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THE CHAIRMAN’S COMMENTARY By Roger Gedye money from the NHS Budget. I like to think that a successful Patient Group can bring together the needs of both patients and doctors: helping to improve the quality of services to patients and at the same time helping patients to understand the daily demands and pressures of the doctors and their staff. RIGHTS/RESPONSIBILITIES Patients have a right to professional treatment, both medically and in terms of the respect they receive from doctors and staff. In my OUR REFURBISHED SURGERY experience patients at Davenport House receive a very I had become quite fond of our high quality of care, and this is compact Surgery at the top of reflected in the result of the stairs! Now that all is satisfaction surveys carried out revealed with the completion of over the years. On the rare the ground floor renovation of occasions when an error has Davenport House, patients can been made, or patients feel they understand how well this have been poorly treated, there challenging process has been is a proper procedure to follow. planned and executed. Our A formal complaint to the thanks go to the team of staff, Practice Manager will be nurses and doctors who took on carefully investigated and the the challenge of providing patient kept fully informed of patients with an unbroken the consequences. quality of service from a fraction of their normal working space. Unfortunately there are occasions when patients forget This has been a good example that ‘rights’ also carry of ‘putting patients first’, a ‘responsibilities’ –Surgery staff phrase beloved of politicians should be treated with respect, trying to squeeze value for even when they cannot meet a

patient’s every need. Receptionists have the toughest job, trying to match every patient’s request with an appropriate (and preferably rapid) response. Davenport House runs regular training sessions for its reception staff, and has to bring new recruits up to speed as quickly as possible. This has been particularly evident in the last few months following the departure of three experienced team members. Perhaps it is natural to take the service offered by the receptionist for granted, particularly when one is feeling unwell, but the occasional word of thanks is greatly appreciated by the staff. GOOD NEWS Let me end on a positive note. A Davenport House patient waiting to see the doctor was overcome by her illness and was close to passing out. While one receptionist brought her a glass of water and words of support the other located an empty consultation room with a couch, where she was visited and treated by her doctor. A small matter but handled with tact and sympathy, greatly appreciated by the patient. I hope that this is typical of your experience too.


Inside this issue: Vitamin D Deficiency


Surgery Refurbishment


Be Clear on Cancer


Dr Stranders to retire Patient Meeting Reports

Did you hear about the girl who insisted on taking her pill with a glass of water from the River Mersey? She’s now three months stagnant!

8 9 /10

Medical Myths


Surgery Timetable


“You’ve got to help me”, cried the man rushing into the psychiatrist’s – “I keep on thinking I’m a dog” “I see. Well just lie down on the couch for a moment” “I’m sorry, I’m not allowed on the couch”.


A LITTLE BIT OF SUNSHINE CAN BE GOOD FOR YOU By Dr Alka Cashyap ‘I eat such a healthy diet’. I told Mrs Green that 90% of the Vitamin D that we need comes from the sun, and the rest comes from the diet. Twenty minutes of exposure to the midday sun three times a week will allow our skin to make enough Vitamin D for the day. Staying in the sun for longer without sunscreen does not make the skin make more Vitamin D and increases the risk It was a typical Monday morning of sun burn and skin cancer. at the Surgery. I was already Eating oily fish such as salmon, running twenty minutes behind, mackerel and sardines, and yet I was in no hurry to call in eggs and meat also help. In this Mrs Green. Why, I wondered, as country, margarine and some but routine testing is not really I looked through her notes, was cereals are fortified with Vitamin recommended. And, of course, I not able to make a diagnosis D. one needs to remember that for her? I looked at all the aches and pains do have other investigations I had carried out causes. on her - the blood tests, the X rays, and even a bone scan. Current research suggests that approximately half of the adult I read through her symptoms. population are deficient in Pain across the shoulders. Pain Vitamin D, particularly in the in the thighs. ‘My ribs hurt, winter. People at risk of Vitamin doctor, and I feel so weak and D deficiency are the elderly, lethargic’. I knew she wasn’t pregnant women and children, making it up, she just wasn’t Luckily, Mrs Green only had a dark skinned people and people that kind of lady. mild Vitamin D deficiency. She who stay indoors or keep took supplements for a few themselves covered up. I scrolled through her notes months but then made sure she again and again, almost chewing changed her lifestyle and A programme for some at risk my nail off in the process. exposed herself to the sun as I groups, such as children under Suddenly, an article I had read had advised. Six months later, five and pregnant women, is last week from one of the she felt like a new woman! being sorted out, so that they medical journals popped into my will get a daily supplement. But mind! Could it be? Not surprisingly, she was keen for the rest, the Department of to tell all her friends about her Health is hoping that we will all I called Mrs Green in with a new diagnosis and asked me if become more aware of this smile. Her complaints had not she should advise them all to condition and make the changed. I printed off a request see their GP? I advised Mrs necessary lifestyle changes so for a blood test, and asked her Green to encourage her friends that the situation does not get to have it done. to expose themselves to out of hand. THE MESSAGE IS: sunshine as I had told her to, A little bit of sunshine is Her results came through a few and to eat a sensible diet. For days later and a feeling of most people that is enough. The definitely elation came over me when I recommended daily dose for the good for you. saw them. My hunch had been average adult is just 10 right! Mrs Green had Vitamin D deficiency! ‘I am so disappointed to hear that, doctor,’ said Mrs Green.

