Doctor Triage at Leatside

We have for a while now been triaging all calls where someone wants an appointment that day.
This means that rather than have a receptionist just book an appointment when the patient asks, instead, having the doctor ring them back to quickly discuss the problem and deal with it in the most appropriate manner. That may of course mean booking an appointment, but could just as well lead to a home visit, an appointment for a blood test, dealing with it on the phone. We have called 999 ambulances on the basis of these phone calls!
This is really in response to there always been more call for appointments than we have appointments to offer. a while back it became clear, when we had started consulting on the telephone more, that many problems could be sorted out purely based on the story of what had been going on. Hence, no need to actually see the patient.
So, out of the many people who ring asking for an appointment the same day we are now able to deal with a lot of those things quite quickly (and efficiently) on the phone now. This means the appointments are more available for those who really do need to be seen.
So why do we have either appointments "today" or about a week away?
Basically, its because they get booked up.
We did experiment a while back with appointments that automatically freed themselves up 1, 2 and 3 days hence to allow a rolling release of appointments for those who didn't necessarily need to be seen today, but then a week off was too long. It didn't really work. In the end our best compromise has more to do with our attitude to appointments actually. The "duty" doctor used just to see only urgent cases on the same day. Now we will see anyone, for whatever reason, if they wish to be seen today.
As always, the message is, if it is a routine appointment for a check-up or whatever then book ahead.
If you need to be seen the same day then let us know and you will be seen.

Why you use a tissue when you sneeze!!

Meningitis

I was sad to see this story on the news last week - a toddler in Cornwall who lost his limbs through having meningitis.

His poor parents are fund raising for money to provide him with the artificial limbs he will need as he grows up.

The NHS and PCTs are constantly faced with calls on their funding, sometimes for things above and beyond might we might call "usual". It is down to the PCTs to decide how best to allocate funds in the best interests of all in their county.

Doesn't it make you think though that in this case, rather than funding some end-of-life  cancer last-gasp hope drugs for vast amounts of money (to the drug companies) money might be better spent on the young, such as little Marshall in this case.

I remember vividly a 17 year old girl I was looking after back in 2004 on the dialysis unit in Leicester.

She had had meningitis, had lost several fingers and toes, lost the use of her kidneys and several other technical complications. She went to have the wounds on her legs cleaned up by the plastic surgeons. That afternoon they rang us from theatre to explain that the deep tissues in her legs were all dead. She came back later that evening having had both legs removed above the knee.

She was devastated, as were her parents and brother. School friends too who kept visiting.

Her life went on though, and she had the prospect of kidney transplants and artificial limbs etc...

In the case of Marshall in Cornwall, imagining the trauma his parents must have gone through, shouldn't the NHS be funding his prosthetic limbs? Rather than having them going out fundraising?

This isn't a campaign on my part I have to say- just a commentary.

Changes to the Minor Injuries Service

"A minor injury is considered to be a cut, bruise, sting, twisted joint or other minor condition and treatment has in the past been provided at the Surgery.
From April 1st Devon PCT has determined that this service will mainly be available from Totnes Hospital Minor Injuries Unit (MIU).
Devon PCT will now only commission and resource GPs to provide a "minor injuries" service where the practice is more than 10 miles from an MIU"

This I lifted from a Devon PCT leaflet they have provided for patients to inform them of the new changes.
We have lots of these at the Surgery for people to collect and read so that they can better understand that if they attend the Surgery with a sprain or cut or whatever, we will turn them away (bleeding maybe?) and get them to go to Totnes Hospital because they've come to the wrong place. Just as if they wandered in to, lets say, the dentists or even the Chip Shop with the same injury.
Devon PCT doesn't pay us to treat this sort of thing- they now pay the MIU.
Devon PCT tells us that this is a change in response to what patients want.
They want the GP to provide management of long-term health conditions, and that patients would rather go to an MIU for an injury rather than to their own, trusted, Doctor.

I have to say though that it just seems wrong, and I find it hard to believe that "patients wishes" is the reason.
It seems more likely that given Devon PCTs perilous financial situation that finances must be the driver in some way.

Totnes GPs have always been able and willing to help people with Minor Injuries if they have attended the Surgery.
Now we are told that it is not our job and we won't be paid for helping you in these circumstances.
We could of course continue to treat patients with minor injuries as and when they turn up, but, you know, quite frankly if we aren't being paid for doing a job we are unlikely to offer it for free. Just like any other job in any walk of life.
Trust me; we could (and did) offer this service much cheaper than the MIU. In fact we never even thought at all about the finances of it. It was just part of the job..... til we were told it wasn't any more.

Sorry. Really sorry.

If you feel stongly at all about this it might help to let the PCT know. Their PALS (Complaints) details are below:

Patient Advice and Liaison Service (PALS)

Telephone: 0845 111 0080 or 01392 385694
E mail: pals.devonpct@nhs.net
Or wite to: PALS, St Edmunds Court, Okehampton Street, Exeter, EX4 1DU

Swine Flu- Mon 27th April, 2009

This is the advice we are getting from the Health Protection Agency

"As reported widely in the press, human cases of swine influenza A (H1N1) have been reported in Mexico and certain areas of the USA. This is an evolving situation and it is likely that more countries will be affected.

