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					IN THIS MONTH’S NEWSLETTER :-                                                                       No. 180 February 2006


                                                                                         REFERRAL MANAGEMENT:
•   Referral Management ..................................... 1
•   Election of LMC Non-Principals' reps .............. 1                                    INTERIM ADVICE
•   Chlamydia Screening Programme................... 2
                                                                              The LMC remains very concerned about the medico-
•   Bodmin NHS Day-Case Treatment Centre...... 2
                                                                              legal implications of the interception of referrals by PCT
•   ISTCs: Pre-op Assessment of patients............ 3
•   Excessive Working Hours................................ 3
                                                                              management and their diversion sometimes to non-
•   Peninsula Medical School News ..................... 4                     doctors who by definition cannot take over clinical
•   Enhanced Services Floor ................................ 4                responsibility from the GP as happens with a normal
•   Locum GPs Pension Arrangements ................ 4                         consultant referral.
•   Training and mentoring of Community                                       The LMC is also deeply concerned about issues of
        Matrons ..................................................... 5       patient confidentiality and patient consent, where the
•   Green Paper on Welfare Reform..................... 6                      patient is not aware that his or her medical details,
•   Pensions: Employers' contributions & tax ....... 6                        divulged to the GP for the purposes of referral to a
•   Allergy recording in GP clinical systems.......... 7                      consultant, are in fact being scrutinised by lay staff. The
•   Dr Basil Bile writes........................................... 8         LMC has raised these concerns with the PCTs and until
                                                                              they have been dealt with satisfactorily its advice is
Items for the Newsletter are always welcome, and                              ALWAYS to refer to The Consultant or to a named
should be sent to the Editor, Rosalind Winter, at The                         consultant. If a lay member of PCT or other trust staff
Sedgemoor Centre, Priory Road, St Austell PL25                                then diverts your referral elsewhere, then any breach of
5AS (Tel 01726 627978, Fax 01726 76247, e-mail                                patient confidentialty/consent will be theirs, not yours;
ros@kernow-lmc.demon.co.uk).         See also our
                                                                              the legal position on clinical responsibility is,
website at www.kernow-lmc.co.uk
                                                                              unfortunately, less clear-cut.

               OUT OF HOURS SURVEY                                                 ELECTION OF LMC NON-PRINCIPALS’
                                                                                          REPRESENTATIVES
At their first meeting of the new year, LMC members
expressed a number of concerns about the future of out of                     The first election of representatives to the new GP Non-
hours care in Cornwall when Serco takes over from                             Principals’ constituency of the LMC will take place in
KernowDoc in April. These concerns are compounded by                          March/April 2006. We will be writing shortly to every
the lack of any information about the sort of service Serco                   GP Non-Principal in Cornwall and Isles of Scilly for
will be providing: we understand that contractual details                     whom we have an address, indicating whether or not
are still under discussion. The LMC is particularly                           they are eligible to be nominated and to vote in the
concerned about the “Top and Tail” arrangements and will                      election, and if not how to become eligible (by paying
be following this up with the PCTs.                                           the Non-Principals’ Levy of £50 no later than 12 noon
There have been suggestions that the over all service                         on Thursday 23 March).
provided by Serco may not match KernowDoc’s. To test
                                                                              If you are a GP Non-Principal and did not receive a
whether or not this is the case, the LMC is conducting a
                                                                              letter from the LMC Chairman in January, it means we
survey between February and June of quantifiable items
such as next-day referral back to the GP, and hospital                        do not have your address, so if you would like to
admissions. Ten practices throughout the county have                          participate in the election, please send your name and
“volunteered” to take part, and results will be published in                  address to the LMC Office as soon as possible.
due course. The LMC would also welcome subjective                             Please draw this notice to the attention of any GP
impressions from practices of whether or not there is an                      Non-Principals who you think may not be on the
increase in daytime GP workload after April.                                  LMC’s contact list.