micrograms per day, and there are some over the counter supplements available. Her friends could certainly see their own GP to talk things through


OUR UPGRADED SURGERY OPENS By Heather Hassall, Practice Manager Almost all of the refurbishment is now complete with the re-opening of the ground floor. From 20 February 2012 the 6 consulting rooms and 3 treatment rooms on the ground floor were available for use. Also open are the main reception desk, reception office Ground Floor Reception and the staff meeting room. The main entrance doors at the front of the Surgery are double sliding doors, which should provide easier access for everyone. In the winter these have a hot air blower and together these should reduce the heat loss. During the summer months the doors can be set to be permanently open. A new facility is the interview room. This can be used to talk privately to a receptionist if necessary, or could be used for breast feeding mothers, or potentially infectious patients. It also contains a baby changing unit.

THE NEW TREATMENT ROOMS All nurse appointments are now held downstairs in the new treatment rooms. This layout on one floor is of great benefit as all the equipment, stock items and paperwork can be stored in one place for quick access saving time for the whole team, It is also much easier for the nurses to communicate with each other for the benefit of improved patient care. There are also three fridges which during the flu season will make it so much easier to store the vaccines without worrying if there will be enough room for the travel and childhood immunisations. We are confident that these more spacious arrangements will make access easier for all our patients. There is continuing upgrade work in the building with the redecoration of the stairs and landings. New carpet will also be laid in these areas. Finally, the temporary constructors’ unit beneath the building will be removed and the staff car park repainted and enclosed. This work is due to be finished around the end of March.

The layout of the ground floor is similar to the first floor, with a separate corridor between the waiting area and consulting rooms to help maintain confidentiality in the consulting rooms.

The past year has been difficult at The 7 times for Doctor’s Consulting Room consulting patients, rooms on the doctors and first floor staff with continue to be changes to available and Surgery times, the temporary drilling and treatment alternative rooms on the routes into the first floor have building. now reverted Overall this to administrative office space, as was the original upgrade has intention. aimed to make Ground floor waiting room the best with reception on the left Patients should check-in for their appointments possible use of on the ground floor at reception or via the self space and check in system. At this point there will be ensure that the information on whether their doctor is located on Surgery meets the latest standards for a medical the ground or first floor. There are signs to centre. We would like to thank all patients for locate the consulting rooms from reception. The bearing with us and hope that, like us, you will refurbished lift will provide easy access for feel that the disruption was well worth the buggies and wheelchairs. outcome. There are still some finishing works to be done: Please contact the Practice Managers if you the delivery of new waiting room furniture, leaflet have any queries or comments. (01582 racks and possibly patient information screens. 463007)



Treatment Room Treatment Rooms A






Corridor leading to Treatment and Consulting Rooms



Waiting Area

Interview Room

Dr Cashyap 4


Dr Chafer

Dr Stranders Staff Meeting Room



Administrative Offices

Front Entrance


Dr Wadhwani



Dr Lamb

Dr Thenuwara


Consulting Room 7



Corridor leading to Consulting Rooms

Orthodontist Waiting Area

Administrative Offices

Doctors’ Consulting rooms Nurses’ Treatment rooms Utility rooms

Administrative Offices Toilets Lift 5



BE CLEAR ON CANCER By Dr Kirsten Lamb BOWEL CANCER A new campaign has been launched to encourage people to report possible early signs of bowel cancer. It is well recognised that if we can spot the signs of cancer early then outcomes are better. In other words treatment is easier and more effective and our chances of having the cancer cured are better. So the message for bowel cancer is:

So why try to spot cancer early? 

