GET ME OUT OF HERE, I'M A PHARMACIST!

I don't like to associate myself with the similar titled television offering, but for once, I have a lot of sympathy for the celebs. (I will say that only once!!)

The last month has been a roller coaster of activity behind the scenes, and whilst anyone checking the web site (www.locumpharmacistuk.com) might have noticed very little changing, behind the scenes, in the 99% of the site which the public can't see or use, we've introduced so many changes and improvements that I'm in danger of losing the plot.

I now know more about Active Server Pages and Comma Seperated Variables than most people, certainly most in Pharmacy, anyway. These and a host of other items are helping us make the site an interactive quantum leap forward from what we have been doing. So far. you may have noticed "Test data" where Available Bookings ought to be and much of the Urgent Bookings have been ignored whilst we test out the system.

Result? In 2010, pharmacists will be able to log in to their own personal page, or "Lounge" (User Name and Password Protected) and update their information; availability for locum work, interest in permanent vacancies, job search, and also manage their own professional and financial information relating to work done.

Clients (Owners, Managers, Area Managers and Locum co-oordinators) will have their own "Lounge" (also User Name and Password Protected) to help manage and request locum bookings or request the Recruitment Service for Permanent Vacancies.

All of this information will feed into our databases at the touch of a button and allow us to interactivley support you, whether you are looking for Locum Work, a new full time job or if you need a locum or manager.

There will be other special features only available within The Members' Areas which will be accessible only to Registered Users. Registration will be free. Anybody can rgister their interest by telephoning, texting or e-mailing with your contact e-mail address, so that we can notify you as and when services come on-stream.

We think it will make life so much easier for everyone who chooses to use it, that we can't wait for 2010 to come! Why not make it your New Year Resolution to join up and see the benefits this will bring to you? We'll be waiting in the New Year for you, but in the meantime, does anyone know how to get me back to 2009 - I don't want to miss Christmas!

BNP - have we learnt nothing from history?

I was shocked to discover that almost a million British people voted for the BNP (British National Party) in the recent European Elections. Seventy years ago a whole generation of young men (and women) combined from all parts of the world fought - and many died, giving their tomorrows for us to have freedom today. Those who fought against the horrors and evil of Nazism came from all countries, races, colours and creeds. A tide of humanity united against the atrocities that were committed against so many innocent people, and hoped that they had left behind a better world for us to inhabit.

Nick Griffin and his party have the right to free speech that we often forget is so precious to liberty - Napoleon Bonaprte was quoted as saying "Four hostile newspapers are to be feared more than a thousand bayonets". Free speech is a two way street, however, and whilst some of the questions and comments put to Mr. Griffin showed him and his beliefs to be at best, confused, at worst, abhorrent, my favourite quip of the night was from Bonnie Greer, who kept her cool admirably throughout, pointing out "All of us are descended from Africa".

I've always found pharmacy to be a very tolerant and meritocratic beast and have rarely come accross any racist tendencies with people I have worked with. I'm sure some individuals have experienced it in their time and I have been told by some during a recruitment process that they do fear it's effect and impact, which has a huge influence on areas where they might consider working and living. That is soul destroying to hear.

My favourite incident which highlighted the crass stupidity of people believing in racial stereotypes occurred a few years backm, when we recruited a man, we'll call him Geoff (not his real name) for an independent pharmacy, after considering posts with a small group and a major multiple. Geoff enjoyed three years in the job in a middle class, almost exclusively white populated area. His patients and customers really thought very highly of him, not just because he was so good at this job, but because he was a really pleasant, caring, dedicated man who would go out of his way for anyone. I don't know if it helped his situation that he spoke with a cut-glass English accent that would have fitted well on the BBC in the 1950's.

More than once after securing the job for Geoff, I visited the pharmacy to see how he was getting on. It never failed to make me smile when a ptient who had spoken to him on the telephone came into the pharmacy and saw him for the first time. After asking to speak with Geoff, they were told politley, "Hello Mr. Jones, nice to meet you at last. I'm Geoff". There would follow a moment of uncertainty as Mr. Jones would stutter, "But.. but..". "Geoff would help them out "Yes Mr. Jones, I'm black. I'm from Nigeria". A relieved Mr. Jones would reach out to shake Geoff's extended hand "But you sound so English!".