         LMC Newsletter                                                   Page 1
                                                                           g                                        February 2006
        LMC Newsletter                                                                          February 2006


    BODMIN NHS DAY-CASE TREATMENT                                CHLAMYDIA SCREENING PROGRAMME
                CENTRE

From the Bodmin NHS Treatment Centre,                          A reminder to all practices involved in the
Boundary Road, Bodmin PL31 2QT                                 Chlamydia Screening Programme:
This brand new, State of the Art, Day Case Treatment                       TREATMENT SHEETS
Centre, located adjacent to the Bodmin Community
Hospital, has now opened its doors and begun treating
patients. The Treatment Centre, owned and operated by          Could all practitioners who are prescribing or
Capio Healthcare, is now fully operational and an open day     treating patients with a positive chlamydia test as
has been arranged for Wednesday 1st February, with             part of the Cornwall Chlamydia Screening
sessions at 12 noon, 3pm and 6pm. Anyone who is                Programme please remember to send completed
interested in looking round should contact the Treatment
                                                               treatment sheets back to the Chlamydia Screening
Centre direct on 01208 262520
The Treatment Centre is able to accept direct referrals from   Office (CSO) at Camborne and Redruth
GPs and Optometrists and the range of procedures               Community Hospital.
currently available are:-
                                                               Without these sheets the CSO cannot complete
Ophthalmics       Phako extraction of lens and lens implant
                                                               the data required for the Department of Health,
                  Non phako extraction of lens and lens
                  implant                                      which is mandatory.
                  Removal of lens – not replaced
                  Replacement of prosthetic lens with          Thank you for your help and time in ensuring the
                  prosthetic lens                              continued success of the programme. Any queries
                  Minor ops around the eye
                                                               should be directed to the CSO on 01209 881727.
GI Tract Diagnostic Osophagoscopy
                 Gastroscopy                                        FALMOUTH - GP PARTNER VACANCY
                 Colonoscopy
                 Sigmoidoscopy
                 Proctoscopy                                     TRESCOBEAS SURGERY, FALMOUTH
                  Minor therapeutic endoscopic                 We are looking for a new PARTNER to
                  Osophagoscopy
                  Gastroscopy
                                                               commence July 2006
                  Colonoscopy
                  Sigmoidoscopy                                • 8 sessions per week, 10 weeks holiday/study
                  Proctoscopy                                  leave
                                                               • 9,125 patients
Gen Surgery       Simple haemorrhoidectomy
                  Simple anal procedures not needing           • Purpose built premises
                  overnight accommodation.                     • Community Hospital next door
                  Hernia repair – inguinal                     • GMS, No OOH, 1000 + QOF points
                           Femoral
                           Umbilical                           • Paperless
                           Simple incisional
                  Non plastic minor skin procedures            Applications with CV to –
                                                                       Simon Fox, Practice Manager,
Gynae             Minor lower Gynae procedures                    Trescobeas Surgery, Trescobeas Road,
                  Minor upper gynae procedures not
                  requiring open abdominal surgery or an                   Falmouth TR11 2UN.
                  over night stay in hospital.                               Tel: 01326-434876

Further Gynaecology procedures will be added, including        Email: simon.fox@trescobeas.cornwall.nhs.uk
Termination of Pregnancy, in the near future. Details will
be sent out when these are available.
                                                                 Closing date for applications – 31st March 2006


        LMC Newsletter                                     Page 2                               February 2006
      LMC Newsletter                                                                   February 2006


 ISTCs: PRE-OPERATIVE ASSESSMENT OF                                 SALARIED GP -
               PATIENTS                                       STRATTON MEDICAL CENTRE

