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Thank you for your interest in our vacancy for a Physician Assistant. The attached information will give you some background into how the English healthcare system works, and how indeed how we would propose to integrate you into our practice. Our website may give you a bit more background – www.saxonbrook.co.uk If you would like to be formally considered for the position, apply here: http://www.saxonbrook.co.uk/apply.html As yet, we have not set a final interview date – however these are likely to be in London in June/July. At this stage an indication of any dates you would be unavailable to attend for interview – and an indication of how much notice you would require to make the necessary arrangements at work to attend would be appreciated. We are going to be at the AAPA Conference in San Antonio this year, when informal discussions prior to short listing may take place. Dr Geraint Thomas Partners: Dr Geraint Thomas, Dr Ian Anderson Saxonbrook Medical Centre, Maidenbower Square, Maidenbower, West Sussex, RH10 7QH Tel: +44 1293 450400, Fax: +44 1293 450401, E-mail email@example.com, www.saxonbrook.co.uk Starting any new job is always a difficult time and moving to a new area can make the experience even more complicated. The following notes, which are specific for Saxonbrook will hopefully assist you when looking at the relocation. Saxonbrook Medical is part of the Primary Care service given to patients under the National Health Service. As such, it retains an independent contractor status and is set to run as an autonomous business entity. However, the design of the NHS is such that clients receive the service free at the point of delivery, with the various authorities funding the service through a variety of initiatives. This means we do not require the patients to pay us when they attend the clinic. However the authorities require us to collect a large quantity of data and to provide our care to set standards in order to achieve the various targets set by the Department of Health. The working day for the Medical Care Practitioner will be from 9am to 6pm, having a lunch break of one hour. During this time the nurse practitioners would operate a triage service for case presentations and where the case was beyond the levels of competency of the nurses they may seek to refer the case to the MCP. The MCP would also undertake their own clinic where patients will have made direct bookings for appointments of 10 minute duration. Protected time to support the nursing team would exist around this clinic. Other clinical duties during the day would include making home visits, but these are a relatively few in number; 2 or 3 per week would be the norm. You will also be expected to undertake administrative work, including reviewing results and reports on patients and taking necessary actions such as ensuring further referrals or prescriptions are changed, as well as preparing reports for other agencies. The Medical Protection Society will offer malpractice insurance on your behalf for the above duties, the cost of which will be met by the Practice. The Practice is fully computerised, with all consultations and other clinical tasks carried out on screen. As such it is necessary that you are familiar with using Windows based products. A key difference with the NHS, from what you may have experienced in the USA is the interface between primary and secondary care. Page 2 This is most evident when patients are admitted to hospital and the hospital staff become responsible for the care, rather than the primary care physician continuing to have the responsibility during their admission. Many procedures are carried out by the hospital rather than in the family practice office. These include endoscopy, biopsy and radiology (with normal practice being to send a report rather than the film – with associated delay). The NHS" resources are often limited and frequently it may be necessary to support patients through periods of high anxiety whilst investigations, opinions and procedures are awaited, with relatively long waiting times. Medical Care Practitioners have a developing role within the UK and the legal and registration status of the role is changing, and expected to change further. Currently, there is no structure for NCCPA examination within the UK and whilst it is possible for Continuing Medical Education courses to be certified for Category 1 training the procedures are complicated. However, Saxonbrook Medical does run weekly clinical training sessions and we are exploring whether these can be recognised as part of the ongoing education you require. We are aware that the AAPA Conference does provide this, as well as enabling an opportunity to promote what we are doing. As such, some funding towards attendance at the conference may be available, (typically funding alternate years), but you would most likely be expected to participate in our booth presentation within the exhibition hall for some of the time. The NHS does