No Longer voices in the wilderness

One of the good things about my job is that I am in touch with more pharmacists in a day than most other people. If you act as a manager, owner or locum, you probably are the only pharmacist in a premises and don't get chance to exchange views or opinions and I know that many people feel that they are lone evoices in the wilderness, ignored and disregarded by the powers that be, unless they are unfortunate enough to fall foul of the regulations for some reason, RP being the most recent one to have caused massive confusion and anxiety. Many people have privately expressed the feeling that if they could find a job that kept them and their families in the same degree of financial stability and comfort that they currently experience, they would almost certainly take it. What a sad state of affairs that we have come to this.

Words often mean more when we know the people who speak them, and when their opinions strike a resonant chord with us. Two examples I can quote from people whom I know and who have put their words on record recently with regard to RP. Richard Rutter and Dorothy Drury have left comments on the PJonline for all to see.

http://www.pjonline.com/news/rp_regulations_should_be_applied_flexibly_says_doh

Please look at these and see if they make sense to you. Perhaps those who drafted the RP regulations and pressed for their implementation should have consulted the likes of pharmacist such as Mrs. Drury and Mr. Rutter, and thousands like them. It would surely have led to a better scenario than the risk of a criminal prosecution for such heinous acts of misconduct, such as forgetting to log out at the end of the day.

We hope to quickly establish a specific forum on this issue with an input from someone who has access to the powers that got us into this mess. Keep checking back to the main web site and join the debate. People often complain that they are ignored and that they have no voice - we aim to help remedy that, but it will take your contribution to achieve it. Don't settle for being a silent majority of one any longer: your opinion matters and can help to change things for the better.

Don't forget to sign out as Responsible Pharmacist

So there we have it-forgetting to sign out at the end of the day when you go home is a criminal offence under Responsible Pharmacist legislation. Inspectors from the RPSGB will take a pragmatic line, according to an interview in Chemist & Druggist, but does that make you sleep easy at night? After the Elizabeth Lee case and all that followed, this is potentially a step that could give a pharmacist a criminal record!

What do we do about it? I don't know, but will be e-mailing the one member of RPSGB Council whom I know and asking her to raise this matter urgently and see if a review of the legislation can be brought about to make it much more sensible. I didn't join this profession to be criminalised for something so apparently trivial, did you?

1st October, a momentous day!

1st October was a massive day in history.

• 331 BC: Alexander the Great defeats the Darius III of Persia at Gaugamela, making him master of Asia Minor.
• 1938: German troops march into the Sudetenland, Czechoslovakia, under the auspices of the Munich Agreement.
• 1949: The People’s Republic of China is proclaimed, following the Communist victory in China’s civil war.

Did anything else of note happen for you on this day?

AFTER ALL THESE YEARS, I'M NOW A RESPONSIBLE PHARMACIST

And I have a card to prove it! I haven't figured out how I've got away with it all these years, behaing irresponsibly. I guess that someday it was always going to catch up with me, and from today I must put aside all childish things and behave responsibly.

The trouble is, when I read closely all the different protoccols and interpretations being offered (imposed?) by different companies, I'm not that sure what has changed in reality, other than the long overdue farce that a pharmacy was hitherto breaking the law if sales of GSL medicines were allowed to take place when the pharmacist was not present, when the petrol station down the street could sell what they wanted. When I was getting some milk the other day from a supermarket which didn't have a pharmacy, I noticed Canesten Combi on the shelves on open display and available for anyone to buy. So, if a pregnant lady describes symptoms which match thrush, if it the first episode, we are obliged to refer to the GP to ensure that there are no underlying problems with the pregnancy. Or she can just walk to the supermarket and buy it to avoid the hassle, because in a previous pregnancy we did the same thing and the GP prescribed Canesten anyway and grumbled about our incompetence. When I later explained the referall protocol he (the GP) was non-plussed and clearly unaware, which speaks volumes for inter practitioner communication.

But, I digress. I have always worked on the basis of if I'm the pharmacist on duty, I'm responsible. I accept that where there are two pharmacists on duty, there needs to be a clarification of roles etc., but as we all know, that's a rarity. So what has changed? I now have a card telling everyone I am responsible.

I can't speak for anyone else, but I have never had a problem with patients/customers knowing I'm responsible, I make it plain. Whether it's tryingto make eye contact as soon as they are near enough, whether it's the interaction between the staff and myself, whether I just have one of those faces which says "I have a very responsible job around here - if anything goes wrong, I'm responsible!"

