Penguin68

I would tend to add (3) when a large coach or articulated lorry swings in and out of the much restricted road space to turn, and crushes thereby a cyclist, which apparatchik or counselor will stand up and admit that it was their mad scheme which has led to death or serious injury at a junction noticeably without either before the changes were made, and will resign? Oh, silly me, none of them will.

Not as easy to read as a note on the car windscreen - surely?! Actually, if you don't use your car every day (perhaps mainly at weekends) and you haven't parked it that close to where you live (not uncommon in ED) and don't walk past it as part of your commute you might actually miss a windscreen note - if you, or friends who know your car, read the forum, then maybe it is an effective communications medium. And, as has been noted, any port in a storm when an alarm is going off constantly (which, with an over sensitive motion sensor, these windy conditions could easily trigger).

If you enjoy waiting 4 weeks for a routine appointment, being left on hold for 15 minutes each time you call, y our results being lost and the odd snappy, rude receptionist then I highly recommend Forest Hill Road Group Practice. Not my experience having been a patient there for over a quarter of a century - I have had long waits for an appointment with a (named) doctor over the summer, when the said doctor was on leave, but otherwise seen within 48 hours (or telephone consultation) for anything urgent, normally same day. 'Routine' appointments are the ones which you can (reasonably) wait some time for - it is urgent ('I am actually ill, now') appointments where timeliness is key. Receptionists not rude in my experience, no results lost (for me or the other 3 members of my family). Have had some prescription mix-ups in 25 years, quickly remedied - (mainly one item left off, never the wrong drugs or the wrong strengths prescribed).

I recall some whining by the DMC Healthcare poster that if it wasn't for no-shows everything would be ros(ier) - maybe if it was possible to get through to the practice to cancel appointments no longer necessary (so much time has lapsed patient is better, dead or has found someone to treat them) then there would be fewer missed appointments - no one in their right minds is going to hang on as long (or dial so frequently) or actually go round to the practice just to cancel.

I have been a qualified driver for 48 years - one thing my years of driving have taught me is that accidents tend to happen when road users are (a) confused and (b) frustrated. The proposal as recommended seems to me to have a very good chance of (a) confusing and (b) frustrating road users (all, motorists, cyclists, pedestrians) - particularly when very large vehicles (coaches, lorries) have to swing out into roads which have been artificially narrowed. Where traffic is grid-locked (it will be) pedestrians may choose to hasten across the road amongst what they anticipate will be stationary traffic, until a two- wheeled vehicle dodging between vehicles knocks into them. In general I believe simple is always better - this is one of the least 'simple' traffic arrangements I have ever seen in what is or could be a simple, suburban street junction. The only possible upside is that most collisions will necessarily be low speed and thus relatively low impact.

I think we are talking about ADSL and fibre services here. ADSL can be significantly impacted by the distance from the exchange (the signal attenuates over distance). Speeds will also attenuate where the access is wireless, not wired - so wireless ADSL will be less fast than direct (ethernet) connection to your router, ADSL far slower than fibre (for BT - BT Infinity). The EDT may well be connected by Infinity - and will certainly be a business service. If memory serves 3.28 mpbs over ADSL wasn't that bad, with old(ish) equipment. If you (DF) are paying for BT Infinity however, then you need to contact BT, as something is clearly wrong.

I have BT Broadband (Infinity) - I really haven't had the problems you are talking about, on PCs, TV, mobiles, tablets. I did have a drop-out problem, which I finally identified as a browser clash - using a different browser sorted it (the browser was not compatible with a networking component in my PC). Problems can exist in (your own) hardware and software and can also happen where there is wireless channel contention with neighbours. It is also possible that you have a problem with your external plant (the wires coming into your house from a BT flexibility point - this can normally be checked for, although if the fault is intermittent it can be a beast to uncover). The underlying broadband service can also fall-over, but when it does BT is generally quick about curing it - a couple of years back they had a problem with a firmware upgrade on the exchange side which caused wide spread problems for a few hours until diagnosed and cleared, but normally outages are much more quickly sorted (other than actual physical destruction or theft of cables which can take days to sort out because of the complexity of jointing twisted pair to the (right) twisted pair). As all the physical network (but not exchange based equipment) for residential services other than Virgin media is actually BT supplied you are anyway significantly reliant on BT - and its underlying broadband service (I can state from personal experience) is generally robust and non-problematic. The problem is that 'getting broadband' requires a large number of equipment and software elements, from multiple suppliers, and identifying where there is a problem can be complex. Many years ago an I-Tunes software upgrade included lines of code which disabled certain routers, for instance, - it can really be that weird.

If you own a practice, the more people on your books, and the fewer GPs you hire, the more profit you will make. Other staff costs include receptionists, practice nurses, other clerical and admin staff, as well as expenditure on IT systems, telephony etc. All possible to cheese-pair on. Some medical staff (such as midwives and Community Nurses) may be based in GP practices, but are paid for by NHS trusts or successor. Generally salaried doctors earn far less than the headline earnings you read about for GPs (around ?100k+) which are for partners. Additional payments are made for achieving particular targets, although I am not sure how these are audited.

