers in the practice meant we as GPs could sell the initiative and deliver the patient direct to the Pathways team.           administrating their own work and prescribing efficiently has held the NHS in good stead for         13 Book Reviews
So we, as GPs, had services available for patients to be referred into where we considered that they may be able to benefit       many years.
from advice on working or returning to work. The pilot has been a great success. Patients whom I thought would never                Our patients have continued to hold us in high regard, but not our own bureaucrats for some        14 Charity1; Water in India
                                                                                                                                  reason. Since Margaret Thatcher and Kenneth Clark elevated the managers in the NHS above             15 Charity2; Carry on up the
                                                                                                                                  the doctors, it has been downhill ever since. Hospitals have been degraded and run down, but
work again are not only in work, but terrified I might sign them off sick again. Both patients and GPs have been delighted

                                                                                                                                  GPs have survived and this has irritated those who would like to destroy the NHS as we know
by the initiative’s outcomes and it has spread from our practice to 10 other local sites and now….                                                                                                                                         Amazon
                                                                                                                                  it.                                                                                                  16 5 new hoolets of the Quarter
Pathways Advisory Service Launch Events                                                                                             A variety of methods have been used to undermine general practice. We are all aware of the
                                                                                                                                  amazingly slanted media campaign against us recently. However, more frightening is the                        hoolet is the magazine
                                                                                                                                  replacement of GPs by other staff, if they are replaced at all. The Darzi clinics will have less
Between March and May 2008 Jobcentre Plus, NHS Scotland and the Scottish Government held a series of conferences                                                                                                                                   of RCGP Scotland.
for senior staff in health, social work and employability services to promote and underline the benefits employment can           GPs per 1000 patients and more nurses. All the medical evidence shows that this will lead to               It is supported intellectually,
have on the health and wellbeing of individuals and communities. This recognises that helping people to enter, remain in          poorer care for patients, but the financial evidence shows a reduced wage bill. Of course                   financially and emotionally
or re-enter the workforce can be a significant contributor to reducing health and social inequalities, and help people out        poorer care will lead to increased costs and blighted lives, but it will not affect the short-term               by RCGP Scotland
of poverty. These events provided the opportunity to highlight the successful approach between Jobcentre Plus                     balance sheet. Out of hours services in England use many less doctors and evidence of
employment advisers working together with NHS Condition Management and other health professionals in GP surgeries.                reduced care is mounting across the country. We are not immune in Scotland.                          THE PARLIAMENT
Plans are in place to extend this service to other GP practices across Scotland and already over 60 GP surgeries are                GPs are being side-lined and replaced across Scotland as well. The Scottish Government is
involved. If you are interested in developing back to work advice in your practice or want further information, contact Ian       pursuing a Review of Nursing in the Community (RONIC) in four Health Boards. The                                        Editor:
                                                                                                                                  organogram for RONIC shows a generic nurse as the pivot for primary care with the PHCT                            Chris Johnstone
                                                                                                                                  and GPS on the periphery of the page. In Glasgow the Health Visitor review aligns HVs with
Taylor at Ian.G.Taylor1@jobcentreplus.gsi.gov.uk or go to
                                                                                                                                                                                                                                                  Assistant Editors:
                                                                                                                                  social work teams rather than with GPs and PHCTs. None of these changes are based on
http://www.dwp.gov.uk/asd/asd5/summ2007-2008/494summ.pdf
                                                                                                                                                                                                                                                       Niall Cameron
                                                                                                                                  evidence and in fact fly in the face of all the evidence there is. RONIC will be evaluated and
                                                                                                         Chris Johnstone
                                                                                                                                                                                                                                                       Louise Hallam
                                                                                                                                  then permanent changes will take place on the back of that evaluation. However for RONIC                              Rob Hendry
Incapacity Benefit is changing…                                                                                                   to be evaluated the changes have to take place in the first instance and are unlikely to be                      RCGP Scotland:
                                                                                                                                  reversed.                                                                                                            Dr Ken Lawton
                                                                                                                                    Even worse in Kinloch Rannoch the out of hours GP service is not being funded properly                              Ruth Wallace
                                                                                                                                  and a charity called First Response is being put forward to provide an alternative to GP cover.
From 27th October 2008, Employment and Support Allowance will replace Incapacity Benefit and Income Support paid
                                                                                                                                                                                                                                                       Josie Westley
                                                                                                                                  Apart from the fact that non-medical volunteers will be used, the local community will have
on incapacity grounds for all new customers across the United Kingdom.

                                                                                                                                  to raise the funds to train the volunteers, who will also have to be found locally.
Employment and Support Allowance will give financial help to patients who are unable to work because of an illness or                                                                                                                      Layout, Design and Printing by
                                                                                                                                    GPs have become the natural defenders of the NHS. Our independent contractor status
disability. Customers able to prepare for work will receive personalised support to help them move into suitable work.                                                                                                                       Thomson Print & Packaging
                                                                                                                                  allows us to tread where others may fear to go. We have earned the trust and respect of our
The new allowance builds on the success of the ‘Pathways to Work’ programme, which has helped over 64,000 people                                                                                                                               www.thomsonprint.com
                                                                                                                                  patients. We can use these tools to speak out and ensure that General Practice and the NHS
into work since October 2003 and offers support such as condition management programmes .
                                                                                                                                  survive for future generations. We remain silent at our peril.
Entitlement to Employment and Support Allowance will, for most customers, be confirmed through the new Work Capability                                                                                                                             Cover Design by:
Assessment, which will focus on what an individual can do, in addition to what they cannot. Employment and Support                                                                                                                                  Robert Hallam
Allowance will not significantly change GPs’ interactions with their patients. The Department for Work and Pensions will           In hoolet 55 we ran an article by Kirstie Nicol in the Himalayas. We forgot to say that Kirstie          The views expressed herein are those
still ask GPs to provide information about their patients but some of the forms to complete for this will change.                 was the winner of The Alastair Short Memorial Award. Details of this annual award are                     of the authors and do not necessarily
For more information, including key facts for GPs and guidance on how to complete the new forms, visit:                           available from Professor Stuart Murray at stuart.murray@nes.scot.nhs.uk                                    reflect the views of RCGP Scotland
www.dwp.gov.uk/esa                                                                                                                                                                                                                                  ISSN 1357/308X
                                                                                                                                                                                      Chris Johnstone                                      Registered Charity Number 223106


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hoolet 56 - AUTUMN 2008                                                                                                                                                                                                                                                      hoolet 56 - AUTUMN 2008




Captain Hugh’s Final Flight…                                                                                                                          Say we end the heartache

                                                                                                                                                     T
                                                                           Captain Hugh paused “I already land the plane on my own with                      o be, or not to be; that is the question: I   first day. You go to bed at night and she is the      “your type” - tall and slim and out-doorsy and
                                                                                                                                                             have long given up scheduling social          last thing you think of. You wake in the              ready for a laugh. You thought you had




I
“Every system is perfectly designed to achieve the result it
                                                                         only a flight attendant for support and, because I’m popular,
                                                                                                                                                             engagements for a Friday evening. In          morning and she is the first thing to come into       “shared interests” - badminton and the hills or
achieves”
Don Berwick                                                              successful and provide an excellent service, I’m a drain on the             our practice, I take the final surgery of the         your mind. The agony of unrequited man is             Schubert and film noire or origami and
                                                                         organisation- where does it all end Dai? …”                                 week. I discovered a long time ago that close-        that he just cannot fall out of love. He carries      Japanese raw fish, whatever. But the truth is
     t was an ordinary day in an ordinary office in a major Scottish       Dai simply nodded, seeing for the first time Captain Hugh losing          of-play on Friday is the occasion when patients       a torch, and the flame will just not be               that all of that was irrelevant. She was an
                                                                                                                                                     choose to muse on Hamlet’s great dilemma.             extinguished. It does not matter what tactics         alien. She might have had a head like a
     airport. Mr Dai Rector, Caledonian Hairy Planes Operational         control.                                                                    There is hardly a more uncomfortable                  he employs to end his agony. He knows his             donkey. Love is not the sum of its parts. Love
     Manager stood pensively, dreading his first meeting. Captain          Nine months later, after several hours of careful deliberation,           experience in Medicine than listening to a            love is doomed. He might prostrate himself            is not an epi-phenomenon.            Love is a
Hugh R Conscientious was CHP’s star pilot, revered by passengers         Sheriff Principal Isobel Lyon sighed and signed the document in             patient struggling to decide whether life is          before his loved one and beg her to return. He        phenomenon. And, dammit, she will not die.
                                                                                                                                                     worth the candle, when all the time your eye is       might make a complete fool of himself.                And there’s absolutely nothing you can do
and aviation professionals alike. He was currently Honorary              front of her. Sheriff Izzy, as she liked to be known, had made her
                                                                                                                                                     on the clock. Are you going to get to the             Worse, he might make a nuisance of himself.           about it.
Chairman of the British Master Aviators and worked tirelessly with       name in family law and was renowned for her compassion and sharp            theatre for 7.30? As John Cleese once said in         On the other hand he might be eminently                 The one thing, the only thing, you can do
the BMA to protect both pilots and passengers using his legendary        legal mind in equal measure. She was well aware of the “Izzy Lyon”          a movie, “It’s not the despair; it’s the hope!”       sensible; knowing that his love is futile, he         that will do you any good, that will save your
                                                                         pun, and had used it to great effect to amuse children and vulnerable         Far better to cancel all appointments, get out      might resolve to make a clean break. He might         life, save your soul, is to accept all of the
judgement, skill and attention to detail. Even his very public spat
                                                                                                                                                     a box of tissues, and listen. On a recent             avoid her haunts. He might choose another             above. It happened. Don’t fight it. What’s
with The Hon Mr Guy Sleekit, Junior Minister in the Department of        adults, not to mention a few junior Solicitors.                             occasion I wouldn’t have even made the                path home. He might distance himself from             done cannot be undone. Maybe it was fortune,
Agriculture, Fisheries and Transport on Radio Scotland had                 Sheriff Izzy had presided over the two days of Captain Hugh’s             concert interval. Two patients, back to back,         her friends. He harbours neither grudge not           maybe misfortune. It hardly matters. It merely
endeared Captain Hugh to the public and media alike.                     Court case with professionalism, pragmatism and great sadness. She          were minded to shuffle off this mortal coil.          favour. He never talks about her. He chooses          is.
                                                                                                                                                     Yet they could not have been more unlike. The         not to think about her. All mementoes -                 And once you have accepted that, you can
As always, Captain Hugh arrived precisely on time. “Come in Hugh,        had heard the upset of his wife and the bewilderment of his                 first, a lady, a retired academic, was losing her     postcards, letters, gifts, photographs, text          begin to get better. You are no longer
have a seat” said Dai. Captain Hugh was                                                              colleagues. She had prompted the                memory. Subtly at first. She had been amused                                                                struggling. And for one glorious, epiphanous,
struck immediately by Mr Dai’s                                                                       distraught radar operator to describe           to find herself wondering why she had walked                                                                pivotal moment, you are serene. You are once
                                                                                                                                                     into a room. The absent-minded professor!                                                                   more yourself. It wasn’t your fault, nor was it
discomfort and distress, an unusual sight                                                            Captain Hugh’s micro light heading due
                                                                                                                                                     Then she took to making lists. Then she                                                                     hers. There is no guilt. You have as much right
in such a distinguished, albeit retired,                                                             West over the Atlantic, approaching the         couldn’t remember why she had got into the                                                                  to occupy this universe as she has. It’s okay.
Master Aviator.
                                                                  Department of                      fuel Rubicon before finally turning back.       car. Then she got lost. The point about                                                                          And from that day on, imperceptibly, the
                                                                                                     She had commended the Search and                Tragedy, says Harold Pinter, is that it is funny,                                                           colour in the memory begins to fade.
  “Captain Hugh, we’ve known each
                                                                  Agriculture
                                                                                                                                                     and then it is no longer funny. If it became too                                                              Don’t go back!
other for a very long time and I’m going to                                                          Rescue helicopter crew for shepherding
                                                                  Fisheries &
                                                                                                                                                     hard to bear…                                                                                                 And it is le cafard of the writer to remember
come straight to the point” he began “we                                                             Hugh back to safety. She had uncovered            Whoa! Not so fast! History… examination…                                                                  that which never happened; to imagine. As we
                                                                  Transport