In practice, I think the way the regulations have been framed and get interpreted will make them unworkable. We now have too many chiefs and not enough indians. We have Pharmacist (Responsible or Second), Pharmacy Manager/Store Manager, in either capacity rarely a pharmacist but with poweres deferred or devolved (until it goes wrong, then everyone turns to the Pharmacist), ACT's and so on.

Who takes the wrath of the patient if an error is made? If the ACT gets it wrong but the Pharmacist has made the clinical check? The fact is, we all make mistakes, so to single individuals out will not work as it all too often allows us to evade accountability. To quote a football adage, "We win as a team and we lose as a team". This change in regulations may have created a Responsible Pharmacist, but is it in danger of losing accountability? Only time will tell.

Swine flu vaccination? Don't call us!

So there you have it! According to an article in The Chemist and Druggist, the Health Minister, Andy Burnham, has not included Pharmacits in the list of Health care Professionals who should receive vaccination against swine flu http://tinyurl.com/n4393h .

This surely shows either how little the government (and especially this particular Health Minister - formerly Minister for Pharmacy, no less) know or care about the profession. With that in mind, and leaving aside the obvious health issues not just for pharmacists, but for all members of all pharmacy teams, is the penny ever going to drop with us all that we need far more that the proposed new professional body (which the overwhelming majority of the profession did NOT vote for). If this is the best they can do, we need to really take charge of our own destiny and explain, lobby and utilise the media in the way other groups do. There doesn't seem to be anything other than the deafening sound of silence from our leadership.

Most of us have families, some of whom themselves might be vulnerable individuals. To exclude us wholesale from the programme beggars belief, given the likelihood that as a group, we are more likely than most to come in contact with the public. How many pharmacies are either collection points for anti-virals or will inevitably be the front line in meeting potentially infected people face to face, seeing the public are being told not to go to work, to A & E, the GP - but theyare not being told to avoid the pharmacy, where they can at least buy medicines to treat their symptoms or collect prescriptions.

Co-op Pharmacy withdraw from NPA

Official notification today that the Co-operative Pharmacy has withdrawn from the National Pharmaceutical Association. This has implications for all pharmacists and locums, especially with regard to PIA. Whilst the Co-op have a history of insurance via the CIS (Co-operative Insurance Services), so this doesn't seem an unreasonable move, the small print may yet need to be checked as to how it might impact on indemnity insurance. We should all be checking our own policies carefully to make sure we have adequate protection in the rare event that we need it.

On the plus side, they have set up their own helpdesk which they claim will do the same job as the NPA Information Service and this is available during store opening hours. Perhaps we could get some constructive feedback on how this is working from locums where they have to use it?

On a broader front, it does beg the question as to whether the NPA will be damaged by the loss of such a large cohort of members - the Co-op is now the third biggest pharmacy chain in the UK so this will represent significant loss of revenue to the NPA as well as loss of members. Will it affect service levels and support generally in the future? Only time will tell.

Where does the responsibility lie with The Responsible Pharmacist?

There seems to be more confusion over The Responsible Pharmacist regulations, at least as far as some companies are concerned. I quote what one has sent out to all it's branches and regular locums recently.

" The Responsible Pharmacist will be responsible for the establishment, maintainance and review of a range of Standard Operating Procedures (The Superintendent's Office will be writing these and sending them out from July 2009)."

I know I can be a bit slow on the uptake, but surely this statement alone demonstrates either a lack of understanding by this company (there are others, this is just one example) or reflects the general malaise that has taken root in our half baked rush to a new professional body. If The Resposnible Pharmacist is the person who establishes, maintains and reviews, then the Superintendent can surely not write these, otherwise (by definition) the Superintendent is The Responsible Pharmacist. Assess and advise by all means - two heads are better than one, at least in most cases.

If The Responsibile Pharmacist is unable to excercise their responsibility (because the Superintendent has taken responsibility) how are they responsible?

In other words, when things go wrong, and we all know that things go wrong, who will bear responsibility? If we have a professional body now or in the future worth and credibility, surely now is the time to resolve this looming disaster before it affects a patient and we all look like fools. I can make a fool of myself, without any help from anyone else assisting, but this begs the question "Do these people have a clue about anything?"

I believe I know the answer - WYBMADIITY?

So, what's the question?