not yet recognise MCPs as having prescribing rights, such that all prescriptions need to be countersigned by a doctor. Whilst frustrating, it is anticipated that the situation will change in the near future and in the interim the practice has a straight forward process for meeting the current regulations. Working in the UK requires a valid visa and work permit. An application will be made on your behalf for the work permit and then you will be able to apply for a formal visa. This is a relatively straight forward process that we will assist you with. You may also be able to obtain a work visa for your partner, but we are unable to guarantee this. Further information on this is available if you click here. The recruitment process, and subsequent formalities around work permits and the like, will take a while. Linked to this, we will ask that should you wish to leave before the end of your 2 year contract, you offer us a 3 month notice period to allow us to recruit a replacement. Living in England is expensive, and direct comparisons on standards of living are difficult to make when looking at salary. You will have 5 weeks holiday, additional National Holidays as well as one week for study leave, which may also need to be considered when making comparisons to the our systems. We are able to offer a relocation assistance package of £1,500 which would be repaid in part if you left partway through the contract. Page 3 Some Practical Issues Healthcare Moving to Crawley as an employee you immediately receive many benefits. For example you and any family member will be entitled to our NHS system. All you would need to do is register with a local medical practice showing some form of identity and your intentions to stay for longer than 6 months. Once you are registered you would also be eligible for any hospital treatment in our local NHS hospitals. Both hospital and family practice treatment would be free of charge. Banking At Saxonbrook Medical your salary is paid into a bank account on monthly basis. This is easily set up and Crawley has a variety of banks to choose from. To open an account a letter of introduction can be arranged for you. You will also need to bring with you previous bank statements and pay slips from your previous employment. Typical information can be found from our bankers at www.natwest.co.uk. Housing Finding a home in Crawley is not a difficult process, but may appear expensive if you have not seen UK prices before. Homes for sale or for rent are advertised weekly. As a rough guide, a 1 bedroom apartment would rent for £600 per month, £750 for a 2 bedroom house, £950 for a 3 bedroom house, and 4 bedroom family house would be about £1100. A small 2/3 bedroom house would cost about £200,000 to buy, a 3/4 bedroom house would be about £300,000 and depending on location, the costs can be a lot higher. Estate agents are available to guide you through the process of buying or renting. If you decide to rent, the sort of information they will require is previous address, proof of employment and income and credit references. Many suitable properties are advertised on the web, and a typical local agent is www.taylor-robinson.co.uk . Education The education system in England differs from that provided in the United States. Education is compulsory for children between the ages of 5 and 16 years. The schools are divided into primary (5 - 11 years old) and secondary (11 - 16 years old). Most schools are free and supported by public funds, and information on schools around Crawley can be found at http://www.crawley.gov.uk/stellent/idcplg?IdcService=SS_GET_PAGE&nodeId=204 . There are independent private fee paying schools, an example is at www.ardingly.com. Transport Moving to Crawley, which is adjacent to London Gatwick Airport, and has excellent rail and road links, means that it can be an ideal place to act as a hub to explore England, and indeed Europe. Gatwick Airport has a variety of low cost airlines based there, that can offer flights to Europe for about £45, and at times even cheaper. Page 4 Entertainment in and around Crawley Relaxation is also important after a busy working week. Crawley has a variety of good restaurants and typical old British Pubs with a friendly atmosphere. If Keeping Fit is important to you then Crawley can offer a new leisure facility "K2" with state of the art fitness equipment. There are a number of local attractions which you can find more about in the following links: www.sussextourism.org.uk www.visitsussex.org There are also a number of local historic sites within a short distance from Crawley: Hever Castle Henry VIII retreat www.hevercastle.co.uk Wakehurst Place Royal Botanical Gardens www.kew.org Leonardslee Gardens Renowned rhododendrons www.leonardslee.com Pulborough Brooks Royal Society Nature Reserve www.rspb.org.uk Royal Pavilion Regency Palace of King George IV www.royalpavilion.org.uk Portsmouth Dockyard King Henry VIII"s Mary Rose flagship www.historicdockyard.co.uk Fishbourne Palace Roman Vila of King Togidubnus