have a problem with your flights…”                                                                   his meticulous planning in ensuring that        investigation. There might be medications.                                                                  were closing up, I needed prompting again.
                                                                                                                                                     We can do some tests. Let’s do some simple                                                                  The receptionist intoned,        “Mr and Mrs
  Captain Hugh looked puzzled but                                                                    no-one else could be injured directly by        ones now. Orientation for time and place,                                                                   George Pringle-Stewart, 76, Wetherill Mews,
professional, “What sort of problem?” he                                                             his actions and worse still, she had felt the   name of the PM, name of the President, recall                                                               Dartington.”
asked, “they’re at 96% capacity with only                                                            anguish of the man from his logs, notes         of an address after ten minutes. I kept it                                                                    And because she had been absolutely
                                                                                                                                                     simple.                                                                                                     accurate, I began to suspect that the Pringle-
a 2% delay quotient”.                                                                                and diary entries.
                                                        Common Sense
                                                                                                                                                       John Russell, 17, The Meadows, Edinburgh.           messages, all are destroyed. To fresh fields and      Stewarts must have an existence. I might write
  “This is difficult to hear” stuttered Dai,                                                           Sheriff Izzy’s judgement would be               I forgot to ask her it after ten minutes. She       pastures new! Absorbs himself in his work             them a letter. And if the address was legible,
“but frankly you’re too popular.                                                                     “guilty and admonished” for his breach of       prompted me, with a smile. Yes, she would go          with renewed energy. Takes up a new hobby.            the envelope stamped, it would be franked and
                                                                                                     Public Order. She couldn’t quite                to a clinic. No, she wasn’t going to do               Gets up to date with all the tiresome chores he       delivered to its destination. Mrs Pringle-
Passengers can’t get a flight with you for
                                                                                                                                                     anything silly. In fact she was mischievous           usually leaves to the last minute; does his tax       Stewart would glance quizzically at the
the best part of a month and they’re                                                                 understand why this trial had ever come         enough to tell the receptionist about my failing      return in April; mends fuses, cuts the grass.         postmark. “George! A letter from Scotland.”
reflecting this in their questionnaires for                                                          to her Court but her discreet enquiries had     memory. She in turn wanted to be tested. I            Catches up with all the old friends he’s been         She would feel a flutter of anxiety. George
the Quality of Flight elements of our contract with the National         unearthed the influence of Mr Guy Sleekit. Sheriff Izzy resented her        gave free rein to my imagination.                     neglecting. Goes to concerts, goes to the             had retired from the Civil Service two years
                                                                                                                                                       “Mr and Mrs George Pringle-Stewart, 76              movies, plays squash, gets fit again, has some        ago. He had been in Intelligence. Could it be
Hairyplane Service”                                                      Court being used for nefarious political purposes and ensured that          Wetherill Mews, Dartington.”                          fun. Goes out on a date; might even start a           that they were looking for him again? She
  “But surely they’re booking flights with colleagues, we know that      her judgement would carry a number of recommendations and some                Next patient. Young man jilted by young             relationship.                                         thought fearfully, surely not. Surely they
we can always offer flights within two weeks with perfectly              damning criticism, some of which might resurrect the career of a            woman. Well, we’ve all been there. He was               And you know what? None of it makes the             would not have to close up Wetherill Mews,
                                                                                                                                                     barely out of his teens. He had taken to              slightest difference. You long to obliterate the      say goodbye to all their friends in Dartington,
competent pilots” responded Captain Hugh uneasily “a simple              devoted family man and consummate professional. She knew of the
                                                                                                                                                     walking along cliff edges, and peering over. It       pain of your love in precisely the way a dose of      and move to Canada?            Her hand was
crosscheck of the computerised booking date would clarify, wouldn’t      media frenzy which would follow her report and could already                wasn’t an impulsive thing. He hadn’t seen her         morphia obtunds pain; it’s not that the pain          tremulous as she opened the letter. “George!
it?”                                                                     foresee the political blame and counter blame as positions were             for 18 months. The pangs of disprized love.           has gone, merely that it doesn’t seem to matter       Do you know this man? How extraordinary!”
                                                                         protected and accusations denied. She was reminded of Don                     If anything, this young man was more                any more. You long for that. But nothing you            “My turn,” said the receptionist. She could
  “Aye, logically it would” replied Dai “but DAFT measures it by
                                                                                                                                                     wretched than the elderly lady. She could not         can say or do or even think will alter the course     hardly say it for laughing. “The Right
relying on passengers recollection of their booking via a                Berwick’s’ quote “Every system is perfectly designed to achieve the         remember; he could not forget. She was in his         of true love. True love has a life and a will of      Reverend Professor Sir Archibald Montague-
questionnaire and the only thing most passengers remember is that        result it achieves” and couldn’t help wondering about the apparently        dreams. Did he dream in black and white or            her own, and she is entirely without your             Prendergast-Willoughby junior, OM, Bart,
they couldn’t book with Captain Hugh. DAFT insists that this is the      spiteful nature of the contract. Still, that was for the politicians and    in colour? Colour gets filched out of dreams.         power. You can slander her, curse her, banish         Flat 23B, 1298 Amerigo Vespucchi
                                                                                                                                                     And memories. When they are new they are              her, abuse her. You can try to ignore her,            Boulevard…”
best assessment tool and we have no means of appeal or challenge.        commentators to dissect although the headlines were likely to               in glorious Technicolor. But the archive of           mock her, smother her, murder her in cold               Nowhere in the universe does he exist.
We stand to lose a great deal of income and, with the Minimum            reverberate again when she presided over the opening of a young             memory is, at best, sepia-toned. How else can         blood. And none of it makes the slightest               “…Addis Ababa.”
Plane Income Guarantee being abolished, we may not be able to            GP’s breach of the peace case next week… however strong the                 we cope with the agony of remembering                 difference.                                             Return to sender.
                                                                                                                                                     everything? Imagine if your unrequited love             You didn’t choose her. You may think you
survive”. Dai looked uncomfortable, very uncomfortable. “I’m sorry       feelings, it really wasn’t too clever super gluing the Secretary of
                                                                                                                                                     stayed with you, year after year, her image           invited her into your life, but actually, she gate-
Captain Hugh, we need to move you to a non-flying position or let        Health.                                                                                                                                                                                             aren
                                                                                                                                                                                                                                                                 Hamish Macl
                                                                                                                                                     forever imprinted in your consciousness,              crashed. She squatted for a while. You think
you go to another Airline”                                                                                                                           drawn with the same intense hues as on that           there were reasons why you liked her. She was
                                                                                                                   Alex Thain
4                                                                                                                                                                                                                                                                                                             5
hoolet 56 - AUTUMN 2008                                                                                                                                 RCGP SCOTLAND NEWS                                                                                            hoolet 56 - AUTUMN 2008