A GP surgery was contacted recently by the
Plymouth Nuffield in respect of a patient about       We are a seven partner, friendly, motivated,
to undergo an NHS procedure two weeks later.          GMS practice in the attractive seaside resort of
The Nuffield wanted the surgery to carry out all      Bude seeking a Salaried GP to work 4 – 6
the necessary pre-operative ECG and blood tests,      sessions per week.
as the patient claimed to be too unwell to travel
for the pre-op assessment that was booked for         •    14,300 patients
later in the week.          By chance the patient     •    High achieving QOF
attended the surgery on the same day as she was       •    Paperlight, EMIS LV system
supposed to attend the pre-op clinic, from which      •    Nurse Practitioner, strong Nursing
it transpired that she was fit enough to travel but            & Admin team
was unwilling to do so because of the                 •    Six weeks annual leave plus study leave
inconvenience of the distance involved, and           •    Cottage Hospital
hence wanted the tests done locally.
The surgery quite properly refused to carry out                   Practice Profile on request
the pre-operative tests on the grounds that this
was a secondary care procedure which the                    Apply with CV and covering letter to:
Nuffield is funded to carry it out as part of its            Kathryn Pengelly Practice Manager
contract with the PCT. There was no suggestion             Stratton Medical Centre, Hospital Road,
from the Nuffield that the cost of the pre-                  Stratton, Bude. Cornwall EX23 9BP
operative assessment be transferred to the
surgery.                                                                Email:
The LMC will be meeting PCT representatives in        kathryn.pengelly@strattonmed.cornwall.nhs.uk
February and has added this to the agenda for                   Telephone: 01288 352133
discussion. It is important that GPs make it clear
from the outset to patients who exercise their
choice to have their treatment at distant venues
that the total treatment package will be carried              EXCESSIVE WORKING HOURS
out there, and the patient will be expected to
attend there for all appointments applicable to
that procedure.                                       At the January LMC meeting a member asked
Meanwhile the Nuffield patient’s PCT has              for advice on a potentially dangerous situation
responded:                                            which had arisen at his practice. A doctor had
"Thank you for making us aware of this. Our           worked a full night shift with KernowDoc, and
contract with the Nuffield does include all pre-op    then worked all the next day in the practice,
assessment and all patients should be aware that      before a long drive home.
this will require a trip to Plymouth."                The LMC agreed that GPs should be
This is good, but not good enough: "patients          reminded through this Newsletter that it is
should be aware" - but patients are clearly not       their own responsibility to ensure that they
aware, and the ISTCs aren't telling them. We          are fit to work, and that there is powerful
suspect that       when it comes to shedding          evidence that working such very hours may
workload whilst retaining the payment for it, the     well be unsafe. If anything were to go wrong,
ISTCs are likely to prove just as savvy as the        either in the surgery or on the road, and it
acute trusts have always been, because they           became known that the doctor had been
know there will always be GPs soft-hearted            working for such a long period without a
enough to do their work for them rather than          break for sleep, the doctor could well find
inconvenience the patient in any way.                 him/herself facing a GMC hearing.


      LMC Newsletter                              Page 3                               February 2006
       LMC Newsletter                                                               February 2006