www.sussexpast.co.uk Arundel Castle 11th Century Stately home www.arundelcastle.org Leeds Castle Royal residence over past 1000 years www.leeds-castle.com Royal Tunbridge Wells Georgian Spa town www.visittunbridgewells.com Hampton Court Palace Tudor Palace www.hampton-court-palace.org.uk Kensington Palace Home of Diana, Princess of Wales www.kensingtonpalace.org.uk Wimbledon Lawn Tennis Museum www.wimbledon.org/museum Bluebell Railway Steam Train Line www.bluebell-railway.co.uk Theatre Entertainment of a high standard is available at our local theatre. We have a varied program through the year which you will find on www.hawth.co.uk Brighton On the South Coast, with it"s Regency history, the City has a wide variety of places to visit and things to see, www.brightonbusiness.co.uk www.visitbrighton.com London Living in Crawley has the advantage of a good rail system that can get you to the centre of London City in 30 minutes. www.visitlondon.com, is a wealth of information, but the London eye is the way the world sees London www.ba-londoneye.com. With London so close you have the option of going to Oxford Street, Harrods and then to the West End to see a good show and still be back in Crawley before Midnight. To find out more about London Shows log onto www.officiallondontheatre.co.uk Taxation As fulltime employees in the UK, you will pay UK taxes on your income as a Physician Assistant here. You will not have to pay USA taxes on your UK pay. However, if you have income in the USA that is otherwise taxable (accounts, bonds, etc) you will still need to file a tax return to the IRS for those items. If in doubt, you should speak with an accountant regarding your own situation Page 5 JOB DESCRIPTION JOB TITLE: Physician Assistant SALARY: circa £45,000 HOURS: 40 hours per week – 2 year fixed term LOCATION: Based between two office locations in Crawley - Maidenbower and Northgate Surgeries RESPONSIBLE TO: Dr I Anderson JOB SUMMARY: This post is to provide medical services that the post holder is competent to perform, consistent with their education, training and experience. This is to be delivered through written delegated authority from the supervising doctor who has the responsibility for the patient. This delegation does not relieve the supervising doctor from the responsibility of continued care. Main Duties and Responsibilities: Through the activities of the post holder being directed by the supervising doctor, and acting as an agent for the doctor, any orders given or tasks performed shall be considered as if they are performed by the doctor. As such, they can be initiated without specific patient orders. The duties of the post holder will include, but not be limited to: 1. Take a history from a patient, perform a physical examination and make an appropriate assessment and diagnosis; initiate, review and revise treatment and therapy plans, recording and presenting pertinent findings in a manner consistent with practice procedures. 2. Arrange for laboratory and radiology procedures, screening and other therapeutic activities including therapeutic diets, physiotherapy, occupational therapy, as well as nursing services. 3. Inform and counsel patients regarding matters pertaining to their physical and mental health. This may include topics such as medication, diet, social habits, family planning, normal growth, development and aging, aiming to promote their understanding of long term management of their disease, thereby ensuring compliance to NSF guidelines. Page 6 4. Where needed to arrange admissions, preparing appropriate referral documentation, or to facilitate continuing care in the community through the provision of services from available community resources, including statutory and voluntary organisations. 5. Perform minor procedures which are typically performed under local anaesthetic, subject to verification of training to perform the procedure. 6. Assist in the clinical and administrative processes that are required to ensure the smooth running of the Practice and to enable it to meet the various quality standards that are expected of it. 7. Perform audit, research and analysis tasks associated with practice activities. 8. Assist in clinical teaching and supervision of peers, colleagues, and students, as well as participate in the practice education programme. 9. Ensure good working relationships with all members of the multidisciplinary primary healthcare team. 10. Keep up to date with medical research technology and related issues; ensuring such training and development meets clinical governance guidelines for Continuing Professional Development and a Personal Development Plan. 11. Undertake other activities where needed that are within the post holder"s clinical competence and which would not otherwise jeopardise the delivery of primary medical services to patients. 