Swine Flu -where's the locum contingency?

We've worked hard as far as we have been able over the last two or three years to persuade many groups (Companies, PCT's, LPC's, locums, pharmacies) to have contingency plans in place should their pharmacy be affected by any pandemic, not just this current Swine Flu outbreak. Few people appear to have thought us relevant and so have either ignored us or, as we suspect, might not have given the remotest thought to community pharmacy.

If your manager, pharmacist or locum gets hit wirh Swine Flu, what do you plan to do? Call or -email us and assume we can fulfil demand? Have you considered the possible cost? We have enough of a fight getting the summer holidays covered for some pharmacies at a cost which they feel to be reasonable, what will happen to costs in a pandemic?

We might have to persuade people to work in your area from another part of the country. Such people will need accomodation in most cases. They might not want to come to work in an area where Swine Flu has taken hold in any case, irrespective of what they might want to charge.

If you're a locum, are you aware that you have a contractual liability to provide a replacement if you are unable to fulfil a locum booking? Swine Flu is no exemption from this obligation, but in real terms, could you obtain a replacement?

As usual, down at the coal face, too little thought has been given to keeping the pharmacy network going if and when things do go wrong. Some long days and nights look to be in store for those left holding the baby and thos of us who will do our best to help.

Greedy locums save the day?

Have you ever noticed that when a company can't get a locum for a particular day, some of their staff complain that they will have to resort to using "a greedy locum". What they mean, of course, is one of the last minute or emergency locums, or more often than not, someone who has already worked a full week and offers to give up their day off to help. If anyone else does overtime, don't they normally get extra pay such as time and a half or double time? Not pharmacists, they (apparently) are greedy for asking to be paid more!

Of course, if there is a need for a locum, it either means that someone else is off sick or for other good reason, a mistake has been made in the booking process, so a pharmacist is not present or that some other pressing reason has arisen requiring the presence of a pharmacist somewhere other than where they were originally intended to be. Note that the NHS Pharmacy Contract does not allow any leeway on this matter - it requires the contractor i.e. the owner of the company owning a pharmacy - to provide NHS Pharmaceutical Services during their contractual hours. The regulations DO NOT STATE that if it costs a contractor more to secure the services of a locum than they might wish to pay, then they are allowed an exemption from this requirement.

Very often, it seems, that the people responsible for booking locums for companies are ignorant of the responsibility that goes with the job (If anyone is any doubt about the consequences of making just one mistake, consider Elizabeth Lee and her situation) and of the length of time required for us to train before we are allowed to practice.

For those that are jealous of what a locum can earn, I suggest they stop what they are doing and go back to school (at least 3 good "A" levels needed, usually two years study, then the pharmacy degree course, four years, then the year's pre-registration training before we can earn a living). Just think, in the seven years that will have passed by then (assuming that you pass all the exams and other hurdles), locum rates will be even more than they are now, and you too can become "a greedy locum". Of course, you won't, because you're not greedy, so you won't charge what the rest of us do, will you?

I am the one in ten

According to the PJ 1st August 2009, "One in 10 pharmacists is considering quitting" the profession, according to the workforce survey comissioned by the Royal Pharmaceutical Society. Commenting on this, Sue Ambler (Head of research and development at the Society) said; "The data will be utilised to help identify how both the General Pharmaceutical Council and the new leadership body can further and strengthen support for pharmacists".

What a load of bulls!

I think I may have the most oringinal excuse ever for being late for work! To get to the office, I have to drive through Beverley Westwood, a large area of grass or parkland with a few trees and copses dotted about. The Westwood is big enough to incorporate Beverley Racecourse comfortably. As a view from the front windows of the office, there are worse vistas to look out on, although The Rose and Crown public house is situated right on the corner of the road leading into the Westwood, and on a hot day it's not much fun glancing up to see people enjoying cold beer or lemonade whilst we plough through the bookings.

A local bye-law allows any yeoaman who was born within the town walls of Beverley, to "graze his cattle at no expense on the Westwood. The thing is, when these beasts are grazing, they really do run free and frequently decide to cross the road to see if the grass is greener on the other side. They couldn't care less about the traffic, they just wander about at leisure and as half a ton of animal closes up, you realise that if they decided to run, they could cause major damage to your car. One or two of them look a little smug, as if they know you're late and they seem to go that bit slower. There's nothing you can do, but wait until they've gone.