If you’ve had blood in your poo or looser poo for 3 weeks, your doctor wants to know. Now many people feel very embarrassed to come to see us to talk about ‘poo’, ‘motions’, ‘stools’ or whatever other name we use for faeces.

   

But our bowel is just another part of the human body. Doing a rectal examination is therefore the same as examining any other part of the body for us as doctors but more embarrassing for us as patients. As GPs we will work hard to put you at your ease. The examination usually takes only about 1-2 minutes. If after examination we do have concerns that ought to be addressed by further examination, we will make a referral for you to have other tests such as colonoscopy where a flexible tube is passed through the anus to reveal the whole colon.

1 in 3 people will develop some form of cancer during their lives Cancer is much commoner as we get older 9 out of 10 cancers occur in people over 50 years The earlier cancer is diagnosed the better the survival rates Survival from cancer has improved dramatically 230,000 cancers diagnosed each year and 120,000 cancer deaths each year.

Returning therefore to what to look out for having decided that it is worth it – here is a crib sheet. 

The lump – for women the scariest is finding a breast lump but other lumps are also important to check out. So for men checking for lumps in the testicle is important.

So this is a national campaign by the Dept. of Health to look at bowel cancer but we ourselves can also look out for the early signs of other cancers and there are resources to help us. Cancer Research UK offers excellent guidance

Funny moles – the ones where the colour or shape changes or they start itching or bleeding.

Stubborn sores – the ones that won’t heal after several weeks.


Tongue and mouth ulcers – especially the ones that last longer than 3 weeks.

Considering other cancers this is the situation in the UK.

Difficulty swallowing and that indigestion that won’t go away

The hoarse voice and the cough that won’t go away – again especially lasting longer than 3 weeks and particularly if you are a smoker.

Blood in the wrong place – blood in ‘poo’ as per the first message but also blood in ‘pee’ or urine, vaginal bleeding that is odd or occurs after the menopause.


Difficulty passing urine.

Odd weight loss (your clothes become looser but you have not been dieting) or odd night sweats.

Changing bowel patterns especially much looser.

Unexplained pains or aches that go on for longer than 4 weeks.

have received a first bowel cancer screening kit. The test is based on looking for ‘faecal occult blood’. Many cancers in the bowel produce tiny amounts of blood - occult means hidden so the test looks for blood in the stool that you cannot see with the naked eye. Those of you who have already done the test will know that you receive a kit in the post. The kit asks you to spread some ‘poo’ on a card using a stick on 3 different days. You then post the completed card back to the screening unit. The screening programme will be extended up to the age of 75 years. People are sent kits every 2 years whilst within this age range.

There are more than 200 different types of cancer but being aware of these features will help to spot things early.

So be sensible and avoid burying your end

CARE WITH SYMPTOMS It is important to remember however that this guidance points out the presence of the unusual feature for 3-4 weeks before getting concerned. Most of us will suffer the whole range of the symptoms listed above but they will last a very short time and be nothing to worry about. Being vigilant must be balanced with avoiding getting over anxious about everything that happens to us. Hopefully we can help you differentiate the important from the less important when we discuss your concerns in Surgery.

Overcoming fear and embarrassment will help and we can support you in doing that.


Remember too that you can reduce your risk of cancer by:

We can also spot early cancer by screening. In the UK at present there are 3 different cancer screening programmes.

Cervical Cancer Screening: All women are offered a smear every 3 years  from the age of 25 to 49 and then every 5 years from the age of 50 to 65. The intention is that women receive their smear result within 14 days.  Breast Cancer Screening: Those of us over the age of 50 years will be accustomed to our outings to the caravan in the Amenbury Lane car park. The caravan tours the district arriving in each town once every 3 years. Women are invited every 3 years from the age of 50 until 70 years. As the mammography caravan only comes 3 yearly a first mammogram may occur close to a woman’s 53rd birthday. An extension of the age range is being phased in across the UK and will be fully in place by 2016. The new age range will be from 47 to 73 years.