    The Gender Mortality Gap                                                                                                                              CHAIR’S AGENDA                                                        Ken Lawton, RCGP Scotland Chair, talks about
                                                                                                                                                                                                                                      what’s keeping him busy at the College.
                                                                                                                                                                                        A key concern for me in recent months has been the progress of the Review of Nursing in the Community
                                                                            and maintain a range of social contacts in similar situations through                                     (RONIC). After lengthy debate at the last Scottish Council meeting in June I wrote a letter on behalf of the
                                                                            hobbies or interests, and they could exercise some element of control                                     College in Scotland to the Chief Nursing Officer, supported by Dean Marshall, Chair of the SGPC, who co-signed
                                                                            over their departure date.                                                                                the letter. The concerns centred on the short project timescales and the inadequate involvement of our
                                                                              Working class men were, however, in a much different position.                                          members along with a call for improved communication (you can read the full letter on the RCGP Scotland
                                                                            Their situation changed in one gut-wrenching day from having a full                                       homepage). This letter was closely followed by a meeting with the CMO, Harry Burns and Susan O’Rourke,
                                                                            time job to having no job at all. Added to that sense of uselessness                                      Project Officer for the review. Susan offered assurance that the review recommendations would not be
                                                                            was a geographical dislocation from their accustomed environment,                                         implemented until the pilots are fully completed and evaluated. A formal response to the letter has now been
                                                                            and the total dislocation from most of their regular social contacts, in                                  received. I feel optimistic that these issues can be resolved by working together with the BMA, RCN and the
                                                                            one fell swoop. They may well have seen their income drop from that                                       review team and we continue to be well represented on the steering committee by Sheena Macdonald and Bill
                                                                            of a skilled worker to the basic state pension, because many had no
                                                                            other pension provision. Many went through a transitional phase
                                                                                                                                                                                      Mathewson.

                                                                            associated with de-industrialisation where they were pushed from
                                                                                                                                                            Also on the agenda at the recent CMO meeting was revalidation and recertification. Recently revised in July, Good Medical Practice for

                                                                            skilled manual jobs as technicians (e.g.draughtsmen, precision
                                                                                                                                                          General Practitioners is the document which underpins the revalidation process and sets out the standards expected. Progress continues

                                                                            metalworkers etc.) into unskilled low paid service industry jobs
                                                                                                                                                          North of the border with the establishment of the Scottish National GP Revalidation Steering Group, which met for the first time on 10

                                                                            (security, cleaning etc.), with the loss of self worth and self esteem
                                                                                                                                                          September. I’m very keen to move forward on this as it will be a major challenge for us as a Royal College and as a profession in the

                                                                            which that entails. They came from jobs in which they were largely




D
                                                                                                                                                          future.

                                                                            disempowered into a situation where they might expect to have a
                                                                                                                                                            I’m also setting my sights on putting together a ‘roadmap’ for Scottish General Practice in the coming months. I’d like

                                                                            greater influence on events. This proved to be untrue as they were
                                                                                                                                                          to focus on the future for general practice and set some goals for the next 5-10 years that we can take the lead on and

                                                                            launched into a domestic situation which was geared up to operate
                                                                                                                                                          promote. Our Scottish Council meeting on 5 September debated this topic and we will now take the next steps to develop
           epending on whose figures we believe there is a difference in
                                                                            without their participation and where they felt like intruders getting
                                                                                                                                                          this initiative.. I’m always eager to hear your thoughts and opinions, so if you have any comments on this or any other
           age at death between men and women of some 7 to 10 years,
                                                                            ‘under the feet’ of their partners. In any event, the participation in
                                                                                                                                                          topic, you can write to me at Exec@rcgp-scotland.org.uk.
           and whilst some of this can be explained by work or
environmental factors there is a large hole in the calculation which is     domestic affairs was regarded by many as one of the feminine traits
                                                                            referred to earlier, and there may have been a tendency to avoid joint
not easily explained. I believe that there are social factors and
perspectives that can help to explain part of the difference that is        domestic responsibilities to try to cling to an established masculine
                                                                            identity.
                                                                                                                                                                     Call for National Clinical Lead
unaccounted for.
  It is fairly well known that women tend to be more health conscious,        One critical point here is how we define dirt, and many define dirt
or perhaps more illness aware, than men are, but often that thought is
not followed through to its logical conclusion. Women are more likely
                                                                            as something that is in the wrong place e.g. a sweet wrapper around a
                                                                            sweet is not dirt, but lying in the gutter, it is. Socially, an example
                                                                                                                                                                          to inform significant
to present with symptoms, so drug and diagnostic therapy providers          might be the presence of sex workers on the street; the call is always
being fully aware of this phenomenon and seeking to maximise profit
will tend to bias their research towards those illnesses that affect
                                                                            to ‘clean up’ the streets. I have laboured this point slightly because
                                                                            understanding the notion of ‘dirt’ in a social context is crucial to
                                                                                                                                                                        mental health initiative
women, to the detriment of men since research funding is a finite           understanding the low self-esteem of many retirees. They have ceased
resource. This is rational economic behaviour in a market driven            to have an appropriate place in their own society and, unless they
economy, but it must reflect in a difference in outcomes further            quickly find another social role, begin to regard themselves as ‘dirt’ or
downstream.                                                                 perhaps the American usage, ‘trash’ might be more useful in fostering
  Perhaps even more significant are the gender roles to which men           understanding.
and women were required by conventional lifestyles to conform,                So looking at the retired working class man he may be left with a
especially for those who are more elderly and may not have developed        feeling of uselessness. He knows that if he visits his former
a more egalitarian attitude to gender roles. Many elderly people have       workplace, and tries to maintain the social contacts that he had there,
grown up in the social climate where the man goes to work and the           he is viewed with some suspicion by former colleagues who regard his
                                                                                                                                                        The RCGP Scotland Living Better Project is seeking to recruit            cover this role. Expressions of interest are now invited from
woman stays at home and is the housewife (and this piece does not           behaviour as strange. In his home he is an intrusive presence               a Clinical Lead to provide clinical guidance and leadership              individuals who are able to commit to 1 session per week (on
argue the rights or wrongs of that division of labour, only that it did     especially if he disrupts routines, and women friends of his partner
exist for many couples). One of the results of that division, however,      who previously visited during the day reduce their visiting because of
                                                                                                                                                        across this initiative.                                                  average) for the term of the project. Input levels may vary
is that women tended to develop a strong social network based firmly        his presence. He is often excluded from domestic decision making on          Living Better aims to improve the mental health and                     throughout the lifetime of this initiative.
around the home, and that network, principally of women, was able           the basis that the home is the partner’s province. He may have another
to be maintained through passing years into retirement age and              interest or hobby, but many manual workers had little time, little
                                                                                                                                                        wellbeing of people with diabetes and coronary heart disease               You will be an RCGP member in good standing and will have
beyond to become firmly embedded as a factor helping to form an             spare money and less energy at the end of a day to pursue outside           (CHD). The project will work with GP practices across 6                  a keen interest and understanding of the issues surrounding
identity for women. They had a sphere of operation, geographically          interests. This feeling of redundancy, uselessness and worthlessness,
based, in which they could exercise relative autonomy, and this is          the years spent with little or no autonomy only to see the same
                                                                                                                                                        Community Health Partnerships (CHPs) in Scotland to                      mental health. An interest in the links between mental health
widely acknowledged as one of the factors that can prevent a sense of       situation in retirement due to lack of income and authority, the
                                                                            dislocation of the complete loss of the workplace social network, all
                                                                                                                                                        improve the detection of mental health problems in people                and long-term conditions would be advantageous.
isolation and alienation.
  The social network for men tended to revolve around the workplace,        impact on the wellbeing of the retired working class man.                   with CHD and diabetes and improve the support that they                    Expressions of interest, specifying why you are interested in
and many working class men also defined their identity by their trade         Given the widely acknowledged view of how severely psychological
                                                                            issues can impact on physical health it is little wonder that the bodies
                                                                                                                                                        receive for these problems. Living Better is led by RCGP                 this role and your previous experience in leading change and
or skill. This was a powerful factor in creating a sense of self worth
and solidarity in an environment where, unlike women in their work          of these workers seem to run down more quickly than they might              Scotland in partnership with the Scottish Development                    innovation within the mental health field should be submitted
environment, they may well have had little or no autonomy. A large          otherwise do eventually giving up the ghost before their time.
                                                                            Perhaps, therefore, this social approach to comprehending part of the
                                                                                                                                                        Centre for Mental Health and University of Stirling.            It is    in writing to Linda McGlynn, Project Officer, Living Better
part of men’s sense of masculinity revolved around their breadwinner
status, and the avoidance of feminine traits was as important as the        mortality gap can help to fill in some of the blanks in our                 funded by the Scottish Government and runs from January                  Project by 17th November 2008 (contact details below).
display of masculine ones in determining a masculine identity.              understanding of gender difference (and to some extent class
                                                                            difference, since middle class men also tend to live longer than
                                                                                                                                                        2008 to November 2010. The Living Better Clinical Lead will
  For middle class men, slipping gracefully from work to retirement
was a much easier thing than for working class men. They often held         working class men) and its effects on health and wellbeing. I would         provide clinical advice and guidance to the Executive Project            For further information about this role, please contact:
the most highly paid jobs which gave them a fiscal freedom to range         not try to minimise economic and environmental factors and their
                                                                            correlation with wellbeing, but social and cultural factors can also be
                                                                                                                                                        Team and Steering group, and support the development and
further afield geographically in their social lives. They often held jobs
with a fair degree of responsible autonomy which accumulated a              very powerful and much harder to deal with.                                 implementation of the 6 CHP pilots.                                      Linda McGlynn, Living Better Project Officer
pension. They were largely empowered and could negotiate their
                                                                                                                   John Miller
                                                                                                                                                         Living Better is seeking to recruit a General Practitioner to           linda@sdcmh.org.uk (0131 555 5959 or 07973 967122)
retirement so as to gradually reduce their working hours and build up