We know sometimes locums are late for work, especially if they are going to an unfamiliar pharmacy. I'd really like to see the faces on some wallah at a head office when they read the report of why the locum was ten minutes late!

If anyone has any better excuses for being late, please go the forum where we've added a new section for this.

Dispensing error improves a patient's health

It's a topical subject in the week that a London pharmacist was given a suspended jail sentence for being the pharmacist in charge of a pharmacy where a dispensing error occured and whilst the coroner ruled that the taking of some tablets which were dispensed in error did not contribute to the patient's death, the pharmacist was nevertheless prosecuted, I came accross a story of where a dispensing error improved a patient's health and well-being.

The story goes that a patient who always used the same pharmacy had been refused a repeat prescription by their surgery on the grounds that they should still have another month's medication. The patient insisted they had run out of the medication and further discussion led to the suggestion that at the time of dispensing, a dose reduction to half the previous dose had been made on the prescription, but missed whilst dispensing and the former dose had been repeated from the pateint medication record.

The surgery had reported the incident to the pharmacy, who verified that the medication had been incorrectly labelled at the former dose. Meanwhile, the patient was checked out by the doctor, who carried out blood tests and examination of the patient. The doctor's conclusion was that the patient was far better on the higher dose of medication, despite the dispensing error, and forthwith the patient was to remain on the higher dose after all.

The patient declared themselves very happy with the outcome and even thanked the pharmacist concerned for their error, which had resulted in an improvement in their wellbeing. This is a true story. The circumstances have been left vague to protect identities of all concerned.

Should the pharmacist be prosecuted, jailed, fined or given a pat on the back? As many a collegaue has echoed their feelings this week, there but for the grace of God go I.

Is that a date, then?

I recently worked a Saturday at a pharmacy that had a branch close by - let's just say it was one of the many multiples. There were only the two pharmacies in the town. The afternoon became fairly quiet and the staff decided to have a grumble about the previous week's events. It seemed that they had been provided with a second pharmacist from abroad (European Union national, to narrow it down a bit), who had been trained up to what was deemed UK standard and was taking over the other branch as pharmacist/manager the Monday following.

The pharmacist had taken it upon herself to completely rearrange the dispensary (which had been in it's existing layout for some years) so that "it would be easier to find things" and that "any locum will be able to find stock easily". This included moving a set of shelves containing "fast moving lines" from immediately next to the computer and main dispensing area and arranging a shelf five inches deep and with around four inches clearance between it and the shelf above as a "checking area". Now either the locals get very small sized items round there, or it had escaped the pharmacists' notice that rarely used items e.g. 500ml Lactulose, 500g Aqueous Cream etc, would not fit in this gap. No matter, no contingency plan, no sense, no point. Apparently, soneone at head office said it was they way to do things, so that is how things were to be done. It didn't work, but that was not the point.

For most of the day, nobody could find anything in the drawer system, despite the improvement aimed at making my (the locum's) life easier, it was a nightmare trying to find anything at all. That applied equally to myself as well as the staff who had worked there for some years.

What did concern me most was not that the pharmacists concerned had carried out this wholesale rearrangement of the dispensary oblivious to the concerns of the staff who would have to continue to work with the mess she'd made after she'd gone. That was just plain bad manners and arrogance. No, the worst bit was that during the course of he day I picked out from this recently handled stock over two hundred (yes, 200) different items, all of which were out of date. This pharmacist was supernumary, there had been locums in all of the week, so she had not had to bother getting involved in the day to day work.

Now, if you've taken it upon yourself to move every single pack, bottle or item of stock during the whole of the previous week, yet managed to "overlook" so may out of date items (that ignores items which would become out of date very shortly, since I didn't have the time to be as thorough as I would have wished), what on earth is your checking process for dispensed items like? Don't you check the expiry date when checking, don't you have a date checking rota and/or matrix to assist, don't you simply take the job seriously enough to do some of the basics?

By now, this pharmacist, whom I have never met and do not know, is running a fairly busy pharmacy wihtout any scrutiny other than the RPSGB inspectorate making their routine visits. If she doesn't pay attention to date checking, what else does she not pay attention to? This is surely a fundamental failure of training as well as attitude - do you really need the length of training we now require to understand the importance of expiryr and use before dates on medication? It's not rocket science, after all. But then, there lies the nub of it - if the building blocks are not in place, what happens when the rocket tries to lift off?