Stopping smoking – smoking is the worst offender in terms of cancer risk accounting for 1/3 of all cancer deaths Eating a healthy diet – remember the 5 a day message Having a normal weight

Getting plenty of exercise

Having the cervical cancer immunisation as a school girl

Avoiding excessive sun exposure

Being aware of your family history and therefore whether you need to be more vigilant.

So good luck and remember we are always happy to talk with you about anxieties you may have about cancer.

Bowel Cancer Screening: Most people aged between 60 and 70 will by now 7

MY RETIREMENT By Dr Alan Stranders 5 October 2012 will be a ‘red letter day’ for me. I reach the ripe age of 65 and can thus draw my old age pension AND I will be retiring as a General Practitioner from my Partnership at Davenport House. I joined the Practice [then at the Borodale premises in Kirkwick Avenue] in September 1974, when Dr Edgar Whitby was the Senior Partner. I was apprenticed to him until April 1975 when he retired, and I took over his list of registered patients. This 6 months under his tutelage was a rapid learning curve, and a memorable experience for me. Edgar was undoubtedly a GP of the old school’ where ‘Doctor knows best’. This was rather different

I have been privileged to work here in Harpenden, still affectionately known to many as The Village. I have enjoyed my professional career as a GP immensely. For this, I must thank all the staff both past and present who have enabled me to work without undue interruption. They have always been conscientious, helpful and efficient in their duties, attributes I am sure many patients will also recognise.

the Red House [under a previous NHS rationalisation!]. In those days, the Harpenden GPs ran the Hospital via the Medical Staff Committee, with the help of ONE Hospital Administrator. We usually kept the running costs within the given annual budget, and with high efficiency, due to the expertise of the loyal and dedicated Hospital staff.

I have also been helped throughout by other health professionals: District and Macmillan Nurses, Health Visitors, Physios, Social Workers, Counsellors, Complimentary Therapists, all the various Hospital staff, and many, many others too numerous to mention. All these professionals oil the cogs of our health system and whose goodwill, to a large extent, keeps it running.

I must sincerely thank my Partners, both past and present, to my Middlesex Hospital for putting up with me for the Medical School training which best part of 40 years, despite focused on patient-centred care. my personal foibles and my passion for golf! It has been an I was subsequently taken into honour to be working alongside full Partnership and my wife, you all in partnership, Andrea, and I settled in to the companionship and fellowship. busy life of a Harpenden GP. Just like being married really This entailed regular Surgery [but without the sex!!]. And consultations [much as now], yes, thank you Andrea for home visits, nights and In 1979 the Practice moved to always being there to support weekends on-call for the its present site, Davenport me and the Practice all these patients of the Practice. House, which were revolutionary years. new purpose-built premises. At this time it included Indeed, these premises won And finally, and most delivering babies with the awards for architectural and importantly, I must thank you, attending midwives at patients’ functional design of an up-to our patients and your families, homes, or at the Maternity Unit date GP Surgery. for allowing me into your lives at Harpenden Memorial Hospital and your hearts, and for [The Red House]. In addition, That was over 30 years ago, entrusting your medical care to we looked after the Hospital’s and we have now acquired our me over so many years. I shall Casualty Unit and our own innew, modernised and totally truly miss you. patients. All these services are refurbished Davenport House. now defunct since the closure of Again, I believe this is a model the GP clinical departments at for GP Surgeries for the future.



too much medical jargon is used or too much detail is delivered too fast. Patients are often wellDr Andrew Chafer gave a detailed analysis informed and of surveys into the GP/Patient relationship may and how to get the best from your disagree so consultation. His talk at the AGM on 6 practitioners February was illustrated with excellent may need to slides and was extremely informative. have a dialogue. As a GP Doctors feel consultation is under time the cornerstone pressure to of health care, diagnose and and 90% of NHS treat and contacts are via often have most trouble when wrapping up some a GP, it is consultations. Particularly with the 'hand on the important that door knob' syndrome and the patient on exiting both the doctor saying 'Oh, by the way....... and the patient SOME TIPS FOR YOUR CONSULTATION communicate with each other It is helpful for patients to plan what they want effectively. to say: Patients want more involvement with decisions and to achieve this successfully both doctor and Think of your problems as a narrative patients need to be aware of potential 'barriers'.  (Patient Association leaflet - You & Your Doctor - is useful) POTENTIAL BARRIERS 

 Poor GP/Patient relationships. Perhaps onesided with the doctor taking control of the consultation too early without listening out for 'indirect' clues to worries.  Inadequate training of doctors. Failing to ask questions correctly, not listening for answers and not thinking of the whole patient as well  as the disease. Time constraints on consultations which include patients bringing too many demands and issues to one appointment

Increasing number of consultations rising 71% in 15 years without budgets to match, and hospitals devolving complex care to GPs.

