In article <[log in to unmask]>, allan
harris <[log in to unmask]> writes

> Triageing for practices that
>may be 60 miles away is difficult but it does mean that we filter
>the calls for those rural GP's and hopefully only send them the 
>more realistic calls.

This is cloud cuckoo land for us, I think.  Think yourself into the
situation - we are 20 miles from the next practice (3 handed) our roads
are hilly, bendy and narrow.  In the summer they are congested with
visitors.  we are an hour form a DGH ( in the opposite direction of the
next practice as well!).

So we can join up with the next practice - so we are 7 instead of 4 and
provide cover for a huge area with impossible roads and very sketchy
mobile phone or radio cover.  

So that's one in seven with impossibility of one person covering the
area - in the winter let alone the summer.

Then there's the population thing - list of almost 6000 in winter but
26,000 in summer at busiest time.  We provide all the primary care and
cottage hosp cover.  On a summer weekend this is a full time job for our
practice alone - so one doctor is needed per practice area.  IF we
joined with the next practice the numbers and distances are huge.


Then there's the triage thing - are the nurses in casualty to phone a
centre somewhere for someone to triage? - it would need a dedicated full
time open line in the summer.  In the winter I am better of doing my own
triage for a list of 6000 - it allows me to manage the work - if someone
else is doing it they can't possibly know the least aggro local moves I
can make to deal.

Then there's the medical care thing - without a local provision these
people are at least an hour from medical help - we thrombloyse them and
pull asthmatics and diabetics back from the dead fairly regularly.



> It is difficult to assess patients who live
>in an area that you know nothing about but not impossible. 

Surely it's not just patient but situation assessment and planning least
aggro option for the GP that is important.

>
>The call service is efficient, monitored and so far seems to be taking some
>of the burden of the rural members.

I do not see a distant, non-hands-on triage service helping us one bit.
Our cottage hospital nurses are quite good at it though.

>
>There are also shifts on offer in the rural centres, anything from
>300-500 UKP for a weekend day/night shift. I'm not sure of the takeup of
>these.
>
>The Co-op has revolutionised our lives locally and we could never go 
>back. 

Absolutely - and we too need a revolution - but the question is how?
>North Yorkshire is England's largest rural county.

If only size were the only factor ;)
>
>Locums are pretty thin on the ground here also. Perhaps job swapping
>would be a way of getting a break without incurring costs?
>
Now there's a thought - Snowdonia is beautiful.

Cheers :)
-- 
Jelly Bean              [log in to unmask]

When you get fed up surfing....
....go find some waves.


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