Health Board takes over Out of Hours

The Health Board will be taking over the responsibility for Out of Hours GP calls from 6pm on Wednesday the 14th of November 2007.

I'm sorry about the short notice of this, but I only had confirmation of this myself a few hours ago. This was due to a legal dispute over our contract with the Health Board.

The Health Board initially will provide locums to cover the practice in the evenings and weekends and says it will have a more permanent solution in place by February next year. I don't know what that solution will be as the Health Board have not told me what the options are that they are looking at (the last time I heard from them they had three remaining options they were looking at, down from an original list of 8 options).

In the mean time, patients should continue to call the surgery if they require urgent assistance day or night. Between 6pm and 8am the phones will either divert directly to NHS 24, or an answering machine message will tell you what number to call to speak to NHS 24 and/or the doctor on call.

Sadly, one option that the Health Board has already rejected was our offer to continue to provide 24/7 cover from Strachur with a mixture of the current doctors and locums. You can download a copy of the business plan that I submitted here to read more about the plan.

There is a community council meeting on the 28th of November at which the Health Board and I will make presentations regarding the Out of Hours and I hope as many people as possible will attend.

Out of Hours cover

Currently the Strachur Medical Practice is opted in to providing 24 hour medical cover 365 days a year. It is only one of two practices in the area that still carries this responsibility.

As I've mentioned before on the practice blog, this 24 hour responsibility is a huge burden. This is not in any way the fault of the patients in Strachur, who rarely call except in a genuine emergency. I think patients living in rural areas understand that the GP cannot always be immediately available. If a patient had a medical emergency, and called the surgery only to discover that I had gone to Glasgow shopping with my family, then I think they would understand. In the past, the doctor would leave word and would either see the patient on his/her return, or the patient would go to the hospital in Dunoon.

However, my contractual and professional obligation is to be immediately available within the practice area at all times for emergencies. We only have three calls per week in Strachur on average, yet I cannot take my children to Benmore gardens for a walk. A meal in the Loch Fyne Oyster bar is fraught with danger because of the poor mobile phone signal. What if someone dies because I was not able to be contacted?

If a patient were to complain, I would not face a sympathetic hearing. I would be judged by peers who have never worked in remote general practice or as singled handed GPs. Judged by their standards, a trip to the shops in Dunoon could easily lead to me losing my practice, having registration as a doctor taken away by the GMC, or being sued in court.

The Health Board currently pays the practice around £20,000 per year towards the costs of the on call. However, to get a locum doctor to cover the practice costs between £1000 and £1600 per weekend and £100-£200 per night. Were I to be incapacitated for a period of time, the cost of out of hours locum cover alone would be around £110,000 per year. Recently, a friend of mine (a single handed GP on one of the small islands) became very unwell and had to be admitted to hospital. Her Health Board helpfully told her that she was in breach of contract leaving the island and should not have allowed herself to be admitted to hospital until she had organised a locum doctor and waited for them to arrive on the island to take over from her.

Also, it is increasingly difficult to get locums who have any experience of this kind of out of hours. Recently, I have had locums who were worried because they have always worked in Out of Hours centers which had receptionists to answer the phones, nurses to help with patients, and a driver to drive them to visits at night and weekends.

So, reluctantly, I've decided to ask the Health Board to allow me to opt out of the responsibility for providing 24 hours medical cover.

I have submitted a bid from our limited company to continue to provide out of hours cover from Strachur with more locum doctors at the market rate of pay, and they are considering this option. It is expensive, and works out at around £400 to £600 per call.

I have also said that I will always be happy to respond to medical emergencies in the area when I am here even though it will no longer be part of my contract and I will not be receiving any payment for it. Dr Wright has said the same, as has Dr Tittmar. That is part of living in a rural community. If we are unavailable (or the call is not an emergency) then the Health Board will have an alternative system in place for patients to use.

Actually, I think this is the system that most people think we have at the present anyway.

Download leaflet (pdf)

Vacancies: Practice Manager and Practice Receptionist

We are currently looking for a Practice Manager to work 15 hours per week in the practice and a Practice Receptionist to work 19 hours per week.

The posts can be combined should someone want to work full time, or can be split if we have applicants that wish to work part-time in one or other of the posts.

Anyone who is interested should ask at reception for an application pack, call 01369 860 224, fax 01369 860 225, or email

The closing date for expressions of interest is Wednesday the 12th of September, with a planned start date of Monday 8th of October, 2007.

Practice Manager Job Description

Receptionist Job Description

Application Form

Marion Jamieson leaving

We are sorry to announce that one of our receptionists, Marion Jamieson, is leaving the practice at the end of September.

Marion has been with the practice for several years. Although she no longer has a house in Tighnabruaich, she has been traveling in some distance to work in Strachur twice a week. She and her husband have recently moved to a new house in Ayrshire and the traveling distance is now too great for her to continue working at the practice.

We wish Marion and her husband all the best in their new house, and I'm sure all the patients will want to join in our thanks for all her work in the practice over the last few years.

Anyone who would like to contribute to her leaving gift should speak to Liz Fraser at the dispensary hatch any weekday morning.

Breast Screening Service

The Breast Screening van will be in Strachur from the 25th-27th of July.

Women between the ages of 50 and 70 should have received an appointment by now through the post.