Write your concerns down, state worries clearly, take someone with you as a second pair of ears. Don't be frightened to speak up and ask to finish if not all your questions have been asked. Then take any medicine correctly. £1/2 billion is lost per year through failure of this plus the extra time of further appointments. Any differences and disagreements between the doctor and patient should be aired and discussed, and both need to take their share of responsibility so that the relationship becomes more interactive.

Not turning up for appointments and failing to These will be important in the future as the strain of an increasing and aging population cancel. may mean some face-to-face consultations are replaced by telephone or other technology.  Being realistic of expected outcomes e.g. requests for letters to be written immediately. Patients may be allowed access to their records to up-date details such as blood pressure, and may have to take more responsibility for OTHER CONSIDERATIONS managing their illness. So: It's now been realised that patients can USE YOUR CONSULTATION TIME WISELY! remember what they are advised as long as not 




Responding to patients' questions at a Small Group meeting on 8 December 2011 Dr Charli Barbar-Lomax explained some common problems in this area.

Dr Chas Thenuwara gave a talk at the AGM on 6 February 2012 on prescribing issues.

   

There are various constraints that affect what a doctor can prescribe.

How and why spinal fusion of vertebrae was needed, Muscle problems related to taking statins and although these were rare how they could be overcome. How loss of height with age affected organs. He also covered in detail various pain-coping regimes associated with osteoarthritis.

 

Dr Alka Cashyap followed on with a demonstration & explanation of how acupuncture could be helpful to some muscular skeletal problems.

The General Medical Council guidance drugs must be appropriate and in the patients' best interests (not simply because of patient demands or convenience). Effective treatment must be based on the best available evidence. There must be a reasoned argument for refusing to prescribe in particular cases and doctors must have adequate knowledge of the patient.

Locally the Herts Medicines Management Group provide guidelines accommodating the current financial constraints. They have an ethical framework so that all patients are treated fairly. Their decisions like others are based on evidence of clinical effectiveness. Other national bodies such as NICE also issue prescribing policies, at times hotly discussed in the media.

The philosophy is based on energy flows through channels being blocked by disease which can be released by stimulation from needles in various parts of the body. Although it does not work for all, some find it a helpful complement to traditional remedies.

Doctors are aware of prescribing limitations but keep an open mind when responding to an individual’s needs. To make resources go further we as patients should:

A lively discussion continued throughout the evening by the end of which patients felt much reassured.

Use pharmacists more by buying over-thecounter drugs for minor ailments.

Reduce wastage by taking prescribed drugs

We occasionally close the Surgery from 12-5pm to complete staff training. These afternoons are coordinated throughout the area and allow Surgeries to either come together for locality training or to arrange something specific for the Surgery. Training days include staff and clinicians.

Listen to Government health promotion advice (prevention better than cure!)

Be aware that generic branded medicines are just as effective but cheaper than branded ones.

Topics covered in the afternoon have included:

Reduce inappropriate requests to our GPs.


 Basic life support and defibrillator  Information Governance  Child protection  Health and safety awareness  Let’s use it right- signposting patients to the 

right services. Clinical pathways for care

The confirmed dates for training during 2012 are Thursday 8 March, Thursday 28 June, Tuesday 11 September, Wednesday 14 November. Whilst we apologise for the inconvenience of closing the Surgery for 4 hours, these training afternoons are valuable in keeping the whole Surgery team up to date. 10



Over 50 members attended the Patient Group AGM and approved re-election of the Chairman, Roger Gedye, and all committee members listed below, there being no other nominations. The audited accounts were also approved. Minutes of the AGM and the audited accounts can be found on the website:

A man went to his GP complaining of a pain in his stomach. The GP performed a thorough examination but could not find anything obviously wrong. “I’m afraid I can’t diagnose your complaint – I think it must be drink”.“All right then,” said the patient, “I’ll come back when you’re sober.”