    CAMBORNE - FULL TIME GP VACANCY                        ENHANCED SERVICES FLOORS


                                                     Enhanced Services Floors remain a constant
Full time dynamic computerphilic doctor to           issue nationwide, particularly in terms of how
replace retiring third partner in July 2006.         PCTs can be encouraged to spend up to the
                                                     Floor before the end of the 2005/06 year.
•   All usual staff, paperfree, recently extended    Concerns have been raised regarding their
    refurbished premises.                            status and whether, and by whom, they are
•   Opportunity to develop own interests.            enforceable. This has been heightened by
•   High QOF payments.                               examples of PCTs elsewhere in the country
                                                     stating that they will not spend up to their
     Informal approaches/visits welcome.             floor, but instead will use underspends to
Please contact Joy Adamson, Practice Manager,        help offset their deficits.
       at Clinton Road Surgery, Redruth              Current opinion is that PCTs can be
           on 01209 218686 or email                  instructed to spend up to their ESF, although
  joy.adamson@clintonroad.cornwall.nhs.uk            such instructions are not legally enforceable.
                                                     The same applies for PCTs being instructed
                                                     to manage their budgets. Inevitably there is a
    PENINSULA MEDICAL SCHOOL NEWS                    conflict between these two obligations,
                                                     particularly given the financial position of the
                                                     NHS.
                                                     The GPC negotiators’ position has remained
GP Conference – 12 October 2005                      consistent – that the ES Floor should be
We had an excellent turnout for the joint
                                                     spent on contestable Enhanced Services as
Peninsula Medical School and SW Peninsula
                                                     a minimum – and they have and will continue
Deanery GP Medical Education Conference on
                                                     to press the Department of Health to instruct,
Wednesday 12 October 2005. There was
                                                     encourage and performance-manage PCTs
enthusiasm and keenness to be involved from
                                                     to spend up to the Floor.
those who attended. It was good working jointly
                                                     LMC representatives will meet in February
with the deanery. A summary report has been
sent to the delegates but the full joint report is   with representatives of all three PCTs in
available on the website:
www.peninsuladeanery.nhs.uk (Foundation –             LOCUM GPs - PENSION ARRANGEMENTS
What is it? – Foundation News.)
                                                     It has been confirmed that the employers'
                                                     superannuation contribution for locum
Year 5 students
In Year 5 the students will spend five weeks in
                                                     GPs remains with the PCTs "for the
General Practice running their own surgery etc in    foreseeable future". The regulations for
preparation for their Foundation Years. Further      locum GP pensions have not changed and
information is currently being sent out by the       locum GPs should continue to claim for
Localities to Practices who expressed an interest    this in the normal way.
in having Year 5 students. For further               Please note that locums should check that
information, please contact the Locality Offices:
                                                     the organisation that engages them as a
        Exeter - Rachel.blake@pms.ac.uk              locum is an approved NHS pension
     Plymouth - Jodene.melville@pms.ac.uk            scheme employing authority to ensure
                     Truro -                         that pay will be superannuable under the
    Claire.newland@centralpct.cornwall.nhs.uk        NHS scheme.

       LMC Newsletter                            Page 4                             February 2006
      LMC Newsletter                                                                     February 2006


                   TRAINING AND MENTORING OF COMMUNITY MATRONS


Many thanks to Ms Helen Lyndon, Professional           there are any problems. To date, I have only
Lead for Community Matrons in Cornwall for             been contacted by one GP to express concerns.
the following response to a letter from the LMC        It would have been helpful to be made aware of
Chairman following complaints from a number            these issues at an earlier stage in the course, so
of practices that GPs were being asked to              that we could have looked at alternatives. Now
provide extensive on-the-job training and              that the taught element of the course is complete
mentoring for their newly-appointed                    I plan to send a letter to all mentors to thank
Community Matrons. In some cases there has             them for their participation, but also to get their
been a lack of communication between the               views on how we could improve this for the
PCTs and GPs when Community Matrons have               next course.
been appointed, and clearly there needs to be
clarification over the issue of training, which        Medico-legal Responsibility
practices maintain they have been asked to             It is my understanding that once the CM has
provide, and have provided, and over the issue         completed and passed the training course that if
of funding for training and mentoring, which           she is acting within the policies and procedures
practices say they have not been offered. The          of the PCT, then the PCT accepts full vicarious
LMC will pursue these matters with the PCTs.           liability for her actions. There is also
Meanwhile it is important to repeat that all           professional regulation within the NMC Code of
practices that have commented to us on the             Conduct that nurses work within their sphere of
issues have been unanimous in their welcome            competence and are responsible for their own
for the Community Matrons themselves, and              actions within this regulation. GPs would not be
in praise of the excellent work that they are          held liable for any error the CM makes.
doing.
                                                       Future training of CMs
From Helen Lyndon:                                     For this course I was heavily influenced by the
Training                                               University to use the competency/mentorship
Training of the new CMs (Community Matrons)            method of training. I am planning at the end of
is provided by the PCT through a Partnership           the course to write to all mentors to thank them
Course with the University of Plymouth for             for their efforts, but also to get formal feedback
which I am Module Leader. It has never been            as to the impact of this on their workload and
suggested that training is the responsibility of       suggestions for future courses. It is my feeling
GPs. During training, the CMs require support          this method needs to be reviewed for the next
from a mentor to enable them to put the skills         course and an alternative e.g. OSCE
they have learnt into practice.                        examination trialed. This is a new course and we
There is also a formal element of competency           are still learning the best ways to deliver.
assessment which the mentor is asked to
participate in. The CMs are encouraged to use a        Communication
wide variety of professionals for mentorship -         Personally, I believe communication about the
GPs are just one suggested group. If a GP does         commitment of practices and the introduction of
agree to provide mentorship then there is a small      the CM role could have been better in some
amount of funding available to support this -          cases prior to the appointment of the CMs.
although we acknowledge that this does not             However, since all 3 PCTs chose to implement
cover the full cost. There is no expectation that      the role in a slightly different way, there was not
a GP alone will provide mentorship. There are          the consistency of communication which was
Mentor's Handbooks which are given out to all          apparent when the first CMs came into post
mentors which details what is expected and my          (through the EPIC project). I would propose we
contact number is in the handbook to contact if        do this differently for the next tranche of CMs.