12. Undertake continuing medical education/examinations to maintain ongoing certification with NCCPA (National Commission of Certification of Physician Assistants) or equivalent. Confidentiality The nature of the work means that the post-holder should preserve the confidentiality of information however gained or stored. Health and Safety The post-holder is required to make themselves aware of and to comply with Saxonbrook Medical"s Health and Safety Policy. No Smoking Policy Saxonbrook Medical endorses the principle that whether people smoke or not is a matter of personal choice, but where they smoke is of public concern. The policy on smoking and health promotes non- smokers and requires that the premises be smoke free. Equal Opportunities It is the aim of the organisation to ensure that no job applicant or employee receives less favourable treatment on grounds of gender, religion, race, colour, sexuality, pregnancy, age, disability, nationality, ethnic or national origins nor should he/she be placed at a disadvantage by conditions or requirements which cannot be shown to be justifiable. To this end, Saxonbrook Medical adopts an Equal Opportunities Policy and it is for the employee to contribute to its success. Page 7 PERSON SPECIFICATION JOB TITLE: Physician Assistant SALARY: circa £45,000 HOURS: 40 hours per week – 2 year fixed term LOCATION: Based between two office locations in Crawley - Maidenbower and Northgate Surgeries RESPONSIBLE TO: Dr I Anderson The successful candidate will have excellent interpersonal and communication skills and first class organisational ability, being able to work within their own scope of practice whilst dependent upon the supervising doctor. An ability to organise and prioritise workload and exercise sound judgement when faced with conflicting pressures is essential. The successful candidate should be qualified to a standard equivalent of Board Certification of the National Commission of Certification of Physician Assistants (PA-C), with at least two years post graduate experience in Family Medicine, or other such specialities that will stand in good stead for such a position, with a commitment to continuing medical education and profession development. The National Health Service has been reviewing the competencies which they expected of a Physician Assistant. Their report at here outlines the thinking behind introducing this role in England. A matrix suggesting diseases which successful candidates ought to be capable to diagnose and manage, to varying degrees is detailed here. However, specific experiences in the following may be helpful. Management of chronic and long-term conditions. Sexual health, gynaecology and family planning Urgent care and emergency medicine Managing patients with obesity and related diseases Mental health, supporting patients with long term enduring mental illnesses Alcohol & substance misuse. The practice is fully computerised and so good basic computer skills are required. The quality that is required most of all is an ability to work well with colleagues with an aptitude to be flexible to meet the needs of the Practice, whilst being enthusiastic to the changes seen across the health service and maintaining a caring attitude to patients. Page 8 In exchange we offer a happy and friendly working environment, which emphasises team working and co-operation, equity in staff policies and opportunities for further personal development. Page 9 CONTRACT OF EMPLOYMENT FOR PHYSICIAN ASSISTANTS IN GENERAL PRACTICE This is a statement to set out the terms and conditions of employment agreed between: Drs Thomas and Anderson of: Saxonbrook Medical Maidenbower Square Maidenbower Crawley West Sussex RH10 7QH And you:- ******** Of: ******** Page 10 1. Job Title Your job title is Physician Assistant in General Practice Work address: Saxonbrook Medical Maidenbower Square Maidenbower Crawley West Sussex RH10 7QH 2. Dates of Employment Your employment is to commence on ******** Any previous periods of employment are not deemed continuous with this post. In the event of a partnership change, your employment will be regarded as continuous. 3. Period of Employment The appointment is for a fixed period of two years or until you reach retirement age or until either party gives notice. 4. Salary Your salary is £***** per hour, based on a 40 hour week. Your salary is inclusive of Sussex Weighting, and other allowances, and is payable monthly on the last day of the working month. 5. Incremental Dates Salaries will be reviewed on an annual basis in April. Annual increment will reflect the inflationary markers adopted by the NHS. Delays in verifying this will not affect any such payments but may result in them being made on a backdated basis. This, and any other discretionary increases will be subject to satisfactory performance appraisal. 