A CAS alert issued yesterday (26th April) states that no cases have been confirmed in the UK at present. The situation is being closely monitored by the Health Protection Agency (HPA), which is working with the Government to review the current incident and any threat it poses to the UK.

The confirmed cases of swine influenza virus infection have presented with symptoms of influenza-like illness: fever, respiratory tract illness, headache and muscle aches. In addition, some have presented with vomiting and diarrhoea.

The virus that has been identified is a novel influenza A virus, which is sensitive to oseltamivir and zanamivir, but resistant to amantadine and rimantadine. The HPA has produced a WHO Pandemic Alert Phase 3 Algorithm for the management of returning travellers and visitors from countries affected by swine influenza A/H1N1 presenting with febrile respiratory illness.

People returning from a visit to an affected area are advised to monitor their health closely for seven days. If during this period they develop a feverish illness accompanied by one or more of a cough, sore throat, headache or muscle aches, the HP advises them to stay at home and contact their GP by phone or seek advice from NHS Direct (0845 4647)."

Pharmacies

Now I am blogging I can't help but get on a small rant I'm afraid.

Pharmacies.

We've had, for so long, 3 pharmacies in town.

Coop and Chaplin Bennetts on fore street and Boots on the Market.

When we opened at Leatside Chaplin Bennetts came to join us then became something else, then Moss.

Status Quo for a few years.

Then Day Lewis bought the Boots shop, after Boots had bought out Moss and relocated to Leatside.

New status quo, coop, boots and day lewis.

Then Day Lewis wanted to move in with Morrison's.

Consent to move was declined by the PCT on the basis that they wanted to keep a pharmacy presence at the top of town.

After a while Day Lewis applied to relocate to Bridgetown.

Perhaps because the PCT thought that this expanded residential area might benefit from a pharmacy their request was accepted.

You'll note that in doing this the PCT had rescinded the requirement to have a pharmacy at the top of town.

Day Lewis then reapplied for the move to Morrison's.

This was declined but they won on appeal as clearly the top-of-town principle hadn't been stuck to.

So there we have it- Day Lewis got what they wanted and are moving in to Morrison's.

You probably know that Boots at he Surgery have only really a fairly small space, so we have been in discussion with boots for some time to see if we can offer them more space. (They get more space to work from; we get more rental income from them)  This may yet come to fruition as we submit plans to expand a bit on each end of our building. But what we then end up with is only the coop on the main street.

I suppose it may be ok, as the pattern of how people use the town and services evolves and changes over time, but I can't help but feel that it is to the detriment of the town as a whole.

Neither of the lower town sites is ideal. Leatside has a tight car park, but is easily on the path and cycle routes.

Morrison's has the big car park, but £2 to park, then to recoup it.

But then again, parking up the town costs now as well doesn't it.

More and more people are using the pharmacies' home-delivery services, and I think any feedback on how to use these more efficiently might be appreciated... perhaps using distribution/collection points like village shops or pubs?

Online pharmacies like pharmacy2u have been publicising direct by mail shots.

I have to say though that I don't like the idea of these. Pharmacists do fulfil a role in safely dispensing medication face to face and dealing with queries... what might decide which pharmacies do well in town in the end, I feel, is the quality of the pharmacists.

Dermatoscopy

We have recently bought some new equipment to better be able to look at moles and similar skin lesions with.
The gadget is called a Dermlite 2, pro hr.
It is essentially a good magnifying glass with polarised light source, enabling us to see better into the pigmented layers of the skin close up and see how they are put together.
It is supposed to be particularly useful for clarifying melanomas from not-melanomas.
Cost a fair bit to buy the kit, but we hope over time that it becomes worthwhile by reducing the need to refer to dermatologists for an opinion.
Dr Morris and Dr Watkins both have the kit and are beginning to get the knowledge, so if you have a dodgy mole take it along for a look-at.
Of course, if you can't get an appointment with them it doesn't mean the other docs have stopped being able to give opinions on moles... by all means ask your usual doc. If they can reassure you then fine. It might be they ask for a demoscopy review though.

Better to have funny moles looked at than not though.

Measles

We've seen a couple of cases of measles this week.
It is actually so much nastier than you think it is going to be...
The last time we had an outbreak must have been 6 or 7 years ago and then I think 2 of the 6 or so cases ended up in hospital with complications.
We do have an MMR catch-up going on at the moment. If you'd like your child immunised then please contact the nurses' administrator to discuss on 860312 from 9am til 10.
I gather from a patient that Mumps is about in her Uni class in Plymouth as well.
It is worth noting as well that at this time of year we often see skin rashes relating to the spring "burst" of UV in the sunlight.
Exposed areas of skin like tops of ears and lips seem to suffer most.
We do also see shingles at this time of year as the UV seems to set that off in some people too...

New Blog

I decided that a blog may be a helpful way to keep in touch with what we are doing, thinking, planning etc at the Surgery.
The surgery website fulfils an informational role but is rather a formal way of doing this.
The blog I hope can be a more informal area where staff at the surgery can post up bits about things they are doing, projects they are working on, areas of clinical interest, bits of latest research, feedback on feedback we've had, and so on.
I might perhaps get the patient participation group members to contribute as well if they so wish.
Who knows where it might go.

Dr Watkins