1830 GMT Time to go home after a very long day. I have a 25 minute drive home and I want to get there before my children, Catrin and Megan, go to bed. I try not to worry about work once I'm home and hope that I've made the right decisions in managing the patients today. A: from Dr Alun Jones-Evans Our current list size seems ideal for our rural environment. We have 10 minute consultations and in general I find this is sufficient time to deal with most problems. Invariably there will be occasions when more time needs to be spent with the patients. Q: from Alan M Bush, AberdeenYou say that you have a reasonable patient to doctor ratio. This should provide you with more time for each patient. Is this advantage prejudiced by the size of your geographical area and lack of public transport? In my town surgery time is a real problem - I cannot ask for a specific doctor if I want to be seen within five days. 1810 GMTI got back for afternoon surgery at 1730. My final two patients include a young lady who is complaining of excruciating abdominal pain and a local farmer who is suffering from tiredness and depression.
I prescribed anti-depressants when he last came to visit me, so this appointment is a follow-up to check how he is getting on with these.
I am used to seeing people with psychological problems. This town was hit hard by foot-and-mouth, so many farmers felt depressed and were under a lot of stress. Some committed suicide, but none were patients of mine.
A: from Dr Alun Jones-Evans Yes because I believe that medicine provides a very satisfying and interesting professional career. Q: from Will Herrington, LondonPolice officer salary �25,953 (after 18 weeks initially training); junior doctor �25,953 (after 312 weeks initially training). Would you recommend your children to become a doctor? 1700 GMT I'm on my way back from seeing Mr Neal, but I've encountered some roads that have been flooded from the heavy rain.
I am seeing patients back in the surgery soon, but I'll have to find another route back.
A: from Dr Alun Jones-Evans I read medical journals when time permits and get information from hospital doctors when they send discharge letters on people who have had hospital care. If I'm unsure about a particular problem then I'll research it on the internet.
These days it is not unusual to find patients who are more informed of their medical problems than I am.
Q: from Mike Williams, NottinghamHow do you manage to keep up to date with all the medical advances? 1600 GMT I've just arrived at my next house call. I've come to see Ronald Arthur Neal and his wife and carer Doreen. Mr Neal had a hip replacement operation six years ago and never felt it was quite right.
He had an X-ray which showed the hip replacement was quite loose. He was on the waiting list for 15 months for a revision operation and before he got to have his operation he sustained a fractured femur.
If he had been operated on sooner the break in his femur could have been prevented. It's common sense that if someone is waiting so long with increasing pain they should be seen quicker. I did write to the hospital to suggest he be placed towards the top of the list.
He hasn't been outside the house for at least eight weeks now. I'm going to make sure he increases the dosage of some of his tablets he is already taking for dizziness and hypertension.
1510 GMT I'm off on my next house call to Meifod which is 6 miles away from the surgery and it's started raining again, so it could take longer than I thought to get to if the roads are blocked.
Meifod was blocked off last Monday as well after the roads became flooded, so I might be gone sometime.
1444 GMT As I drive back to the surgery to collect some things I need for my next house call, I miss all the beautiful countryside that is surrounding me.
I'm so busy that I don't often get to appreciate the stunning landscape. It's stopped raining at last but my next house call will be harder to get to because of flooding.
My wife is also a GP so it can make it hard if we're both on call at night time.
I live in Llanfyllin which is 15 miles away from the surgery, so I can't just pop back home for lunch. But being so far away does have its advantages. One of the doctors living in the town can sometimes get disturbed when he's not on call.
1427 GMT I have to make quite a few house calls because of the poor state of the public transport system in Llanfair Caereinion and the surrounding area.
I've just arrived at the house of Martina Down, who moved from Somerset to be with her daughter in Wales.
She suffers from multiple sclerosis and is wheelchair-bound following an operation to remove an overgrowth of bone from her foot after a chronic ulcer was found on it.
I'm going to listen to her chest, but it looks like she is suffering from a recurring chest infection.
Mrs Down gave up her job with Scope to come to Wales and she has found that since she has been here, she has been constantly ill. Reduced activity can pre-dispose some people to infection, so I have prescribed her a course of antibiotics.
She had a chest X-ray the day after Boxing day, so I won't need to send her in for another one, however she has also just complained of digestive problems, so I want to start her on some tablets to reduce acid secretions in the stomach.
1403 GMT I'm off on my home calls now after finishing writing up some paperwork from this morning.
It is still raining, so it looks like it will be quite difficult to get around as many of the roads are flooded from heavy rain overnight.
This means that I have to travel quite long distances to get to many of my house call patients.