6                                                                                                                                                                                                                                                                                                      7
hoolet 56 - AUTUMN 2008                                                                               RCGP SCOTLAND NEWS                         RCGP SCOTLAND NEWS                                                                                 hoolet 53 WINTER 2008
                                                                                                                                                                                                                                                   hoolet 56 --AUTUMN 2007

       ver the past twelve months RCGP

O      Scotland and Coeliac UK have been
       working together on the GP training
curriculum. Coeliac disease is now
                                                                                                                                                 Modular Quality                        JOIN THE PARTNERSHIP
incorporated under Digestive Disorders. The
curriculum captures the wide-ranging
                                                                                                                                                 Practice Award                                             Patient Partnership in
                                                                                                                                                                                                            Practice is the public
                                                                                                                                                                                                                                          patients and public.
                                                                                                                                                                                                                                        • Influencing activity in Scotland that
competencies required and also provides                                                                                                                                                                     involvement group of          impacts on the quality of patient care.
additional learning support materials.                                                                                                           In response to a large number of                           the Royal College of        • Working together as a team to ensure
Coeliac UK and the College in Scotland will continue working together to develop the curriculum content and resources that are available on      requests from practices who want                           General Practitioners         that the activities of the College
the recognition and management of coeliac disease.                                                                                               to take part in QPA using a more                           (Scotland).                   respond to patient needs.
Six things you might not know about coeliac disease:                                                                                             flexible timescale, RCGP Scotland
Coeliac disease is a life-long autoimmune condition caused by an intolerance to gluten, the protein fraction in the cereals wheat, barley and                                                                P3 meets 4 times a         If you would like to be involved in this
                                                                                                                                                 has developed a pilot ‘Modular
rye. Coeliac disease is thought to affect 1 in 1001,2 people, although only 1 in 8 are diagnosed3.                                                                                                           year to gather views       opportunity to work alongside lay
                                                                                                                                                 Quality Practice Award’. Covering                           from the public on the     representatives to enhance the quality of
 1 Symptoms vary in terms of severity. Gastrointestinal symptoms can include tiredness, anaemia, headaches, mouth ulcers, weight loss,           organisational and clinical areas,     College’s contribution to the primary care      services provide by GPs in Scotland, please
   skin problems, depression, neurological symptoms, recurrent miscarriages and joint or bone pain. Symptoms for coeliac disease are             and involving the whole team,          agenda and, in particular, to take forward      contact us for further information.
   similar to Irritable Bowel Syndrome (IBS) and consequently misdiagnosis is common4. The draft guidelines for NICE state that before           mQPA will be offered to all            issues that matter to patients.                 Deadline for applications: 17/10/08
   a diagnosis of IBS is given, coeliac disease should be excluded5. There are currently no equivalent guidelines for Scotland.                  practices in Scotland from April       P3 is seeking 2 new GP Members
 2 There is a clear procedure for diagnosing coeliac disease. The first stage is to measure coeliac disease-specific serology, IgA based                                                We are recruiting new GP members to work        Policy & Committee Co-ordinator
                                                                                                                                                 2008.
   tTGA (tissue transglutaminase antibodies) and/ or EMA (endomysial antibodies). A small bowel biopsy is then required to confirm                                                      with our 10 lay representatives as part of an   RCGP Scotland,
   diagnosis6.                                                                                                                                                                          active team whose aims are:                     25 Queen Street, Edinburgh,
                                                                                                                                                                                                                                        EH2 1JX.
 3 Oats are generally contaminated with other gluten-containing grains and so unsuitable for people with coeliac disease. Although most
   people are able to tolerate uncontaminated oats without a problem, some research has suggested that people who are gluten
                                                                                                                                                 Modules                                • Developing ideas and leading activities       Tel: 0131 260 6800
   intolerant may react to avenin in oats7.                                                                                                                                               that encourage GPs to work in                 Email: p3@rcgp-scotland.org.uk
 4 In the UK people with coeliac disease are eligible for food on prescription. The foods that are available on prescription are listed in the   GP practices can take the                partnership most effectively with             www.rcgp-scotland.org.uk
   Monthly Index of Medical Specialities (MiMs), the British National Formulary (BNF) and the Drug Tariff, as well as in Coeliac UK’s Food       following modules in any order:
   and Drink Directory. National prescribing guidelines for gluten-free foods have been developed to assist health professionals8.
 5 Coeliac disease is genetically based and linked to the HLA antigens, DQ2 and DQ8. There is a 1 in 10 chance that a first line blood
   relative of someone with coeliac disease will also have the condition9. There are no agreed recommendations for screening relatives
                                                                                                                                                 •   Patient Centred                    Celebrating the 40th anniversary of the
                                                                                                                                                 •   Management of illness
   but genetic screening can exclude the possibility of coeliac disease in relatives of people with the condition.
 6 Other autoimmune conditions occur in association with coeliac disease and include thyroid disease, rheumatoid arthritis and Type 1
                                                                                                                                                 •   Records                                RCGP Oral Contraception Study
   diabetes. Coeliac disease occurs in 3-6% of people with Type 1 diabetes10 and most specialist diabetes centres now screen for coeliac         •   Special Groups
   disease in patients with Type 1 diabetes. There is no association between Type 2 diabetes and coeliac disease.                                •   The Learning Organisation                             Friday 14th November 2008
                                                                                                                                                 •   The Practice Team
                                                                                                                                                                                            King’s College Conference Centre, University of Aberdeen

                                                                                                                                                 Cost                                   The North East Faculty of RCGP Scotland and the University of Aberdeen are hosting
                                                                                                                                                                                        a one-day conference to celebrate the 40th anniversary of the RCGP Oral
                                                                                                                                                 To assist the practice in achieving
                                                                                                                                                                                        Contraception Study. The event is held in partnership with the University of
                                                                                                                                                 the modules they will have access
                                                                                                                                                 to a personal QPA advisor. The         Aberdeen, who have hosted the study at its Centre of Academic Primary Care since
                                                                                                                                                 cost is £200 payable at the start      1997. The study is one of the RCGP’s finest academic achievements, comprising
                                                                                                                                                 of each module. A certificate of       over 47,000 women through 1400 general practitioners. The study’s results have
                                                                                                                                                 achievement is awarded on              always attracted international attention, perhaps not surprising given that more
                                                                                                                                                 completion of each module.             than 100 million women around the world currently use the pill, and an estimated
                                                                                                                                                                                        300 million women have previously done so. The RCGP study provides important
                                                                                                                                                 If the GP practice completes all of
                           Villi Before                                                                Villi After                                                                      information about the long-term safety of oral contraception, as well as providing
                                                                                                                                                 the modules over a five year period
Coeliac UK is the national charity for people with coeliac disease and dermatitis herpetiformis. Healthcare professionals can join Coeliac UK    they can, if they wish, submit for a   data about other issues related to women’s health. The study continues to be an
free of charge. You can contact Coeliac UK via their website at www.coeliac.org.uk or by phoning their helpline on 0870 444 8804 (Helpline       practice visit with an aim of          excellent exemplar of the research potential of clinical general practice records.
open 10-4, Mon, Tue, Thu, Fri and 11-4, Wed).                                                                                                    converting the six module passes
                                                                                                      Emma Merrikin, Dietitian, Coeliac UK
                                                                                                                                                 into the QPA award, which would        The programme of the conference will present some key findings from the study,
References
                                                                                                                                                 be valid for five years. The cost of   look at how research and contraceptive practice has changed over the past 40
1.    Bingley PJ et al (2004) Longitudinal studies of parents and children study team. British Medical Journal. 328, 322-3.
2.    West, J. et al (2003) Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut; 52:960–965.           the visit would be based on the
                                                                                                                                                                                        years and discuss the future of the RCGP study itself. A number of both
3.    van Heel, D.A. and West, J. (2006) Recent advances in coeliac disease. Gut 55: 1037-1046.                                                  current charge for QPA less the
                                                                                                                                                                                        international speakers and speakers from the Royal College of General Practitioners
4.    Shahbazkhani B et al (2003) Coeliac disease presenting with symptoms of irritable bowel syndrome. Alimentary Pharmacology &                monies already paid for the six
      Therapeutics. 18(2): 231-5.                                                                                                                modules                                have agreed to present at the meeting. These include Dr Clifford Kay the originator
5.    National Institute for Clinical Excellence (NICE) (2008) [online] Irritable bowel syndrome in adults: diagnosis and management of                                                 of the study and former Director RCGP Manchester Research Unit.
      irritable bowel syndrome in primary care. Available at: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927 [Accessed
      16 July 2008].                                                                                                                             Interested?                            Attendance is free, we just ask that you register for catering purposes. The
6.    British Society of Gastroenterology (2002) [online] Guidelines for the management of patients with coeliac disease. Available at:
      www.bsg.org.uk [Accessed 16 July 2008].                                                                                                                                           conference is EPASS accredited and in addition, we are seeking CPD accreditation.
                                                                                                                                                 For more information please
7.    Lundin KEA et al (2003) Oats induced villous atrophy in coeliac disease. Gut 52, 1649–1652.
8.    Primary Care Society for Gastroenterology (PCSG) (2006) The Management of Adults with Coeliac Disease in Primary Care.                     contact Diane Rich on
      Rickmansworth, PCSG.                                                                                                                       drich@rcgp–scotland.org.uk or          To attend please phone or email Miss Margaret Ross:
9.    Greco, L. et al (2003) The first large population based twin study of coeliac disease. Gut 50, 624-628.                                    0131 260 6821                          (10224 559456, m.a.ross@abdn.ac.uk).
10. Holmes G.K.T. (2002) Screening for coeliac disease in Type 1 diabetes. Archives of Disease in Childhood. 87(6):495-8.