If you haven't got a shredder, and plan to buy one, it is a good choice to buy a 'cross-cut' shredder, which cuts the paper into pieces about an inch long and 3/10s inch wide rather than one (an older style) which just cuts into long strips, which are easier to reassemble. You can now buy relatively economic shredders which cut 8 or so pages together. Which is not to say this is what the scavengers written about are actually after.

The stark reality is that if you need to see a GP urgently ... But only at certain ED surgeries - many do offer real 'same day' appointments - mine does for instance, for 'urgent distress' (i.e. actually being ill). This will either be immediately face-to-face or a telephone consultation - often all that is needed. I only have to wait any length of time if I want to see a named doctor - and then this will be about something routine - i.e. care review of a long term condition, when I am looking for continuity of care. That is why the DMC saga is so annoying, even in ED it doesn't have to be like that - it's not just 'the way it is' in SE London.

Absolutely yes - the 'research' published by Andrew Wakefield has been shown to be rubbish, and withdrawn by its publisher, and Wakefield has been struck-off. There is NO evidence that the MMR jab causes any problems, and, in so far as any vaccination could be an issue, having separate jabs rather than the combined MMR would be more, not less likely to cause these problems. Protecting your child from measles and mumps will save them from the possibility of nasty complications (and both diseases are unpleasant to have, even if no complications arise), and rubella, while itself quite a mild infection, can lead to dreadful disability if caught by a pregnant woman. Because of the stupidity of parents earlier on you cannot rely on herd immunity, in London, protecting your children if unvaccinated. You are lucky to have a doctor who is bothering to remind you of this. Follow his advice.

Plusnet is wholly owned by BT - but operated at arms length. Like any ISP/ broadband provider (save those providing satellite broadband, which is very expensive, or mobile broadband - slower and also often more expensive than e.g. fibre services) it has to have a physical link into the house - it uses telephone lines (as do most providers other than the former NTL Cable company, now re-branded as Virgin, who uses cable access). Hence you have to be getting telephony from someone for them to be able to connect to you. Almost all domestic physical connexions (other than cable TV) are eventually provided by BT Openreach, the provider of wholesale local network to BT Retail as well as to most other non cable ISPs. Just out of interest, emergency services (999) are only guaranteed delivery over a hardwired phone using a landline, because landlines are powered from exchanges which have back-up battery systems in case of power failure. Even if you lose power in your home, a hardwired phone will still work - wireless handsets rely on the base station to be powered, the exchange power won't be sufficient to run those. Mobiles will of course continue to work, if you have power, and signal!

BT started in the telephone business - its delivery mechanism to the house is via telephone lines - Virgin started as a cable business, its delivery is via coaxial (was anyway) - the engineering in the BT Network is enhanced telephony, that of Virgin enhanced cable. Hence BT charges for the (telephone) landlines it uses to deliver services - broadband with telephony; Virgin offers broadband with cable. It's the way their network topologies were designed and work. For Virgin it's actually more difficult to provide telephone services over their sort of network - hence they are happy not to have to. For BT it's the telephone network which forms the backbone of their delivery system, - although now there is Fibre to the Cabinet (FTTC) they offer hybrid systems - but the twisted pair going into the house is essentially part of the telephone network, which additionally (with the right electronics) carries broadband.

Sorry - I think I had read that piece and sort of forgotten its origins.

Good piece - you might want to think that with the Grove abandoned, the Dog shut and being rebuilt as a reduced pub with rooms and the Half Moon in doubt, the Dulwich Estate has managed to blight every decent sized pub (EDT an exception, and not that large) in the area. And the Estate doesn't own the EDT site. Are they secretly teetotal Quakers?

20 years and more ago the early inoculations were covered off (as far as reminders) by the Health Visitors (do those still exist?) with the pre-school reminders coming from the surgery, if memory serves. The schools then handled school-time inoculations - such as the TB one. We had to fill in a form each year for the school saying which inoculations had been done, which also acted as a reminder. Since then I think more inoculations have been introduced (my eldest, certainly, was pre-MMR) and surgeries have been incentivised by payments (I believe) if they achieve the right percentage of inoculation take-up - so presumably in their best interests to remind. I think things like tetanus boosters were alway going to be down to parents to remember.

This water-logging was on established graves, not new ones. One's 30 years and more old. I think the new asphalt is important as regards draining and run-off.