      LMC Newsletter                                Page 5                               February 2006
      LMC Newsletter                                                                      February 2006


   GREEN PAPER ON WELFARE REFORM                                   PENSIONS: EMPLOYERS’
                                                                  CONTRIBUTIONS AND TAX
At the end of January the Government published its
Green Paper on welfare reform with the aim of            Some accountants have raised the question of GP
removing one million people from Incapacity Benefit      clients who have paid PP contributions in respect
by 2010. It is clear that they are pushing for a major   of NHSPS earnings in 2004-05 and 2005-06
culture change to encourage people off benefit and       intending to use the ESC A9 to waive relief on
into work, with General Practice playing a significant   the NHSPS contributions and claim it instead on
role.    One of the ideas floated was that of
                                                         their PP contributions. If they do so, the relief
Employment Advisors sitting in on GP surgeries to
offer help and support. GPC Chairman Dr Hamish           waived is 20% (or up to 29% if the GP is paying
Meldrum said that although he had no problems with       added years contributions, NHS AVCs or
this in principle, there were many questions about the   FSACVs), GPs have often paid the PP
practical implications of doing so that would need to    contributions on the assumption that the NHSPS
be answered.                                             relief to be waived would only be 6% (as was the
                                                         case before 1 April 2004), particularly as the tax
Another idea, floated in the media at the end of         position has only been clarified very recently.
January, was that GPs might be financially               In such cases, there is nothing in ESC A9 to say
incentivised to write fewer Med 3 certificates.
                                                         that an election to waive relief on NHSPS
Following some robust comments and
representations from the GPC and BMA, the                contributions is irrevocable. So, if their income
Government seems to have dropped that particular         tax liability has not been finalised yet, a GP may
idea, certainly for the foreseeable future.              revoke their election for 2004-05 and claim relief
                                                         on what is now the 20% (6% employee and 14%
                                                         employer) contribution to NHSPS. HMRC has
                                                         confirmed that it would have no objection to the
        PNEUMOCOCCAL VACCINE:                            PP contributions being refunded in such cases.
      LETTER TO THE GPC CHAIRMAN


Dear Dr Meldrum,

Philip Leech spoke to you this morning about the leaked story in today's Independent about
pneumococcal vaccine and other changes to the routine immunisation programme. I understand he
confirmed that the information reported was not accurate, did not come from us and he expressed his
regret about the situation. I would also like to offer our apologies.
It has been our intention that CMO would be in contact with you as soon as we were able to share the
information, as far as possible in advance of any announcement. We are currently in the process of
finalising a mandate for NHS Employers to take forward discussions with you around the complete
immunisation schedule, including issues that you yourselves have previously raised. We do recognise
there have been issues around communications in this area and we will ensure that NHS Employers are
mandated to discuss a communications strategy with you as part of this work.
We deeply regret when information is leaked and the Profession learns about it either through their
patients or from the media.
Thank you again for your assistance (and patience!) on this matter.