8                                                                                                                                                                                                                                                                                9
hoolet 56 - AUTUMN 2008                                                                         RCGP SCOTLAND NEWS                                                                                                                                 hoolet 56 - AUTUMN 2008



THE SCOTTISH FACULTIES   Patient
– WHAT DO THEY ALL DO? Partnership                                                                                                                                                  View from Holyrood

                                                                                                                                                                                    O
  When you become a member of the             • Moving into Management event
College you are linked to the nearest         • Bad News – What it is and how to share                in                                lot of time listing the improvements

Faculty in your area. There are five            it.                                                                                                                                           ne of the self-appointed tasks of the    public image of general practitioners is not as
                                                                                                                                        that might be made to the leaflet.
Faculties in Scotland: North, North East,                                                                                                                                                     Health and Sport Committee is to         positive as it has been in past years.
East, South East and the West.                • 3 Day Residential Networking Course
                                              North East of Scotland
                                                                                                   Practice                             Arriving at the practice I was then
                                                                                                                                        presented with a new leaflet which                    look into the possible health legacy       As I was in general practice when the new
  The baseline activities held in each area     (9 per year)
                                                                                                                                                                                    of the 2014 Commonwealth Games in                  deal came about, I know that responsibility
                                                                                                                                                                                    Glasgow and so far the evidence has been           for any outcome which is now regarded as
are Faculty Board meetings (four per
                                                                                               In June 2008, I finished my term of      had ALL my carefully considered
                                                                                                                                                                                    depressing. Witness after witness gave             less than desirable by outsiders falls to the
annum), Associates in Training support           This is not an exhaustive list and there
                                                                                             office as chair of P3– the patient         improvements already in place. This
                                                                                                                                                                                    evidence of diminished interest in their           government of the day. As usual the amount
events such as welcome evenings,              are many educational, social and
                                                                                                                                        happened every time. After my initial
                                                                                                                                                                                    particular sport following Games success.          of work performed out of hours was greatly
                                                                                             group of the College in Scotland. It

careers events, an annual lecture and         networking opportunities in all of the                                                                                                Whilst this is not necessarily cause and effect,   underestimated, as was the ability of GPs to
                                                                                             has been a very interesting three          irritation I realised that this was what

general meeting. We also provide support      faculties throughout the year.                                                                                                        society has changed over the years, there are      work hard and achieve targets set for them;
                                                                                             years. The duties of the chair             QOF was all about – improvement –
for candidates of iMAP and the Unified          The faculty offices are kept up-to-date
                                                                                                                                                                                    certainly not grounds for optimism that            targets which benefit the population at large
                                                                                                                                                                                    sporting success encourages exercise               as serious disease is diagnosed and treated.
                                                                                             increased dramatically since I took up     and I should be pleased that I was
Route to Fellowship.                          on what is happening in their local areas                                                                                             amongst the rest of us. Truth is that we           So I can understand how bruised
  Each of the Faculty offices have            as well as across Scotland and the UK
                                                                                             the position. One of these duties has      involved in a worthwhile exercise. It is
                                                                                                                                                                                    probably spend three weeks riveted to our          professionals feel when this success is
developed their own calendar of               wide and are always looking for members
                                                                                             been to attend meetings of Scottish        not so easy to judge improvements in
                                                                                                                                                                                    television sets, cheering on our own athletes,     measured solely in terms of increased
educational events, created by a              to contribute to consultation discussions.                                                                                            and then settle back to the same life of           income achieved or hours less spent at work.
                                                                                             Council. As I was leaving 25 Queen         other areas since you don’t always

dedicated Education Committee made up           So, there is lots going on in all faculty                                                                                           indolence that we led before. If you add to        But from my viewpoint the way that the
                                                                                             Street after my last ever attendance at    know what went before. The theory of

of both Faculty Board Officers and            areas! As a member, you can join any
                                                                                             Scottish Council I was amazed to           having a patient survey is a good one       that the suspicion that elite sports people        profession is responding to these attacks is
                                                                                                                                                                                    sometimes sacrifice their own long term            less than sensible. For example, take the
members in the local Faculty Area.            faculty you wish and attend any event                                                                                                 health for the sake of a medal chance, then        article by Peter Murchie in the last issue of
                                                                                             notice a photograph in the entrance        but some of the questions are difficult
  Specific initiatives in the Faculty areas   being held by any of the faculties. You                                                   to understand and some are just plain       you begin to wonder if elite sport is worth all    Hoolet. Amongst waves of self-pity he
  include:                                    may find that the faculty local to home is
                                                                                             hall which included my face.
                                                                                                                                                                                    the investment we put into it. The brutal fact     criticises MPs and MSPs for having a high
                                              not necessarily local to your work, or vice
                                                                                               In my role as a Quality & Outcomes       silly. Practice staff are finding it more
                                                                                                                                                                                    is that no major Games anywhere in the             income yet demanding that GPs work out of
• Modular leadership course                   versa. You may want to join your local                                                                                                world can show a significant health legacy.        hours whilst not making evening
North East Scotland                                                                          Framework (QOF) reviewer, I seem to        difficult to persuade patients to
                                                                                                                                                                                      It is not just athletics that causes concern     appointments for their constituents. I cannot
• Practice Receptionist courses               faculty, but be kept informed of all the
                                                                                             have specialised in reviewing areas of     complete the forms and in areas of
                                                                                                                                                                                    either. The Scottish Premier League insists        vouch for MPs but most MSPs I know have a
• Practice Manager/Supervisor courses         work of the other faculties to ensure that
                                                                                             deprivation. I don’t know why this is, I   poor literacy this is only too easily
                                                                                                                                                                                    that all its clubs have under-10 or under-11       heavy burden of evening work, perhaps not
• Practice Nurse courses and Health           you are receiving a broad range of                                                                                                    teams and, as clubs want to catch talented         one to one appointments, but meeting a
                                                                                             feel myself to be more of a leafy          seen as a burden too far. It is
   Visitor courses                            educational and social opportunities.          suburbs type of reviewer but mine is       splendid that this task is to be            players as young as possible because they          variety of special interest groups to learn
                                                                                                                                                                                    then cost less, they happily go along with this    about their problems. And my income as a
• Highland School Mentoring Scheme
                                                                                                                                        undertaken centrally but that too will
                                                                                                                                                                                    idea. The result is that some under 10 year        politician is much less than I would have
North of Scotland                                                                            not to reason why. Anyway, GP
                                                                                                                                                                                    olds spend 4 hours most Saturdays travelling       earned had I stayed in general practice. As
• Practice Receptionist courses                 Stephanie Slade, Faculty Support
                                              E-Bulletin                                     practice staff working without the         present many challenges. We can
                                                                                                                                                                                    to a club for 90 minutes of football, then 4       for bleating about politician’s expenses, how
• Practice Manager/Supervisor courses         Manager for Scotland, produces a regular
                                                                                             benefit of daylight, behind grills AND     only trust that the patient’s voice
                                                                                                                                                                                    hours on the return journey. Is this what we       many years did we work at pointing out to
• Practice Nurse courses and Health           e-bulletin that will give you information on                                                                                          want for our youngsters?                           the press and others that it is wrong to add
                                                                                             boards on their windows, nevertheless      continues to play a part in reviews in a

   Visitor courses                            all 5 faculties and the work being                                                                                                      Another recent task of the committee has         the costs of running reception and office to a
                                                                                             appear to love their jobs. You don’t       real fashion.
                                              undertaken in each area as well as                                                                                                    been to look into the reasons why telehealth       GP’s income and then complain that GPs are
                                                                                             have to take my word for it their job        It occurred to me in one very
• Pension Seminars for members                College-wide. To receive the e-bulletin
                                                                                                                                                                                    initiatives have taken so long to mainstream       grossly overpaid? I am sure that there are
West of Scotland

                                                                                                                                                                                    in this country. It is only a small matter of      some politicians who do abuse their expenses
                                                                                                                                        deprived area of Glasgow that the part
• Fellowship Support Group                    please       contact       Stephanie      on
                                                                                             history proves it to be so. Enthusiasm
                                                                                                                                                                                    consolation that other countries face the          but this should be taken up as a separate issue
                                              stephanie.slade@nhs.net or telephone
                                                                                             practically beams from them even           of the practice leaflet that mentioned
                                                                                                                                                                                    same problem. What seems to be needed is           rather than hinting that we should do without
• Woman Doctors group
East of Scotland                                                                             during the relatively stressful            Pregnancy Planning may have had
                                                                                                                                                                                    for a handful of successful pilots to be           secretaries, word processors and other office
                                                Further details of all the work being done
                                              01224 558043.
                                                                                                                                                                                    selected and then implemented with much            costs.
                                                                                             experience of a QOF review. On this        novelty value. When teaching science

• Working as part of a team event             in each of the Faculty areas is also                                                                                                  more drive than has been shown in the past.          By attacking politicians you are in danger
South East                                                                                                                              I did cover this subject in some detail
                                                                                             evidence base GPs are performing very
• Medical Terminology event                   available on the website (rcgp.org.uk).
                                                                                             well. QOF does not have an element         but school attendance is poor in those      Professionals are understandably hesitant          not just of blaming the messenger but of
                                                                                                                                                                                    about embracing new technology but the             increasing his hostility also, Through little
                                                                                                                                                                                    potential benefits of telehealth developments      fault of your own, GP’s now no longer have
                                                                                             referring to stability of staffing but     who need education most. It is good
                                                                                             perhaps it should. New systems and         that such important information has a       are so great it is time we cracked on with         24 hour responsibility for their patients, care
Want to pop into your local Faculty office?                                                  routines are constantly being imposed,     second chance of getting through.           them. And if it hasn’t been done anywhere          for patients for much less than half the hours

The Faculty Administrators are:
                                                                                                                                                                                    else why shouldn’t Scotland take the lead?         in a week and are perceived to be much less
                                                                                                                                                                                      Now I come to a matter which I need to           easy to see for an episode of acute illness.
                                                                                             not to mention regular training            We educators must keep trying
                                                                                             requirements, all of which must be         despite the uphill task. Perhaps that       explore with some delicacy, risking                GPs are in danger of steadily losing the high
                                                                                                                                                                                    accusations of being a poacher turned              regard in which they have always been placed
Syvie Main                           North Faculty
                                                                                                                                        is our real contribution to posterity
                                                                                                                                                                                    gamekeeper. I know from reading various            in the past. There are politicians who will
                                                                                             challenging for the entire practice.
                                                                      01463 258 830
Alyson Tulloch                       North East Faculty
                                                                                                                                                                                    medical publications, including Hoolet, and        take up your cause but the profession needs
                                                                                               When I started reviewing I               and the pictures on the wall are just
                                                                      01224 558 042                                                                                                 from letters to the papers, how bruised many       to supply the evidence that will help them
Fiona Robertson                      East
                                                                                             concentrated on the GP practice            ephemera.
                                                                                                                                                                                    GPs feel about recent turn of events               make a case. It is time to stop whingeing and
                                                                                                                                                                                    regarding extended hours, criticism about GP       get on with it.
                                                                      01382 420 089          leaflets since I was fairly confident

Fiona Paterson                       South East                                                                                                                                     income and the like. I am also aware from
                                                                                             that I could understand that part.

