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19 June, 2000

From:  Gwion Rhys

Regarding your comment........... Welsh reform was a shambles and has yet to reveal its nadir; from "Well done BMA"

There are benefits of shambles!! In Wales we don't have primary care trusts and rural out of hours development money remains ring fenced. I feel that through the assembly; the whims of Milbank can at least be filtered somewhat. We have a system of devolution. Assembly members can address Welsh issues, and can fine tune ideas to fit a Welsh perspective. Isn't that what your website is campaigning for; the need for democratic processes to be in place. and institutions to consider local and rural issues. The Labour party seem to propose changes based on the demands of South East English commuters.

With an assembly we have an opportunity to adapt some of the flood of changes that are hitting General Practice. Using the blunt instruments of the GMC, BMA or GPC to try to change government policy certainly doesn't seem to work.

The assembly isn't perfect; many healthcare reforms have been delayed due to the chaos that exists in Cardiff (but I'm not complaining about delaying some recent changes, such as NHS direct). Despite this, it's certainly better to have our assembly that at least tries to liase with doctors, rather than to have our future decided on the whims of London's focus
groups.
Gwion Rhys
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Staithes Surgery
July 25th

I am trying to reorganise our Controlled Drug Register.  I wonder whether there is a purpose built version?

Yes.  Try Phoenix Medical Ltd, 0121 433 8614 or the National Pharmaceutical Association 01727 832161.
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From:  Tha-Dhanas, New Zealand
August 5th
My small ad has prompted a reply from Dr Imran Rafiq, Pakistan University (Lahore), 25 years of age.   Unfortunately his e-mail was deleted due to a computer error.   Would you place another ad asking him to contact me again?  He seems to be very interested in coming to NZ and maybe we could help.   Thanks for all your help.

Tha-Dhanas - New Zealand.
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Dr JB (Midlands)

Could you please advise regarding oxygen dispensing:
1.    Transportation by dispensers in private cars.  Do their cars need to be labeled as such with stickers?
2.   Are there insurance implications?
3.   the setting up of cylinders in patient's houses.   Is it appropriate for dispensers to do it or need it be done by a doctor?

1.    No stickers are needed
2.    It would be sensible for the insurance company to be told if private cars are being used for business purposes.  It is for you to decide whether you should reimburse any increased premium and mileage at an appropriate rate.   Insurers will want some idea how frequently the vehicle will be used for this purpose.
3.    The person who sets up the cylinders in the patient's house must be trained and be able to instruct the patient or carer in how to change cylinders.  I am not aware of any legal requirement for it to be a doctor.

Finally, do look at the Drug Tariff or my book, The Complete Dispenser, about payment and how to claim it - and about storage of cylinders.
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None of the pharmacies in our large co-operative area are willing to open out of hours to serve the patients we see during the night.   We feel that there must be a supply of medicines for these people.   Consequently we are looking to set up our own dispensary/pharmacy to open only during the hours between 7pm and 7am.  As the pharmacists show a distinct aversion to helping we believe that the HA may be sympathetic.  We would be grateful for your advice.
"Suzy"

It will almost cetainly be necessary for you to apply to open a pharmacy as opposed to a dispensary.  Therefore you will need a superintendent pharmacist and your premises will have to be approved by the Phamaceutical Society..  When applying for your new pharmacy it will be essential to prove that it is both necessary and desirable and will not prejudice the proper provision of pharmaceutical services in your cooperative's area.  

Full, detailed help on setting up a company etc was sent to the correspondent and is available to other cooperatives and practices upon request.

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I have been a GP partner for 2 years and can't believe what a mistake I've made, in a dispensing practice — the patients are fine, the partners a good bunch, but ... your comments on the web site are absolutely right .... the countless ways in which we are working in a hostile environment ... I just can't believe that the GP politicians are representing grassroots GPs in any way ... I think that I'm a tough enough person to manage it (post MRCP, the old days of 56 hour weekends and all that) which means that, given that I'm not a moaner, the WHOLE profession must be completely disillusioned. My two senior partners admit that they are fed up and are to take early retirement, and the recruitment crisis in our neighbouring practices are real (and above average income, cheap housing, nice area).

And the government must be assuming one important point - that GPs cant do any other job, in other words, the government are relying on GP’s being "trapped" well I have news for them — GP’s are business people and can find a well paid job in other ways ... in other words, GP’s won't just be retiring early, but ... YOUNG GPs WILL BE LEAVING AND FINDING WORK ELSEWHERE - THIS IS GOING TO BE NEW. There is no doubt that there is going to be a flood of GPs exiting the profession over the next few years. Mr Blair can chuck taxpayers money into all the institutions that he wants, but without doctors around the results will be interesting. Forget see a GP within 48 hours, more like 48 days.
Richard Beatty
November 2000

I've read in detail the article "Industrial Air Pollution and the Country Doctor" by Dr. Dick van Steenis.

I read at the end of the article that the author has expressed his willingness to provide more complete and detailed information or advice on request.

I have some questions about the existance of proper abatement equipment to remove PM's from Orimulsion-powered Power Plants below both legal and
recomended levels to avoid the adverse effects concerning asthma, cancer and heart attacks, among others.
Roberto Perez-Franco
Panama

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Dear David,

Splendid! Thanks for starting such an interesting and informative magazine.
I will give it a plug in the Somerset LMC Newsletter.
Regards,

Harry Yoxall

 

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