The rain came and so did the flood . . .

Yesterday, about lunchtime, it started raining here in downtown Northernshire. Slowly, as the temperature rose, the snow and ice started to disappear.

Last Friday’s “something for the weekend” emergency surgery had 3 punters. This Friday’s “something for the weekend” emergency surgery was full to the gunnels. Not one of them was an acute, life threatening, medical emergency. The first 5 each spent 15 minutes talking about nothing medical. As a doctor we were wasted as there was no illness.

For days our surgeries have not been full but the supermarkets have. Emergency surgeries of 24 patients have had maximums of 7 punters. What does that say about real illness, the effect of weather has upon it and how the population view General Practice as visits have been minimal which they should be anyway in any first world country?

Accident and Emergency attendances have been almost 5 times higher but this might be due to genuine illness like broken bones that needs acute medical care.

The cold snap has posed many questions in our minds about the use of General Practice by the population and its provision by Government, and illness and how, and when, it presents. We do not have the answers but we will try to find them.

The drive home was a mix of low cloud and fog on roads awash with water and the Practice Ferrari was taken on the back roads for a change albeit it at no more than 40mph at best.

The weekend forecast is for more rain and above freezing temperatures. This morning most of the snow and ice had gone so hopefully come Monday things will be back to normal. Full surgeries, possibly fuller than normal surgeries, as people now feel the need to venture out for “necessities” and “emergencies” other than food and petrol namely healthcare.

All of our staff we have spoken to this week have said the same thing that they wish the snow will go. Many have struggled in, some literally on hands and knees, using buses and trains instead of cars to get into work and many have fallen or skidded their cars but still they have come. They have arrived late but have arrived and then worked as normal.

Thank you to all our staff and we suspect in many other Northernshire practices the same will apply.

We would also like to thank the local ambulance service who have done an incredible job given the circumstances and for the first time in ages cancelled the normal outpatient taxi service that is 90% of their workload. Before the NHS emergency work accounted for 90% of the workload but it only took 2 years for people to realize that taxis are provided for free by the State for healthcare.

General Practice is not liked by the Party but, bar one day only, we have provided a full service.

Praise be to the Party for all of their support during these difficult times. It has been much appreciated as always.

The Met Office have forecast a milder and wetter winter as well what joy . . .

Snow in Northernshire some practice points.

Snow is white rain or frozen water that falls from the skies under certain atmospheric conditions. In terms of its impact on United Kingdom there seem, based on our cumulative experience here at ND Central, to be certain patterns that occur each time we get a bit of the white stuff.

The first is when more than a centimetre or in old money about half an inch falls in an hour or so all businesses shut up shop and decide they have to drive home. In doing so all roads become congested and traffic grinds to a halt.

Full surgeries result in no more than 3 patients turning up in 3 hours and local politburos whose function is vital to the smooth running of the NHS shut up shop too and vanish.

We here in GP land wait until the last patient is due to have left and then spend 4 hours in traffic doing the normal half hour commute.

The next 2 days virtually no-one ventures out, local PCTs declare public holidays for all their staff for increased efficiency while GPs open and most staff manage to get in after the first day of disruption. Initially few patients turn up and home visits decline to almost zero as people realize that they can’t get out so their GPs can’t in either as opposed to the normal GP visit request of we can get out but can’t be bothered.

Surgeries experience new hazards.

When one walks into reception it looks like it has been a convention for incontinent geriatrics as in front of each desk is a large, and increasingly larger each hour “wet patch”. The entrances to the building look like a rugby team after 8 pints of lager has decided to let rip in the same spot and there is an even bigger wet patch that squelches under foot and water is visible either side of your boot. And that is with the extra carpet on top of the wet patch to absorb the water deposited by all the patients’ footwear.

Footwear also changes with most now wearing Wellingtons. For those of us that have to do visits a good pair of Italian made mountaineering hiking boots capable of taking crampons combined with Yeti gaiters are essential for visits off the main roads where the hazards of compacted snow and ice and a foot of uncleared snow present the combined hazzards of slippage and very wet trouser legs (well you did ask!). One does not wish to land up in A&E as a GP wearing a pair of normal leathered soled shoes in these winter conditions as we can hear the laughter now.

The interior of the car after a few days develops a new damp odour due to the deposition of snow from boots and the daily commute starts with 10-15 minutes of clearing any new snow off the vehicle and de-icing the windows on the outside and increasing removal of water vapour from the inside before one can safely drive off.

Although the practice has grit bins these empty rapidly and soon grit becomes unobtainable.

As the roads become clearer surgeries start to become full again and visits increase although the hazards do not disappear once one leaves the safety of the main gritted routes. Taxi trips increase as people cannot get their own vehicles out and although a lot of people do walk some fear the risk of falling on iced pavements outweighs the cost of the taxi fare.

Examinations take longer as patients arrive looking like suburban Yetis in increasing numbers of layers and bizarre South American woollen headgear to protect them from the bitter cold of the walk from the house to the car and then the second exposure to the Arctic conditions from the car to the surgery.

In rooms with poor heating electric fires appear in order to prevent the occupants’ hands turning blue during the course of a surgery and the sight of patients in Yeti wear recoiling from the first touch of real cold from a doctor’s, or nurse’ hand which has been in the cold for more than a couple of minutes.

One of us went to a local hospital yesterday and made a very pointed observation that while the local supermarkets. which don’t charge for parking. had managed to grit and clear large areas of their car parking space the hospital had only cleared a small part at the front main entrance and, despite charging for parking, had done nothing to clear the roads or parking areas.

We did note that they were starting to put some grit down using a makeshift hopper on the back of a van but we suspect this will have little effect on the 2-3 inches of compacted snow and ice that had developed after several days of no treatment. The local shopping malls’ car parks were snow free oasis and well gritted by contrast and still they offered free parking and make a profit.