Yours sincerely,
David Salisbury

Immunisation Policy, Monitoring and Surveillance Department of Health Wellington House
133 - 155 Waterloo Road
London SE1 8UG

      LMC Newsletter                                 Page 6                               February 2006
       LMC Newsletter                                                                                   February 2006


          ADVICE FROM THE GPC - ALLERGY RECORDING IN GP CLINICAL SYSTEMS

Introduction                                                   However if your clinical system’s allergy recording
In September we published an advice note regarding the         mechanism does not use Read Codes to record allergies,
handling of allergies in preparation for the electronic        then you should in addition double enter all allergies as
transfer of GP records. This guidance supersedes and           Read coded data, as well as via any system specific
formalises that advice. It has been developed after further    mechanism.
discussion and consultation with the GP2GP team, users
groups, suppliers and the GPC’s legal advisor.                 This will have the effect of providing a backup to any
                                                               system specific entries, adding another level of patient
The context                                                    safety and mitigating any possible liability in respect of the
The context of this advice is that we are all going to be      clinician. We hope that most GPs will see this as a
moving from an environment where we just create records        worthwhile duplication to enhance patient safety.
for ourselves, to one where records will be routinely
transferred between practices and shared with other            All of the double entered read codes will be reliably
clinicians. The consequence of this is that new                transferred between systems via GP2GP and it will be
responsibilities arise.                                        possible to search for any such codes in the receiving
                                                               system. Care will have to be taken in interpreting the
The problem                                                    context around these codes such as certainty and severity.
Transfers of allergy information between same GP systems
generally work well but transfers between different GP         Please check with your supplier or your users group for
systems may not always result in all the allergy               precise advice as to how this applies to the system you use.
information being transferred because allergies are handled    They will know whether your current system’s allergy
in different ways in different systems. Not all systems use    recording uses Read codes.
Read codes to record allergy information, some use other
code sets and others may use bespoke codes. Qualifiers         The Read codes available are not exhaustive and may need
that exist in one system may not have an equivalent in         expanding but where they exist they should be used. They
another. Translation arrangements are therefore needed.        do change from time to time and GPs should keep
The GP2GP team has developed import mechanisms                 themselves up to date.
designed to recognize incoming system specific allergy
information that presents this information to the user and     GP2GP import mechanisms will evolve over time and GPs
then prompts for action. If the incoming allergy codes         should keep themselves up to date.
cannot be safely mapped to the receiving system they will
be degraded and may appear as text alone or as text            All GPs are reminded of the Good Practice Guidelines for
associated with less specific codes.                           GP electronic patient records http://www.dh.gov.uk/
                                                               assetRoot/04/11/67/07/04116707.pdf which contain
Another issue is that system specific recording of allergies   detailed guidance on the use of electronic records in
can be limited to prescribable items, thus omitting some       General Practice. Chapter 5 and appendix 2 deal with
extremely important non drug allergies.                        G2GP record transfer. Updates to this guidance will be
                                                               prepared and published by the GP2GP team as further
                                                               supplements available from the GP2GP website http://
Our Advice                                                     www.connectingforhealth.nhs.uk/delivery/programmes/
GPs should continue in all cases to use their system-          gp2gp .
specific mechanism for recording allergies. It is essential
that allergy information is properly recorded on your own      Dr Paul Cundy, Chairman, GPC IT Committee
system to ensure it can be recognised and dealt with during
GP2GP transfer. Receiving systems will have any                We have been asked which codes GPs might use. The
incoming allergy information that has been entered using       following are examples from the 5 byte Read Codes;
the sending system’s specific mechanism presented to           Chapter title               Read codes beginning with
them as part of a receipt workflow (for detailed advice see    Drug – Adverse reaction – AR        TJ…
references below). This workflow should facilitate             H/O Drug allergy                    14L..
appropriate translation into the receiving system’s allergy    H/O Non drug allergy                14M..
alerting mechanism.                                            Allergy unspecified                 SN53.
                                                               Anaphylactic shock                  SN50.
For systems that use Read code(s) as part of their system      Food allergy                        SN58.
specific process no additional entries are required for drug   Personal history of drug allergy    ZV14.
related allergies. The Read code(s) will be unequivocally
recognizable by the receiving system although some             Equivalents exist in the Clinical Terms Version 3 and
system specific qualifiers may not be.                         SNOMED code sets.