If you have not received an appointment, or are outside the normal age range but would like to arrange an appointment, all 0141 572 5800.

New lights


The electrician should be coming on Monday (18th June, 2007) to fit the new lighting for the practice.

I've always hated fluorescent overhead lights, and the ones in the practice are the old-style ones which are particularly ugly and prone to headache-inducing glare.

To replace them, we'll be using ceiling mounted spot lights. We can't mount them into the actual ceiling because we would have to remove too much of the roof insulation for fire safety reasons.

However, Ikea do nice spot lights mounted on a ceiling track that should produce a pleasant, warm light in the practice with minimum glare.

Book writing

I'm busy writing a new book just now, and my publisher has given me a deadline of the end of July, so Rosemary Wright and Jurgen Tittmar will kindly be carrying out all of the surgeries until the end of July. I'll still be on call at times, and I'll be about at the surgery doing paperwork and generally trying to avoid actually writing the book!

Robbie Coull

Practice manager leaves

As many of you know already, Gill McCormick the practice manager is no longer working with us. Sadly Gill had to be dismissed last month, which means more work for the rest of the team at the practice.

We'll be looking for a new practice manager later in the year.

Change in consulting times

We've been experimenting this month with a slight change to our consulting times. We have been having an afternoon surgery from 3pm to 5pm on Tuesdays and Thursdays. Previously we had an evening surgery from 4pm to 6pm on those days.

This seems to work very well. Patients who work, or who have children, can now get a routine appointment at a range of times to suit them. Also, Kate our practice nurse works from 3pm to 5pm on those days now as well. This allows us to work joint appointments more easily. This makes things easier for patients who need to see the doctor and nurse together. It also makes things faster and easier for patients that the nurse wants the doctor's advice on. Or for patients that the doctor needs the nurse's assistance with. For example, intimate examinations or wound dressings.

So the new consulting times for the doctors are:

Monday 9am-11am and 4pm-6pm
Tuesday 9am-11am and 3pm-5pm
Wednesday 9am-11am
Thursday 9am-11am and 3pm-5pm
Friday 9am-11am and 4pm-6pm

This makes a huge difference from the old consulting times that Dr Basu used which were just from 9am-10am and 5pm-6pm each day.

(Please note that for now Dr Wright still uses the old consulting times on the days that she is working.)

NHS Prescription Tax rise

The NHS has decided to increase the prescription tax to £6.85 from the 1st of April.

Easter Holiday

The surgery will be closed on Easter Monday, the 9th of April.

Dr Coull will be on call for emergencies over the Easter weekend, so in an emergency call 01369 860 224 to contact the doctor.

Parents - get free Calpol and Nurofen on prescription from the dispensary

Coughs and colds are in full swing just now, so remember that children are entitled to free Calpol and Nurofen for Children, on prescription, from the dispensary.

Simply place your order at the dispensary. Usually it will take two working days for us to dispense and check you medication, but if your child needs to see the doctor, we can dispense it during your consultation.

We're now 20% bigger!

The practice list size has grown from around 700-750 permanent patients in April 2006 to just under 900 patients now.

To cope with the extra workload, we have extended the doctor's consulting times to allow up to 100 patients to see the doctor each week without having to 'double up'* any appointments.

We are also hoping to employ a technician to take bloods and do blood pressures. This will free up more time for patients to see the doctor and practice nurse.

Thank you to all the patients who have made the effort to come to the surgery instead of having a home visit. This helps us to be one of the few practices in the country that sees all patients the same day, while still allowing patients to book appointments in advance if they prefer.

* 'Doubling up' is when we squeeze two (or more) patients into an appointment slot. We do this to make sure that everyone can still be seen the same day without having to wait. However, this means less time for each patient, and often results in the clinic running late.

Free WiFi Wireless Internet Spot

The practice waiting room now has a free wireless internet access point.

If you have a wireless laptop, or a WiFi enabled PDA (such as the Palm TX), then you can use it to surf the internet or send/receive emails from the practice waiting room.

Simply select 'Strachur Medical - Public WiFi' from your wireless device to use the free service.

Like the internet, the WiFi spot is an open network. So don't send anything confidential (such as passwords or bank details) unless you are connected to a secure web page. Secure pages are indicated by https:// at the start of the address and a lock icon in your browser.

See here for more information on using WiFi.

Medication Reviews

We now have the automated medication review system up and running. It took a bit of time (there were several hundred patients with nearly two thousand medications that all had to be updated on the computer by hand).

This system will allow us to monitor patients on repeat medications more safely. The system will automatically remind you when you are due for a medication review. Medication reviews are usually done every six to twelve months, and they allow the doctor to check that you have had all the right monitoring done. This greatly improves the safety of repeat prescribing.

You should also notice that your repeat ordering form has been tidied up, making it easier to order your repeat medications.

The safest way to order your medication is to tick the boxes on your repeat order form, and to hand this in to reception. You can also post it to us at the address at the top of this webpage. Or you can fax it to us on 01369 860 225. Please try and avoid phoning in repeat requests if at all possible, as this is more likely to lead to mistakes and ties up the phone line and staff time.

Your medication will be ordered and checked, and will be ready to collect from the dispensary in 2 working days.

If you see a note on your repeat ordering form saying your medication review is due, then simply make an appointment to see the doctor for review before ordering any more medication.