Gordon MacPherson                    West
                                                                      0131 260 6800
                                                                                             Before the first few reviews I spent a             Suzanne Clark                       chatting to fellow MSPs and an increasing
                                                                                                                                                                                    number of members of the public, that the
                                                                      0141 337 3268
                                                                                                                                                                                                                                                        Ian McKee
10                                                                                                                                                                                                                                                                                11
hoolet 56 - AUTUMN 2008                                                                                                                                                                                                                                                                      hoolet 56 - AUTUMN 2008


                                                                                                                                                                     chains, Mr Houdini is unable to shake off the
Edinburgh International Film Festival 2008                                                                                                                           desire to make contact with his dead mother.
                                                                                                                                                                     Wherever he goes he seeks out the psychic
                                                                                                                                                                                                                            Book Reviews
M
                                                                                                                                                                     community in an attempt to communicate.
                                                                                                                                                                     Although he can tell a charlatan at fifty paces he
                                                                                                                                                                     never gives up the possibility that one day
            oving the Film Festival from August to      cars and of course, smoking. Harry loves his wife     go home.                                               someone’s “gift” will lead him to his mother.
            June was a move designed to give the        but he also loves the beautiful young widow, Kay.       I’m reluctant to dub this next one “Paris – The
                                                                                                                                                                                                                            View from the Surgery                               The Social Entrepreneur -
                                                                                                                                                                     Enter Catherine Zeta-Jones, the plucky Mary,
            festival space to grow without the          He knows if he leaves his wife she will be            Movie” because it’s not really about Paris but in      whose obvious charms give her an advantage over        Dr Ken B Moody                                      Making Communities Work
constraints placed upon it by the competing             devastated so he decides the best thing to do is to   an ensemble cast the city is certainly one of the      her competitors. Some very weird dream
festivals in August. That’s all very well, but did      kill her. Sharing his plan with his old friend        central characters. If you’ve ever been to Paris,




                                                                                                                                                                                                                                                                                T
                                                                                                                                                                                                                            Matador Press 2008                                  Andrew Mawson