I have recently been walking around Camberwell Old Cemetery, and have noticed considerable water-logging of graves - and that at the top of the hill. I suspect that the recent tarmacing of the pathways will have exacerbated the problems of water run-off - many of the graves (including depressions of burials now unmarked) were ponds. The problem of water-logging will be exacerbated down the hill particularly where trees (which are fine sinks for water) are removed - thus making the proposed new (or revived) areas for burial even more prone to flooding and water-logging, as I would imagine there will be a lot more tarmac put down for pathways to support vehicles (hearses etc.) in the new burials. Do you know whether there have been proper hydrological surveys done of the site, and forecasts of impact once the existing scrub woodland is removed? I suspect this could be an additional argument that those wishing to preserve the woods may wish to put forward.

So, if your child is over 3 years and 4 months and hasn't had their pre-school immunisation or are overdue any others and you want them to have it, make sure you make an appointment. This is a really worrying development to the DMC saga - childhood immunisation is vital (and I think is one of the things GP practices are specifically paid to do, but I am happy to be corrected here). If these are not happening there may be a real problem of local epidemics (where 'herd immunity' is compromised). Normally injections would be handled by the practice nurse, rather than GPs, but it is easy for parents to forget (or simply not know) the relevant timings.

It is well within permitted development so won't need planning approval. If you want it certified as a permitted development (you will if you ever want to sell) then you still have to submit plans etc. to the council - and permitted development or not it must still be built to building regs. Even if it doesn't need planning permission per se it still needs to be viewed and OK'd by the planning department. Which means you will need proper professional plans if you want it to go through smoothly.

Having read this thread, and its many predecessors, it appears that there is little issue with the quality of the medical staff at DMC (indeed some praise for some) - it is their availability which is an issue. This appears to be a function of either/ and poor resourcing or poor processes & systems. Unlike many GP practices which are partnerships, the salaried doctors will not also (I am guessing) form part of a practice management team, so there is little they can do to improve things. For whatever reasons it is the business model being employed which is failing patients here - poor resources and/ or poor management systems will not be improved by adding (as the practice appears to be trying to do) to patient numbers by further recruitment. One might suggest it is doctors and office staff they need to be recruiting, not patients. Indeed a focus on business diversification before the core business (GP-ing) is remedied seems a policy of madness. Offsetting your over-trading by pushing customers onto other business (those designed to remedy out-of-hours and emergency surges of need) is a short term remedy only - true as a business modelled on customers not using it (the ideal GP practice has very large numbers of extremely well patients who never book appointments or need treatment) you can get away with this for a short time - but a consistent failure to deliver against your contract with the NHS will, eventually, catch up with you, even in this gentlemanly world of second, third and fourth chances. Sadly, GP capacity in ED means that the entire patient list will not be able to vote with their feet. There is a shortage of GPs in London in particular - and getting to see doctors is not ideal in any surgery (although many locally are much better) - but this is no excuse for DMC to be such a performance outlier, even in a stretched area.

I think you can only now go to the Lister if you have a recommendation from your GP. So, a bit of a Catch 22 when you can't get to see or talk with one.

I could perhaps have added to my post above on GP earnings that another nice little earner is diversification - in DMCs case I believe a well staffed pharmacy - not only can you expect to 'pick-up' all (or at least most) practice prescription sales but pharmacists can also sell OTC medicines and products and pharmacist only medicines - here medical 'advice' can lead directly to a sale - if you reduce the amount of NHS paid-for advice (doctors, nurses) you can boost sales here. You can also offer therapies - again often paid for by the client. A surgery becomes a useful hub on which other, non NHS businesses, can be built. A canny business might even over-prescribe into 'its' pharmacy to generate extra revenue. However, as GP practices do have a 'budget' out of which prescriptions are taken (I believe) you would have to get the modelling right here to make real money, although I am not sure what actual remedies are taken against GP practices that bust their prescription budgets.

The GP practice will get paid on a capitation basis, and additionally for achieving government targets, such as inoculation levels, health checking older patients etc. GPs may be partners (they get a share of the dosh) or salaried GPs (get paid a wage by the practice owners/ partners). Locums will be salaried. The practice will pay their administrators, receptionists, clerks etc. and practice nurses. Midwives and Community (used to be District) nurses are I think employed directly by the NHS but may work out-of GP practices. Where a practice (or several practices) are owned by one person (or a company) they make their money out of the difference between what they get from the NHS contract and what they pay-out for staff and premises. The headline figures quoted for GP's earnings (?100k and over) can be much less for salaried and locum GPs - particularly if young. If you have a large capitation and a (relatively) small wages bill it can be very lucrative to own GP practices.

Actually, it is sort of annoying when commercial vehicles are being regularly parked even just over-night in wholly domestic (residential) streets - particularly when these are over-large and take up more than one normal domestic car space (smaller vans aren't an issue). A neighbour runs a business where he has his own (family) car - fine - but where two huge white vans (two car lengths long) are also regularly parked up - blocking parking for the residents who live around me. A wholly residential street is slowly turning into a lorry park (effectively). It is of course entirely legal but it is also somewhat inconsiderate. The vans are away during the day (except at weekends), of course, but if they get back before the residents do...