       LMC Newsletter                                      Page 7                                       February 2006
      LMC Newsletter                                                                   February 2006


DR BASIL BILE WRITES ...


“Striking Doctors On The March” thundered            to tell me it is due to the wrong type of leaves on
The Times, “50,000 surgeries closed as GPs           the line and will be fixed Monday week.
threaten to desert”. Whoopee thought I, our          9.01: Told by receptionist that we have no
negotiators have finally decided to stand up to      appointments left today.
HM Gov and its bullying “you screwed us over         9.02: Computer comes back on, announces on
the new contract so we’re out for revenge”           the screen that my password is out of date and I
posturing. Sadly not. On reading on it became        cannot have access.
clear the headlines relate to our saxon cousins. A   9.03: Password changed to Hatepatients7
third of German doctors earn less than £1,400        9.04: Message from reception - Mrs Purbright
per month, while the many that fly over here to      has cancelled as I am running 4 minutes late and
do weekend moonlighting can pocket £2,000            she will writing to the PCT to complain.
each trip. Small surprise then that thousands of     9.05: Buzz for second patient
Jerry Docs have announced they are going to          9.05.30: Message from reception - Mrs Highorse
abandon Europe’s most modern health system to        has cancelled as I am running early and she will
work in Britain. Ironically what is also upsetting   be writing to the PCT to complain.
them is that their own government is seeking to      9.06: Computer crashes - IT lead Dr Hilda
restrain them from prescribing expensive             Bunnytunnel phones me to explain it is due to
medicines as well as capping the individual          Mars being in conjunction with Venus and it will
budgets of Practices. So they should feel            be fixed on Tuesday week.
perfectly at home here then. Welkommen.              9.07: Request for urgent visit from a mother who
                                                     has run out of Calpol and her car has been stolen
Tony and his cronies are presumably rubbing          by her estranged husband so she can’t possibly
their hands in glee as if we turn bally bolshie he   come in to the surgery. If I don’t visit she will
can replace us wholesale with the German             report me to the PCT. Give her PCT phone
invasion. It might therefore be a judicious time     number.
in the Grand Duchy to consider reviving the          9.08: Computer crackles in to life and I call in
spirit of Dad’s Army in our LMC Cabinet. With        next patient who has received a letter asking her
Captain Mainwaring Dommet at the helm, Rabid         to come in urgently to discuss her recent test
Rob in the role of the spiv selling dodgy            results. Haven’t a clue what it is all about but
blackmarket stockings and bananas, Dr                luckily all is safely recorded on the computer.
Bumbleton dashing around in “Don’t panic Mr          9.09: Computer crashes. Unable to give her
Mainwaring” and “They don’t like it up them”         results. She tells me in the midst of hysterical
Corporal Johnson mode, Ashtray Rooster as the        weeping that her husband, an out of work all-in
John Laurie gloomy pessimist and The Absent          wrestler, will be round to see me shortly to
Abbott as the Ian Lavender “Silly Boy” I feel        discuss the shortcomings of the service I offer.
sure we can sleep easy in our beds when the air      Meanwhile she is going to report me to the PCT.
raid siren sounds and the sky is full of parachute   9.10: Post card arrives from Dr Hilda
canopies supporting stethoscope wielding             Bunnytunel, from Brazil, from where she has
Berliners. Just in case Plan One flounders I will    been phoning me all morning, reversed charge
describe a typical working day for a Tommy Doc       calls of course. Hopes to be back Wednesday
in the hope that it can be used in a leaflet drop    week.
over enemy territory.                                9.11: I telephone the German Embassy asking if
8.59: Arrive at desk allowing 60 seconds to deal     they could send a German doctor to replace me
with queries.                                        A.S.A.P.
9.00: Computer crashes.                              9.12: Smash up computer with sledgehammer.
Practice IT Lead Dr Hilda Bunnytunnel phones         Feel a lot better. Phone PCT to report myself….
      LMC Newsletter                             Page 8                               February 2006

				
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