1230 GMT Before Oliver leaves, his mum asked me about a complaint she has been suffering from. She would like a new prescription for some more Codeine to help relieve the pain that she has been feeling and asked me now because it will save her getting back to the surgery again. It is half-term week so I'll be seeing a lot of children and their mums before the week is out. 1200 GMTLittle Oliver Lewis has just walked into the surgery. His mum, Jackie is concerned about his cough as he suffers from asthma. Oliver is nine-years-old and recently hyperventilated in the swimming pool following an asthma attack.
I'm just going to listen to his chest and I can hear he does have an infection there. He has had a nasty cough for three weeks now so I think it is about time he had some antibiotics.
I'm going to prescribe him Amoxcycllin which is an antibiotic and also make him increase the number of times he takes his Becotide, which will help him prevent any future attacks.
He also takes ventolin if he does feel wheezy. I am just going to give him a peak flow test as well to test the capacity of his lungs.
A: from Dr Alun Jones-Evans No. We've got a low list size and traditionally doctors in rural areas have a lower percentage of patient's to GPs because we spend more time travelling out to see them. I think our list size is sensible. Q: from Mark Huyton, England Do you have more patients on your list than you would like in an ideal world? A: from Alun Jones-Evans Once I decided I wanted to become a doctor I applied for various medical colleges in the sixth form and was offered a place at Kings College, London. I spent six years studying medicine. The course is actually five years, but I failed my second year, so had to retake that.
I then did a year of what are called pre-registration house officer jobs which involves working in a hospital dealing with general medical and surgical problems as part of a team of doctors.
Then I decided to train as a GP and I did a three year general practice vocational training scheme at the end of which I was qualified to work as a GP.
From my personal experience it is worth it in the long run. I enjoyed medical school, socially and the academic aspect. But the courses have changed since I trained. I find working in general practice very satisfying, professionally and I enjoy living and working in a rural area.
Q: from Amit Patel, Leicester How did you become a doctor. Which qualifications did you take, and is it worth it in the long and short run? 1100 GMT My first patient of the day is 11-year-old Megan Popplewell from a village called Foel which is 10 miles away from the health centre. Her mother called up at 0900 after Megan complained of a swollen and infected eye.
Megan came with her mother Carol and her brother Luke. I'm looking at the eye at the moment and it looks very sore. Megan is explaining that it started watering yesterday and then just got worse this morning.
It's not conjunctivitis as I thought earlier, but she has got an infection of the lower eyelid. Sometimes the glands in the eye get swollen which can lead to infection.
I have just given her some ointment to put on the eye every day, so it shouldn't be too long before she is back to her normal self again.
A: from Dr Alun Jones-Evans That's a big question. I think it will continue in some respects as it is, in as much as there will be a local general practice service. I think most practices will tend to get bigger though and there will be a bigger range of services offered locally. Traditionally GPs also own their premises but I think we will see a move towards centrally-owned premises with GPs working as salaried staff. Q: from John How do you see general practice going in the next 10-20 years? 1031 GMT A well deserved coffee break. Time to grab a moment of quiet before the day gets really mad.
It's quite a big surgery with a large catchment area, so when I go out on home calls later I'm going to be driving some long distances to meet the patients who need medical attention quite urgently.
Then after that it will be back to the health centre. It keeps me busy!
1015 GMT I'm still fielding emergency calls that are coming in. Since 0900 I have had nine calls. One of the patients that I have seen before is coming in to the surgery at 1110 because she is feeling unwell after having a hepatitis injection.
I also had to reissue a prescription for one of my patient's who is suffering from constipation. It's amazing how many different illnesses I have to treat in one day. Another of my patients is suffering from a skin condition so I have issued him with some more medication and will be making an appointment to see him at a later date.
The surgery's waiting room is filling up already.
I'm just off to search now for some of my patient's medical records before they come into the surgery.
0907 GMT Already the calls are starting to come in though. The mother of an 11-year-old has just called me. Her daughter has a problem with her eyes. It's most likely to be conjunctivitis, but she is coming to the surgery to see me at 1100.
Just as I put the phone down, it rings again. This time I offer a consultation in Welsh because some patients prefer it. About a third of all my consultations are in Welsh.
The patient is having problems with the painkillers I prescribed to him on Monday. He is suffering from joint pain and arthritis. I tried him on some strong anti-inflammatory painkillers, but he had a reaction to those, so now I am going to prescribe Rofecoxib which should offer him some relief from the pain.
0845 GMT I've just arrived at the surgery and it looks like it's going to be a very busy day. I'm acting as the duty doctor today, which means I have to respond to any patient that requires urgent medical attention.
I am also in charge of answering any queries about a patient's prescription including any problems they might be having with their medication. But first I have to stock up on some emergency drugs just in case I get called out on an emergency in a hurry. I also have to double check that these drugs are not out of date.
It hasn't stopped raining today and many of the roads are completely flooded, which makes any emergency calls difficult to get to even in my 4x4 vehicle.
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