Do you have a partner that doesn’t conform? Me too, writes our practice manager using the alias Mary Mippins. Life would be so much easier if they all did the same thing, wouldn’t it? And did as they were told.

I keep thinking I’ve got it all sussed. Extended hours? In the bag. The doctors are behaving themselves quite nicely, and patients seem reasonably happy. Today the senior partner was duty doctor and there were no visits. Nice one!

Except the senior partner keeps disappearing to do visits even when he isn’t duty doctor, and I wonder just who it is that he is seeing. After all, shouldn’t it be recorded for medicolegal reasons at least? I tentatively broached the subject at coffee time.

Had he managed to get much paperwork done, given that he’d had a reasonably quiet morning? No, he hadn’t. Nor had he managed any phone calls. He had, however, managed six unplanned visits. He wasn’t duty doctor either – and the look he gave me dared me to argue with him.

I didn’t bother. Because, at the end of the day, our senior partner is an old-fashioned GP who actually really cares about his patients, will visit them at a drop of a hat, telephone them just to “see how you are”, and work himself into the ground until midnight just to fit it all in.

We laugh and shake our heads when he picks up the phone to tell someone their blood tests are fine, we shrug our shoulders when a patient walks in on spec and is admitted into his presence like an old friend. We sigh when he refuses to put anything on the computer.

He could make life so much easier by conforming to my master plan. Limit phone calls, triage visits, stick to 10-minute appointments (his average is 30 minutes), use the computer, refuse to see patients if they’re late, and pass some of the routine stuff on to the nurse practitioner.

He might even get to eat lunch and smile once in a while, which would make us all a lot happier, but his patients would hate it and that would make him miserable. Advanced access or old-fashioned doctoring? I have come to the conclusion that to achieve the first, you can’t have the last. Which is sad, really.

Forgoing lunch (again), I managed to get to a hospital meeting that centred around ambulance response times and why our particular trust was failing miserably to achieve this. Reasons included a lack of ambulances, lack of trained staff and abuse of the system by patients calling 999 at the drop of a hat.

I ventured to ask whether anyone had looked at the constant abuse of the ambulance transport service. Patients breeze into our surgery and demand transport to their hospital appointment because they can. But if they can breeze in, then they are certainly mobile and can get to the hospital reasonably easily, if they are prepared to pay.

And there’s the problem. Nobody wants to pay. So we negotiate and argue and in the end probably give in because it’s not our budget, and who are we to judge, and no one else seems to be bothering. If practices held their own budgets for this particular service, I wondered, would we see a dramatic decline in hospital transport? Perhaps then there might be more money available for more ambulances to get to emergencies faster and more lives might be saved.

I actually suggested this, saw the reaction, watched a few frantic scribbles and realised I’d probably started something really controversial. I asked for my comments not to be minuted. The chairman, who happened to be from the ambulance trust in question, smiled broadly and assured me my name would not be mentioned.

As I was the only practice manager there, though, I doubt that will help much when the minutes are circulated.

Call me an ambulance – I may need one.