                                                                                                                                                                                                                            D
                                                                                                                                                                     sequences involving Zeta-Jones in her knickers
they consider how difficult it would be to arrange      Richard is his first mistake .... The film is based                                                          and dead peoples bridal wear, commitment to a          £6.99                                               Atlantic Books 2008   £5.99
your day to see films and not miss Sports Day or        on the 1950s novel Five Roundabouts to                                                                       relationship represented as the lovers entwined,
end of term concert or any of the myriad events         Happiness by John Bingham and is directed by                                                                 tethered to a post, underwater, and you have an
that call on a parent’s time in June. Every day         Ira Sachs. Chris Cooper is the well-meaning                                                                                                                                   r Moody’s book is an edited                        his interesting little book starts in 1984
                                                                                                                                                                     everyday tale of odd men who are very fond of
there was a tough choice to make between work,          Harry, Pierce Brosnan the ultimate cad Richard,                                                                                                                               collection of short articles published             - shades of Orwell here? - in Bromley
                                                                                                                                                                     their mothers. Edinburgh looks great however, as
watching my kids doing something really                 Patricia Clarkson is the loving wife and Rachel                                                                                                                               over a number of years in local                    by Bow in East London. An unlikely
                                                                                                                                                                     does Guy Pearce as Houdini, Zeta-Jones and
momentous, possible for the last time or taking         McAdams the younger model. Just don’t go and          you will love “Paris”. If you’ve never been, it will                                                          papers in the Borders. Ken B Moody is the           United Reform Church(URC) Minister is
                                                                                                                                                                     Saoirse Ronan, last seen as the young Bryony in
myself off to the cinema.                               see it if you’ve just given up. It will drive you     make you want to go there. We see the city                                                                    nom de plume, pseudonym, alter ego, or
                                                                                                                                                                     last year’s Atonement, who plays Mary’s tomboy                                                             there after the incumbent drops dead during a
                                                        crazy.                                                through the eyes of a melancholic young man                                                                   doppelganger of David Carvel, GP in Biggar,
                                                                                                                                                                     daughter. Directed by Gillian Armstrong,                                                                   service. The book unfolds in a series of short
                                                                                                              (Romain Duris) who fears he may be seeing              responsible for the brilliant Oscar and Lucinda in
                                                                                                                                                                                                                            Lanarkshire. The double meaning of the
                                                                                                              everything for the last time; we watch the                                                                    name is repeated in all the fictional names         chapters, or long paragraphs, after setting the
                                                                                                                                                                     1997 and Charlotte Gray in 2001. I wonder if
                                                                                                              comings and goings of the people he can see from                                                              throughout the book, which you                      scene in of a very deprived parish with 12
                                                                                                                                                                     Cate Blanchett turned down the role of Mary.
                                                                                                              his balcony as they live their lives – while he is                                                            may find either amusing or                                        elderly parishoners sitting in the
                                                                                                              unable to live his. The lovely Juliette Binoche is                                                            irritating, depending on your taste.                              pews. It follows with the
  This year’s opening film, The Edge of Love, is                                                              his sister, his link to the outside world.                                                                    Dr Moody touches on all facets of                                 pragmatic investment in people,
set in London during the Blitz where the central          Containing less nicotine, Miss Pettigrew Lives      Interweaving multiple plot strands, the director                                                              a rural GP’s life—cases, surgery                                  mainly individuals, resulting in a
characters are Dylan Thomas, wonderfully                for a Day is yet another film set in wartime          Cedric Klapisch makes us laugh and cry at the                                                                 consultations, visits, off duty life,                             new vibrant community.
played by Matthew Rhys, his childhood                   London, where a marvellously dowdy Frances            drama behind a stranger’s life.                                                                               and reflections on the wider world,                                 Titles of the short chapters such
sweetheart Vera, Keira Knightley, and his wife          McDormand finds herself sacked from her                 Quite early on in the festival, I settled down to      The only documentary I saw this year was             seen through the eyes of Moody, a
Caitlin played by Sienna Miller. The three live a       position as nanny and is on the streets without a     watch “Before the Rains”, described as “a                                                                                                                                       as 'investing in dreams','princes
                                                                                                                                                                     Pageant, which follows the preparations of 5           self-confessed curmudgeon. I got a
precarious existence, with the two women                penny. By some quirk of fate she finds herself in     gripping tale of love and betrayal set against the                                                                                                                              into frogs',creating change - a
                                                                                                                                                                     young men entering the Miss Gay America                bit of a flavour of Dr Cameron, as
forming a fierce friendship based on their shared       a fabulous penthouse apartment accepting a job        backdrop of colonial Kerala”. Although I have          female impersonation contest. No hormonal help         portrayed by Andrew Cruikshank,                                   lifetimes task',dancing with
claims on Thomas and he a self-centred drunk            as social secretary to the delightfully dizzy Amy     subsequently seen the trailer for what looks like a    is allowed, no surgical enhancements below the         in the early television series of ‘Dr                             dinosaurs',people before
who wants to be adored by everyone. Vera is             Adams. Miss Adams plays an American actress           beautiful film set in a tea and spice plantation, I    neck, all that is required is a glittery gown, a       Finlay’s Casebook’. Moody, I                                      structures',building a social
being pursued by William, the handsome army             with high hopes of success on the London stage,       must wait for it to appear on general release.                                                                                                                                  business' give you an idea of how
                                                                                                                                                                     truckload of makeup, various contraptions to           suspect, wears tweeds, keeps a
officer, played by Cillian Murphy, who has fallen       juggling three different men, none of whom can        When the lights dimmed I was rather taken aback        squish some bits and enhance other bits - man          fishing rod in the boot of his                                    the story unfolds. The NHS is
for Vera’s charms as she entertains the crowds in       quite satisfy all her desires: riches, professional   when the BBFC certificate popped up and                boobs a bonus for the award winning cleavage. In       Rover, and may yet still smoke a                                  covered with the title 'a human
an underground shelter during an air raid. Vera is      success and true love. There is an element of the                                                            terms of stated ambitions, a desire to find world      pipe. I am not sure what he might think             tragedy ' and is a great example of poor
afraid of falling in love with a man who will go        West End farce to this madcap tale, with men                                                                 peace is less important than raising the profile of    about the feminisation of general practice.         communication and organisational disinterest
off and get himself killed but she can no longer        climbing out the back while sugar daddy comes                                                                female impersonators, which is absolutely not the        It’s a bedside book with very short articles,     in individual care. It also shows how
bear to live on the fringes of the Thomas               in the front door, lingerie being tucked quickly                                                             same thing as a transvestite, apparently. And it’s a   best suited to dipping into. Is it for doctors as
marriage. The screenplay, written by Sharman            under the rug and empty champagne bottles                                                                    multi-million dollar business, naturally.                                                                  politicians can make civil servants and health
Macdonald and directed by John Maybury, deals           stuffed under cushions. Through it all, Miss                                                                                                                        well as patients and the public?
                                                                                                                                                                                                                            The articles are short, sometimes                                 service administrators change
skilfully with the complex issues of love and           Pettigrew guides her new employer, with the           announced “The Song of the Sparrows” was                                                                                                                                        their opinions but the poor
friendship, duty and service, the artist and the        firmness of nanny, heading off each crisis as it      suitable for children over the age of 12 unless                                                               amusing, sometimes tragic, and
                                                                                                                                                                                                                            often thought-provoking. I was                                    recipients still have to tick the
intellectual in a time of war. Ms Knightley proves      arises and dishing out common sense advice to all     accompanied by an adult. Quick check of the
that although she can’t stop her lower jaw from         around. The arrival of the first air raid makes       schedules and I’m in the right cinema at the right                                                            pleased to see an appreciation of                                 right boxes. The visit by Brian
jutting out, she can sing like a nightingale; she       everyone take stock and in the short time they are    time but on the wrong day. Serendipitous as it                                                                Clement Bryce Gunn’s ‘Leaves                                      Mawhinney in 1999 while Maggie
may be too thin but she does look rather fabulous       together, the lives of the stern nanny and the        turns out. I’m sure I would not otherwise have                                                                from the Life of a Country                                        Thatcher's Secretary of State for
                                                                                                                                                                       And so to the closing film, Faintheart, a tale
in a floral frock and wellies with turndown tops.       giddy actress are changed forever. There are fine     seen this charming, life-affirming film about an                                                              Doctor’ recently republished by                                   Health showed just how the
                                                                                                                                                                     that leaves us in no doubt that even geeks and
For Glastonbury next year perhaps?                      supporting      performances       from     Shirley   Iranian peasant who loses his job on an ostrich                                                               Birlinn Press. Gunn was a GP in                                   system works.
                                                                                                                                                                     weirdos have feelings. I must say when I see these
  There is a rather annoying trend appearing that       Henderson and Ciaran Hinds. Based on the novel        farm and is forced to scratch a living as a                                                                   Peebles until his death in 1933,                                    The most interesting chapter for
                                                                                                                                                                     guys at the bus stop, in their historically accurate
issues a short description of the potentially           by Winifred Watson, first published in 1938, the      motorbike taxi in Tehran. His simple life in the                                                              and his book is an important piece
                                                                                                                                                                     battledress (presumable with a secret pocket for                                                                         me was entitled 'inside out' and
offensive content of a film, for example                film is directed by Bharat Nalluri, who was           country has not prepared him for the rampant           their bus fare) it’s easy to smirk, but in this film
                                                                                                                                                                                                                            of Scottish social history. Moody’s
                                                                                                                                                                                                                                                                                              demonstrated a bottom up
“contains strong language” or “contains                 nominated for a BAFTA for the Life on Mars TV         consumerism of the city and he is particularly         we are allowed to laugh out loud with them, at         book reflects his own particular
occasional mild violence” - that surely reserved        series.                                               impressed by what gets thrown away. Soon he                                                                   ‘kind but grumpy’ take on the                                     approach sorting out a way of
                                                                                                                                                                     them, perhaps even to feel their pain. Hot Fuzz
for Tom & Jerry. Several of this year’s films, set in                                                         spends as much time scavenging than driving,                                                                  variety, charm and frustrations of                                getting progress despite the top
                                                                                                                                                                     meets Braveheart with extra fun spotting the
the 40s or 50s, may require the audience to be                                                                bringing everything home on the back of his                                                                   being a GP in the late 20th and                                   down stifling from the
                                                                                                                                                                     various character actors in and out of Viking
warned “contains smoking”; the sight of so many                                                               ageing motorbike. Having never really had              battledress, this film will make you smile, one        early 21st centuries. It is a world that Dr         moneygivers in government. However, New
cigarettes could easily upset. Did people really                                                              anything he now hoards all the treasure he has         way or the other. Directed by Vito Rocco and           Gunn would have had difficulty recognising          Labour did use Bromley as the plan for
smoke continuously in those days or has the                                                                   gathered. It takes a near disaster to open his eyes    starring, amongst others, Ewan Bremner, Eddie          or understanding, and I often got the feeling       Healthy Living Centres and give the humble
cigarette become a rather lazy way of setting the                                                             to the important things in life: his family and his                                                           that Dr Moody might have been a bit happier
                                                                                                                                                                     Marsan and Tim Healy.                                                                                      URC minister a life peerage! Putting faith in
                                                          Goodnight Irene is a rather tedious Portuguese      friends. The perils of recycling!                        Of the films I missed this year, one of the most     in Dr Gunn’s time than the present. However,        individuals to build up new structures around
                                                        film about an English actor living in Lisbon, who                                                            interesting looks like Somers Town which won           unlike Dr Gunn, he has his own website
                                                        earns a living voicing audio books for the tourist                                                                                                                                                                      themselves to invest in local communities is
                                                                                                                                                                     the Michael Powell Award and looks set to take         http://www.viewfromthesurgery.com/ where
                                                        industry. Clearly in poor health, he is ill-                                                                                                                                                                            what this book is all about. I think the book
                                                                                                                                                                     cinemas by storm, directed by Shane Meadows            you can read some of the articles and even
                                                        mannered, drinks a lot – can’t remember if he                                                                                                                       hear the good doctor read from the book. Try        also shows how politicians are designed to
                                                                                                                                                                     whose last feature, This is England, was a huge
                                                        smokes or not – but is nevertheless befriended by                                                            success last year.                                     it out on your trainees and see what they           fail in the current system of government but
scene. There is hardly a moment in Married Life         a beautiful and mysterious new neighbour, Irene.                                                                                                                                                                        you draw your own conclusions about that.
                                                                                                                                                                                                                            think.
that is not swathed in smoke. A stylish thriller set    When Irene disappears suddenly, he gets in tow          Death Defying Acts is the story of a visit to
in New York and Connecticut just after the war
where everyone appears to be rich, white,
                                                        with a rather weird peeping tom to try to find her.
                                                        Halfway through this film, I found myself hoping
                                                                                                              Edinburgh in the 1920s of Harry Houdini, the
                                                                                                              legendary escapologist. Although master of the                    Josie Inwood
wearing gorgeous clothes, driving fabulous motor        that death would come soon so that we could all       straitjacket and unrestrained by shackles and                                                                                  John Gillies                                     Patrick Trust
12                                                                                                                                                                                                                                                                                                                             13
hoolet 56 - AUTUMN 2008                                                                                                                                                                                                                                              hoolet 56 - AUTUMN 2008




 Have a Drink on Us…                                                                                                                                               Average Day on Amazon Hope
                                                                                                                                                                         am – I get woken by the boat’s       history, I examine and then he tells        village, a woman insisted we all take a

                                                                                                                                                                   4     engine as it roars to full volume    them my treatment plan. Sometimes I         coconut from her tree – that day at




A
                                                                                                                                                                         as we slowly sway away from the      will have families of up to 7 people in     break we had the freshest coconut
                                                                                                                                                                   side of the river and start to chug        my area. The majority of complaints         milk ever and it tasted great.
                                                                                                                                                                   along to the next village. I’m on the      involve, fever/ cough/ diarrhoea              1pm – Lunch= chicken and rice
         tragic drowning incident off the coast of Gambia has resulted in          Two fragile blind ex-nurses take great pride in dispensing the free safe
                                                                                                                                                                   top bunk of an 8ft x 6ft twin cabin        /headache with dizziness /scabies or a          We move along the river to the next
         a water fountain being built in Goa which has now been used by          water in plastic containers. A donations box sits beside them should it
                                                                                                                                                                   cocooned in my mosquito net trying to      combination of the above. We were           village, we never know how far we are

         approximately two million visitors and local people.                    be that those using the facility may wish to leave a gratuity, totally at their
                                                                                                                                                                   sleep in the equatorial heat. At 5.30 I    given a flow diagram at the start so it     travelling or what the next place will be

                                                                                 discretion. The funds raised from donations goes towards providing full
                                                                                                                                                                   hear Jorge mopping outside the cabins      makes it easier knowing what to             like or when we will arrive. It really is
  It was in 2004 that Harry Lee, a dear friend and a member of the                                                                                                 and I know it’ll soon be time to make a    prescribe.                                  like an adventure and because we’re
Rotary Club of Renfrew, died while on holiday with his wife Martha.              employment for these two kind souls. When water is in very short supply,          dash for the WC/shower room which is         The boat visits each village on a 3       always travelling, I always feel like I’m
Harry had earlier expressed the hope that at some time he might be able          during the months of May and June, charges of 10p for 5 litres and 25p            shared between the 7 Brits on board;       monthly schedule so a lot of patients       on holiday rather than on a working
to provide a safe drinking water facility in one of Gambia’s poorest             for 25 litres are imposed due to extra costs. For this, however, purified,        (3 GPs, a medical student, a nurse, a                                                  trip.
regions. As Chairman, at that time, of the Club’s International                  chilled and water which is safe to drink is provided.                             dentist and his wife). Watching sunrise                                                  5.30 – We finish seeing patients and
Committee I set my sights on making his dream a reality.
                                                                                                                                                                   on the Amazon is beautiful. I see thick                                                the Peruvian men go ashore to play
  For over six months, tact, patience and tolerance were constants in
                                                                                                                                                                   lush forests surrounding remote                                                        football against whichever village we
attempting to overcome the challenges presented by the bureaucracy of
                                                                                                                                                                   wooden houses on stilts, people in                                                     are in. I sit and watch till the sky