PATIENT GROUP COMMITTEE Roger Gedye Ian Drew John Harris Helen Hartley Rosemary Horne Samantha Mills Malcolm Rainbow Sheila Uppington Viviane Vayssieres

A woman went to her GP and told him “every time I sneeze, I have an orgasm” “Hmmmm. What are you taking for it?” “Pepper,” she replied.

Chairman Treasurer Newsletter Editor Membership Secretary Secretary Younger patients External health affairs Education Marketing

Patient: Doctor, doctor! This swelling on my leg’s getting so big I can’t get my trousers on GP: Very well, then – take this. Patient: Is it medicine, doctor? GP: No, it’s a prescription for a kilt!

Contact details can be found on the Patient Group website as above.

SOME MORE MEDICAL MYTHS By Dr Chas Thenuwara Eating lots of Carrots will improve your eyesight This is a common myth. Carrots are rich in beta-carotene, which the body converts to Vitamin A. Vitamin A deficiency causes night blindness; an extreme deficiency can even cause blindness. Vitamin A deficiency is the commonest cause of blindness in the Third World BUT if you’re not deficient (which is extremely likely in the UK) your vision won’t improve no matter how many carrots or other beta-carotene fruits and vegetables you eat. In fact excessive amounts of beta-carotene can turn your skin orange, although this is a temporary effect. The myth seems to originate from World War 2. The British Intelligence service spread a rumour that their pilots ate a lot of carrots and that’s why they were so successful hitting German targets. Actually they had superior radar surveillance!

Cholesterol is bad for you There is a "bad" and a "good" cholesterol. Bad cholesterol known as LDL is found in saturated fats such as red meat and cheese. Good cholesterol known as HDL is found in monosaturated fats such as oily fish (salmon/ herring/trout) and seeds. Good cholesterol helps transport cholesterol away from the arteries, back to the liver. If you have a cholesterol test often both LDL & HDL readings are made available. Often we use the ratio of the total cholesterol versus HDL to give a better picture of someone’s cholesterol. Diet has an important factor in cholesterol levels. Unfortunately genetically some of us are more prone not to metabolise fat efficiently and despite our best efforts we still have high cholesterol and may be put on a statins. Rarely, some families have a genetic condition which affects the way cholesterol is made in the body. Total cholesterol (TC) should be less than 5 and HDL more than 1.2. Ideally the ratio of TC to HDL should be less than 5 or even lower if you have other risk factors for heart disease e.g high blood pressure, smoking or diabetes. Statins work by blocking an enzyme in the liver that make cholesterol. 11

SURGERY TIMETABLE By Anthea Doran, Practice Manager One of the major changes in the last few months during the premises refurbishment was to the Surgery times with more GPs starting at 7am and many running lunchtime surgeries. Feedback from patients suggests that some lunchtime provision would be an excellent enhancement to our services and so, we have adapted the GPs’ working days to accommodate some middle of the day working. The new system works on a two weekly cycle so that we offer a good mix of times - early starts, lunchtimes and early evening.

Other changes include two reception desks: one on each floor. The intention is for the main desk to be downstairs by the main entrance doors so that it is readily accessible to all visitors and we encourage patients always to enter the Surgery through the automatic doors so that they can check in either at reception or on the touch screen machine. The reception upstairs will normally only be manned by one receptionist and so patients may find they are better served by using the main reception to check in and book future appointments . The new doors are fully automatic and the lift has been enhanced to give disabled access so we will be able to accommodate all our patients. However, if you would prefer to be seen on the ground floor, please let us know when booking and we will accommodate your request. We have included a baby changing area in the interview room on the ground floor. If your baby requires changing or feeding whilst in Surgery, please ask a receptionist who can guide you. We do hope that you will find the new premises easy to use but would appreciate your feedback as we are always keen to improve our services for our patients.

2012 PATIENT GROUP DATES FOR YOUR DIARY Open Meetings at Fowden Hall, Rothamsted on Monday evenings starting at 8.00pm Monday 14 May Monday 2 July Monday 8 October

Weight Management Sports and Exercise Injuries Health Screening

Informal Group Meetings at the Surgery starting at 7.30pm by member application. Tuesday 12 June Holiday Diseases & Vaccinations Tuesday 6 November Issues of Fatherhood Tuesday 4 December Home First Aid

The Nursing Team Mrs Barber-Lomax Jill Hutchinson - The Red Cross


DPPG Newsletter Spring 2012  

The Spring 2012 Newsletter of the Davenport House Patient Participation Group (Harpenden)