CPD (Childish Piffling Details)

Don't misunderstand me. I think it's right and proper that we all keep our skills and knowledge up to date and constantly assess our performance on a regular basis. Hey, I'm no saint, the halo slips from time to time, and I don't do every single CPPE course that comes along, as they don't always have relevance to my area of work.

I have a friend/colleague who works in such a rare area of pharmacy that there is no formal CPD to work from. His area is so specialised that if anyone was to write a course on it, it would have to be him because nobody else does what he does. Who would mark it, assess it or verify that it was appropriate to his needs? Well, maybe his clients and customers. If they were dissatisfied with his performance, they would vote with their feet (well, to be precise, their orders and cheque books).

The CPD isn't the issue. It's how to record something which has no rule book? It's easy to record how you've had a bright idea and discussed it with Mary, your regular locum over a coffee break, and realised that you should make some notes to bring up at the next meeting. If someone wants an answer right now or you are going to lose your order and therefore your income, you need to find out the answer correctly, first time and quickly. Otherwise, kiss your order goodbye! So how do you record it?

The problem seems to be with those who are charged with regulating us. They need to be able to tick the boxes which say "Evidence submitted? Y/N". It's a pass or fail with no quality control built in. Are you really a better pharmacist because you've done a course about "Getting your 5 a day" when you don't work in a sector which deals with patients at that level? I don't think so. What do you think? Answers allowed to the Blog, or why not start a thread on the Forum? Go to the web site www.locumpharmacistuk.com and click on the link to The Forum. Have your say instead of grumbling to yourself like I do on this blog. I'm not always right, just most of the time!

What's the attraction of Norfolk for a locum pharmacist?

I don't know either, but there must be some, maybe at least one! I keep getting asked for work in Norfolk and being told that the rates are really good - they'd need to be! If you've never been to Norfolk, there are a couple of things you should know. It's flat. It has lots of water. That's it really. It's a little mind-boggling to find yourself driving along when suddenly out of the side window, you notice that the water seems to be at a higher level than the car and the only thing holding it back is a muddy bank of earth.

It's probably an ok place if you like doing things on the water, as there's lots of it. And if global warming does cause the sea levels to rise, places will have to be renamed such as Burnham on Sea would become Burnham under the Sea. Still, if the rates are as good as they say, it might be worth a look whilst it's still above water.

Emergency Locum Rates

Is it me or am I missing something? If a company doesn't have a pharmacist for the day, through illness or for any other reason, then they need a locum at short notice. If it's my day off and they want me to work, do they seriously expect me to work for free? I've already worked as much (or probably more than) as I want to to begin with, so am I unreasonable in asking them to make it sufficiently worth my while? Ok, they don't like paying what they call travel time, say £25 an hour plus 2, giving me an extra £50 per day on top of what I would normally charge, so pay me £30 or £35 an hour.

After all, it's not my fault they have a pharmacy without a pharmacist, and if I'm making sacrifices to help them out, it would be nice to feel appreciated for my efforts, not to made to feel like a scrounger or a thief. Saying thank you sometimes would be nice, rather than assuming I have a duty to bale them out of a hole. If what I am doing is "overtime", then anyone else would excpect to get paid extra, say time and a half or double time if it's a weekend or unsocial hours. That would make my rate between £37.50 to £50 per hour. I guess they would like that even less!

Does anyone else think I'm barking mad, or do you expect to be fairly reimbursed, especially if you are being asked to drive a couple of hours each way before and after work. Again, is it my fault they have a pharmacy miles from anywhere and miles from where I live, but I'm prepared to help them out? Perhaps we should pay them for working extra or giving up our days off?

Why is the morning after different in Sunderland and Southend?

I know that there have to be policies for how to get things done, but why is it that I can supply EHC in certain parts of the country but not in others? There's nothing worse than turning away a woman who is clearly in need of the service because I haven't done the local PCT training course. The end result is the same, they either need it or they don't. O.k., there may be different criteria in each area, but I can read, so why not let me fill in a form to say I've read it, understand it and will abide by it's terms and conditions provided I first let them have a copy of my accreditation from wherever I got the training? Or do people have unprotected sex differently depending on the post code?

Weather to or Not

Has the weather affected you and your ability to get to work? or did you hot foot it on your ski's and get there in good time? let me know how many of you Locums made it in...