Gambian administration and local government. It was eventually
                                                                                                                                                                   their canoes or watching us from the                                                   turns red and sunset approaches. 6pm
                                                                                                                                                                                                                                                          and it’s pretty dark. We eat our meals
brought to our notice, however, that a tourist part of Goa, near the
                                                                                                                                                                   shore and the occasional pink dolphin
                                                                                                                                                                   or gecko lizard swimming past us.                                                      on the top deck and in faint light as
grounds of Basilica of Saint Frances, a World Heritage site, was in need                                                                                                                                                                                  the boat lights attract so many
of a safe drinking water facility. It’s location would allow its use by multi-                                                                                                                                                                            insects, which then attract moths and
national tourists and those resident in the area. The local Rotary Club of                                                                                                                                                                                moth eating bats and so on! Chicken
Midtown Panjim worked in partnership with the Renfrew Club                                                                                                                                                                                                and rice for tea – yet again!!
overseeing the planning, building and part funding of the project.
                                                                                                                                                                                                                                                            7pm and they set up the TV and DVD
                                                                                                                                                                                                                                                          player. Sometimes its music and we
                                                                                                                                                                                                              come hoping to get some sort of             have a dance on the mid-deck and
                                                                                                                                                                                                              medication. Many request vitamins and       sometimes it’s a movie in Spanish in
                                                                                                                                                                                                              are unhappy to get nothing. At the          which case the mid deck is crowded
                                                                                                                                                                                                              start of our 9 days of consulting we        with children who have come back on
                                                                                                                                                                                                              got given an inventory of all the drugs     board to stare at the TV. I’m pretty
                                                                                                                                                                                                              on board and had to keep a close            tired after the busy day so have a nice
                                                                                                                                                                                                              check of how much we were using. If         hot shower before navigating myself
                                                                                                                                                                                                              people have pain we could give 5            into my bunk mosquito net contraption
                                                                                   The overseas guest book shows that of the 1.7 million who have used
                                                                                                                                                                                                              paracetamol or up to 20 ibuprofen           again and try to fall asleep to the
                                                                                 this facility, there have been 53 visitors from Scotland since the Harry
                                                                                                                                                                                                              tablets if they had bad arthritis. People   gentle hum of the engines.
                                                                                 Lee fountain came into use in June, 2005. Marion and I are proud to be
                                                                                                                                                                                                              were grateful. Can you imagine giving a       Amazon Hope is always looking for
                                                                                 associated with all our friends in The Rotary Club of Renfrew and The
                                                                                                                                                                                                              British patient 5 paracetamol and           doctors and dentists to help them for

                                                                                 Rotary Club of Mid Town Panjim for making this dream of Harry Lee a
                                                                                                                                                                                                              telling them to come back in 3              the 2 week trips. You spend a few days
                                                                                                                                                                                                              months! Out of the thousand patients        in Iquitos and a day in Lima as part of
                                                                                 reality.                                                                            7am – Time for morning worship. The      we saw, we found 2 people with              it and many people then incorporate
                                                                                 Our Aim……..                                                                       boat is run by a Christian organisation    hypertension and one with probable AF,      travelling to Machu Picchu or the Inca
  The total cost of 6,000 US dollars was shared equally between the                There is currently only one wooden bench sited on rough soil at this site       and the prayers are optional but good      one diabetic, a few children with           Trail for a holiday afterwards. They
Clubs and, for this, there was funded all labour and equipment to provide        which would certainly lend itself to having improved seating facilities           fun as we sing in Spanish and English      asthma and someone with a piranha           have just commissioned a much bigger
a Water Purification Fountain, Water Cooling Plant and a bricks and              since it is located close to a taxi rank and bus depot at the entrance to the
                                                                                                                                                                   and someone translates the reading.        bite wound. The Peruvian midwife            ship which should be ready later this
mortar Water Dispensing Hut construction. The Renfrew Club raised                Church. It is currently, therefore, our aim to provide reasonable
                                                                                                                                                                     7.30 – Breakfast = bread, ham and        would see all the pregnant women for        year and are hoping to send out twice
their contribution through various ventures, the most poignant being a           landscaped ground with at least two concrete benches under the shade
                                                                                                                                                                   eggs as always, instant coffee with        antenatal care and deliver the              as many teams. I really enjoyed this

Race Night held at Harry Lee’s favourite social club                             of mature trees to ensure that this is a tranquil area in which to relax.
                                                                                                                                                                   tinned milk and a strange milky            occasional baby when women come on          trip and would thoroughly recommend

  The Club in India secured a small plot and obtained the necessary              The estimated cost is £545 and we would be grateful to anyone who
                                                                                                                                                                   pudding with cinnamon which was            board in advanced labour.                   it to everyone who has the time and
                                                                                                                                                                   wonderful.                                   There were also the upsetting cases       desire to help. For more information
planning permission for the development on an excellent site close to the        could contribute to or sponsor this amount.                                         8ish – We arrive at a village and        where we would think someone had            see www.vinetrust.org or email
Basilica.
                                                                                                                         Mac De’Souza
                                                                                                                                                                   watch as the crew secure the boat to       cancer but these people cannot afford       health@vinetrust.org .
The Re-Visit……..                                                                                                                                                   the shore and then create a                to travel to the city or pay for tests or
  The visit by my wife, Marion, and I in January 2005 proved to be a                                                                                               sometimes complicated system by            treatment. Emotionally it was
most humble and memorable experience for us. June 2005 saw the
                                                                                                                                                                   which patients can walk the plank to       sometimes difficult knowing that they
completion of the work and the passing over of the title deeds to the local
                                                                                 Water fountain contributions may be made payable to The                           come aboard. We go ashore with the         needed so much more help than we
Club. A memorial plaque to the Rotarian to whom it is dedicated is
                                                                                 Rotary Club Of Renfrew at the following address, who in-turn                      translators and explore the village        could provide. I saw a baby who was

mounted on the front of the Fountain.
                                                                                 will transfer the funds on completion of fabrication and                          while patients come onboard and get a      floppy and hardly responsive with a
                                                                                 assembly, to The Rotary Club Of Mid Town Panjim, India
  My wife and I made a return visit to Goa in January, 2008 and were
                                                                                                                                                                   health promotion talk from the Spanish     raging temperature, struggling for
                                                                                 The Rotary Club of Renfrew will fabricate a Plaque in favour of                   medical team. All the children get the     breath and the worst chest crackles I
amazed at how efficiently the safe water fountain operates.                      contributors to be displayed on site.                                             usual childhood vaccinations and           had ever heard. It was really upsetting
                                                                                                                                                                   everyone gets an anti-parasite tablet.     that all I could do was give some
                                                                                                                                                                   We return to the boat and split into the   antibiotics and hope that somehow the
                                                         CHANGING SCOTLAND                                                                                         different areas of the medical room. A     child would survive.
  North Uist GP Dr John MacLeod retired earlier this year. He, his wife, Lorna, and his parents, Drs. Alex. J. Macleod, OBE, FRCGP and                             hanging bed sheet separates my               11am – we would get a break and
  Julia Macleod have been chosen for inclusion in “Changing Scotland”, a new and permanent exhibition at the National Museum of                                    consultation area from the others and      drink some juice or eat some sort of


                                                                                                                                                                                                                                                                 Edith Watson
  Scotland, Chamber Street, Edinburgh. We congratulate him on this achievement. You can read more about the exhibition, his life and                               the Peruvian doctor consults in the        fruit. I never remembered the names
  his views on the history of the NHS at hoolet’s web articles at:                                                                                                 waiting room area! Jose is my              of any of the unusual fruits we were
  http://www.rcgp.org.uk/councils__faculties/rcgp_scotland/news__views/hoolet/hoolet_web_articles.aspx                                                             translator and together we take a          eating. One day when walking in a



14                                                                                                                                                                                                                                                                                              15
                                                                                Here in another hoolet from John
                                                                                Steyn, GP partner in Blackhall
                                                                                medical practice, Edinburgh (John
                                                                                was also on the Amazon Hope trip).
                                                                                The owl was in an exhibition in one of
                                                                                the bank vaults in Lima showing the
                                                                                pre-Incan period ie 700 BC to 200
                                                                                AD. Is this our oldest hoolet?
Gail Addis captured this hoolet at the
Classic Boat Festival, in Port Soy
Banffshire on Saturday. Owls usually
have nothing to do with boats, but
any excuse for a day out I suppose.




                                         Inglis Lamont, has been a member of
“The partners at Barns Medical           four Scottish RCGP faculties. He is    Andrew Lendrum from Kirriemuir
Practice, Ayr are proud to submit this   presently a member in the West as      spotted this lovely hoolet. It is a
hoolet by way of recognising our         he lives in Helensburgh. He saw this   buckle on the canvas "tilt" on a Series
esteemed partner's ascension to          slightly tipsy hoolet on a lamp        1 Landrover. “I never discovered why
Fellowship. Dr Campbell McGee was        bracket in Derbyshire                  it is called a tilt, an Old English word
presented with this cardigan to                                                 that seems not to be in use in other
celebrate his achievement; Twit twoo                                            contexts as far as I have been aware.
Campbell!”                                                                      Daft ploys retirement brings!”

                 Back issues of hoolet are available again on the web at the RCGP Scotland website.
                                     Follow the links under News and Views to:
           http://www.rcgp.org.uk/councils_faculties/rcgp_scotland/news_views/hoolet/hoolet_in_print.aspx

				
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