The standout moments of our last practice meeting are two quotes from my partners:

• “As doctors, we won’t be able to deliver what patients want anymore. I think we will now only be able to deliver the care that they need.”
• “But patients don’t understand what they need.”

Wow! These two comments are the sort of fodder for searching interview questions with the rider attached: “Discuss”. They do, however, raise interesting points. The NHS is struggling and the squeeze is on to justify referrals, admissions and procedures.

I have just finished analysing our inhouse orthopaedic triage data. It makes interesting reading. Our salaried doctor workforce is young but efficient; they have sound judgement and don’t necessarily over-refer. But what is classified as ‘over-referral’? To a surgical specialty an appropriate referral may be a referral that results in a procedure being undertaken, but is that the sole discriminator of an appropriate referral?

Our registrars have been really good. They have both been interested, involved and have in many respects reinvigorated me as a trainer. It’s good to see that despite my ramblings and pessimism, new and enthused GPs on the horizon. They also seem keen that their cars don’t collide with others in the car park (a saga that seems finally to have ended).

Many projects are currently being pursued in the surgery at present – it’s exciting and challenging. At the core, however, must be a feeling of equality in workload. Following a frank partners’ meeting this appears to be appreciated by all. It’s interesting to consider our own qualities and how, with our practice manager, we can best utilise our skills.

Our practice manager faces the unenviable tasks of marrying things together and of feeding back our inhouse 360-degree appraisal. But we’re adamant this is not to be a counselling session – just a focus on feedback and ‘the raw facts’. How we address counselling and potential support will be decided by the individual. There may be flaws but we’re keen to explore things.