People have been so much nicer too. One of us was helped by a complete stranger to dig a car out after we had to abandon it on the first day of the snow. We were digging away merrily on our own when suddenly a second shovel starting working. Neighbours have been helping people with their cars too. A patient told us that most of the residents of their close on a housing estate, 9 in all, came out to help an ambulance that could not get up onto a main road for 20 minutes.

So here are a few thoughts and observations from the winter wonderland that is Northernshire at present. Hope our readers wherever they are in the world are enjoying their version of our winter wonderland. And some forecasters are predicting up to 2 weeks more of this.

We will cope we have done so before it just makes life a little harder that is all.

Praise be to the Party and all its wise managers who will be coordinating the war on winter with the same efforts used to fight the deadly swine that is the ‘flu. We are in all in such good hands.

Right checklist: boots, gaiters, crampons, ice axe, shovel, window scraper, rope rucksac with emergency kit, snow chains, lashing and lashings of Kendal’s mint cake, flask of warm cocoa and most importantly, for emergency use only, the hip flask and its off back to work we go . .

Something for the weekend sir or madam?

There is always a first time . . .

Following on from yesterday’s weather related post, one of the team, for the first time in their professional lifetime, failed to get their Ferrari out of their manor house’s drive and into work due to snow. There is a huge sense of failing in not being able to get in but the conditions were not the best for rear wheel drive vehicles and most people on the manorial estate that all GPs reside in were in the same boat. More people on foot than usual and all saying the same thing we set off for work and then stopped and hadn’t moved since.

At 06.00hrs was there only yesterday's thin covering of snow by 08.00hrs there was 4 inches. A snowplough got out at lunchtime but the track it cleared and the grit it spread is now covered over by fresh snow. We are stuck and it is still snowing.

The telephone lines have been most entertaining as they are several feet lower than normal and every now and again one of them will start bouncing up and down for no apparent reason before a white, snake like, curved line of snow plummets downwards. The line has broken one thinks as one watches the snow fall down creating a curved indentation in the untouched newly fallen snow?

It looks like it has as one looks at where the line was but then if one looks a foot or two higher one sees the telephone cable is still intact. The schools are closed, the buses cancelled, blood collections normally collected by taxi are being yomped to local hospitals. Those of the ND Central team who could get into work went in 4X4s, on foot or as best they could. Some of us, for the first time ever, could not.

Praise be to the Party for it is always prepared for everything. We are surprised that no-one senior has been wheeled out to tell us how we are the best prepared country in the world for flu, sorry we meant, snow.

Must have been the “wrong” kind of snow? And the ice man cometh tonight . . .

Winter in Northernshire and a new decade.

Today saw a change in the working practices of one of the team here at ND Central as for the first time in decades they did not do the “something for after the weekend” Monday morning surgery. This was due to changes in personnel circumstances and illness within the Practice that meant certain days in the week were less well covered. So like many GP Practices we had to think and adapt the way in which we operate to cover need.

This meant for one of us, instead of being stuck in traffic after more snow on the ground, competing for road space with mothers whose faces were intently shouting at the back seat: “Tarquin will you stop hitting Chantelle with tha Nintendo I am trying to concentrate” seconds before they plough into a line of stationary traffic which “stopped too quick and me eyes was on the road honest officer” we were stuck at home.

An unusual experience not going into work on a Monday (apart from Bank Holidays) for the first time in one’s long working life. Still we did not sit idle as we had plenty of paperwork to do.

At about 10.00hrs we took the dogs for their walk in daylight, not darkness, bright winter sunshine with a brilliant blue sky and no clouds to be seen. There was no traffic noise and the huge blue dome above the thin sprinkling of white newly fallen slow crunching under our boots made Monday feel so much better than normal even though it was minus 4.5 degrees C.

What struck us as we walked was the silence broken only by the noise of jets visible via their vapour trials above us and the crunching of the snow under our boots. At this time of year you realize how many aircraft are above us in the UK but most of the time, because of cloud and wind, you do not see and may only just hear them. Today we counted 8 aircraft in the sky at high altitude at once. Some were flying North to South (or vice versa) or West to East (or vice versa).

All incredibly ordered and the only thing disturbing the silence of a Christmas card perfect winter scene. We thought if there were say for the sake of argument 450 passengers on each plane then above us could be a total of 3600 people en route to various destinations. And this was being repeated every 10 minutes or so as the first planes left our view and were replaced by others following the same directions albeit on slightly different flight paths.

This meant in the course of our hour long walk and according to our mental mathematics that 21600 people had past over our heads in an hour. More than twice the size of our Practice and anyone of which could have been the victim of a terrorist attack.

Scary thinking on a free Monday morning but like all good grunts on the ground we just get on with life aware that life is not a risk free phenomena.

Tomorrow we will not be so lucky. We will be in the morning rush hour with the Shazas driving Tarquins to school. There will be ice on the road and idiots who know that the stopping distance at 80mph on a dry road is 8 feet on ice it is the same. (Stopping distances on snow and ice can be 10 time the normal “8 feet” dear reader).

So while we considered the empty and silent Northenshire winter countryside we felt small but at peace. Does anyone wonder why GPs increasingly opt for early retirement?

After this unique Monday, many more of which may/may not be coming our way, we can see why.

Praise be to the Party whose dedication to finally providing GPs with an occupational health “service” is matched only by its desire to make medicine more and more unsafe while making flying “safer”.

Body scanners at airports, but not for local hospitals (unless by charitable donation), restricting pilots’ hours while increasing GPs and junior doctors, will they be doing the same for the NHS as they do for aviation?