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Wednesday 28 September 2016
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LES and DES – the twin bullies of general practice?

I barely know where to start this month! It's been a rollercoaster of surprise, enlightenment and ultimately the wrong lottery numbers for the 345th consecutive month.

First, enlightenment. I thought LES was annoying, but DES looks like LES's wiser bully brother. I'm talking of the new extended hours arrangements. For me it seems to mean a trudge through Thursdays with my concentration waning by 7.30pm. The darker evenings make it feel worse, l guess!

If another of my patients says, during one of the post-7pm appointments, "you should be at home", l shall wholeheartedly agree and walk!

It was interesting to consider the views of one of our registrars. Recently, one of my patients developed a terminal illness and I offered them my mobile telephone number for advice out-of-hours. It was a privilege to be able to help, but as l discussed this with our GP registrar he pointed out this was not in my contract and nor was I paid for this.

I think, disappointingly, this attitude will be more commonplace in new GPs and I'm sure DES (extended hours arrangements) will not foster goodwill. I will continue to offer my help to those patients who have terminal illnesses out-of-hours and will never be dissuaded, unless DES becomes really mean and then I may start buying buy two lottery tickets!

The surprise of the month – as well as spotting an escaped Chinchilla in the garden at home – was the remarkably amicable pre-Away Day meeting we had. We planned this meeting as a "clear-the-air-and-focus" meeting.

We moved out of our surgery to hold this meeting (success number one), we relocated to one of the partner's houses (not mine – success number two). Food and wine was available (success number three) and we all left with two fundamental questions: "Where do we see our surgery in the future?" and "what is our strategy to achieve this?" This may seem less than successful in that we spent five hours reaching these rather basic questions, but it's a start.

Talking of a start, I've spoken of our new premises for more than a year now. The latest development is our business plan, which requires a 42nd rewrite. The PCT is providing someone to do this.

I guess this manager has been sitting, pen poised, for such an eventuality since PCT mergers began. I think it's a war of attrition – a bit like a claim for attendance allowance – by the time one's waded through the forms, the forms have changed.

Was it not Gladstone who said, "Every time I solve the question, the question changes!"

It'll be three lottery tickets this week, and I hope l catch that Chinchilla before the first frost this autumn.