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Tuesday 27 September 2016
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The sun goes in and the cost-cutting knives come out

Summer is over, swine flu is readying itself for its second coming and the district nurses are being reorganised by the PCT. All is not well in primary care.

On the plus side for our practice, we've taken a plunge and replaced salaried doctors that have left with more up-to-date versions. The new versions seem enthusiastic, though marked by a touch of cynicism that betrays their tender years. This has opened up our appointment system, meaning we have availability today!

We are also planning an "evening of enlightenment" with the receptionists to discuss our appointments, visits and telephone consultations. It'll be a "good cop/bad cop" sort of do, though I'm not sure which I'll be!

We also have another hospital/community event: a ball at a local venue, which includes a band. The unusual aspect is that the three-line whip to attend has also been accompanied by the order that we are not allowed to bring our spouses/partners. This seems slightly odd, but who am I to question the wisdom? I just need to retrieve my black tie from the bag in the attic and hope that the mouse hasn't nibbled at it!

Is Choose and Book on its way out? No one is sure whether the "new way" will be the future way, as funding is being cut. Generally, I've felt patients have benefited from Choose and Book, albeit if secondary care have at times manipulated appointments, rejected reasonable requests and been stubborn when asked to see patients from an area that they're not used to (I refer of course to a geographic area).

I've also been auditing my referrals. I'm getting all reflective – or is it panicky? – as I realise everything's about justification. It could also be that the General Medical Council (GMC) are bombarding us with recertification information and I need to build up my bank of raison d'etre.

Call me naïve, but I've also realised, with some disappointment, that there are quite a lot of people (often referred to as "enterprising") that are milking off the NHS. They have a mantra – "improving patient care, streamlining services and fit for purpose" – but in fact have no loyalty to healthcare and are generally intent on filling their own pockets.

As our district nurses fight for their own jobs, these people look on for opportunities to undercut and yet still improve efficiency. It would appear the NHS is on its way out. My rant is over.