6. Location and Duties The Practice has surgery premises at Maidenbower and Northgate. You are employed to work in either of these premises as required, but you may also be required to work in any other such location as may be agreed. You will be required at the above premises to provide general medical services by way of, for example, surgeries, clinical and relevant administrative work, and other such duties as are required by the Partners under the NHS Regulations and which are reasonably delegated to you by the Partners. Further details of the duties are listed in your "Physician Assistant Job Description", which you should familiarise yourself with. 7. Hours of Work Page 11 Your basic hours of work are 40 hours per week, however you may be required from time to time, to work extra hours as might reasonably be required by your Line Manager. 8. Line Manager Your line manager is Dr I Anderson. 9. Annual Leave Paid annual leave entitlement is 5 weeks per year plus National Bank Holidays. It is asked that reasonable notice be given for booking annual leave of at least two months. The timing of all leave is granted at the Business Manager"s discretion to ensure that adequate cover is available. It will not usually be possible for more than one Medical Care Practitioner to be on leave at any one time. Proposed dates must be agreed before booking your holidays. Leave periods between 1 st June and 30th September should normally be no more than 10 consecutive days. Annual leave is not to be carried over from one year to the next unless it is by prior arrangement with your Line Manager. Your annual leave year runs from 1 st April to 31st March. 10. Study Leave In addition to the above 5 weeks" annual leave, study leave of up to 5 days per annum will be granted for Continuing Medical Education (CME), purposes approved by the Practice, subject to the conditions below. Study leave will be available on a pro-rata basis for part- time medical care practitioners. Such study includes attending a course, (but not exclusively or necessarily), research, teaching, examining or taking examinations, visiting clinics and attending professional conferences. Mandatory training updates are part of your study leave. In circumstances where a course undertaken is of exceptional value to the practice, study leave periods may be extended, at the discretion of the partners. The following conditions shall apply:- The leave and the purpose for which it is required must be approved by your line manager and/or the partners. The cost of the course or the study as detailed above shall be the responsibility of the practitioner concerned. Where leave with pay is granted, the Medical Care Practitioner must not undertake any remunerative work without the special permission of the Practice. At the discretion of the Practice – typically on 2 yearly basis, course fees and travel expenses to the AAPA Conference may be paid. In such cases some involvement with Practice promotion would also be required during the Conference / Exhibition. You should keep notes of what you have learned when on study leave, and should be prepared to present these to your line manager or at a practice meeting. 11. Statutory Sick Pay (SSP) If you are entitled to SSP this will be paid to you by the Partners at the appropriate rate for the agreed qualifying days. These will be days on which you would normally work. A copy of the SSP Scheme is available in the Surgery. Page 12 12. Medical Examination This appointment is conditional upon a satisfactory medical examination / report. The Practice may require you to undergo a medical examination at any time during your employment by a medical practitioner nominated by the Trust which will include reasonable testing and diagnostic procedures. You may be required, prior to commencement, to be immunised against certain illnesses which the Practice deems necessary in order to protect the Health and Safety of employees and/or to minimise the risk to patients. 13. Notification of Absence Notification of absence owing to sickness must be made to the Business Manager or the Senior Reception Administrator as early as possible on the first day of sickness. Sick pay may be withheld because of late notification. If the absence continues for four calendar days, a self-certificate form SC1 must be submitted to the Business Manager so that SSP can be claimed. After seven days" absence a Doctor"s Certificate must be submitted. If while on holiday you are ill for more than seven days and a Doctor"s Certificate is obtained, you may be eligible for further paid leave. Any accident or injury to a member of staff or the public must be entered in the Accident Book and reported to the Health and Safety Representative for that Practice, and also to your Line Manager. 14. Practice Sick Pay The practice will only cover the first 4 weeks of sickness in any one calendar year. The Partners recommend that you take out an independent policy that covers you in the event of an extended period of sickness. Sick Pay payments incorporate entitlement under SSP. In the event that you claim compensation in respect of any injury or sickness which caused absence from work for which the Practice had paid sick pay, you must refund to the Practice an amount of sick pay equal to the compensation received by you in relation to the period concerned. This includes any other state injury or sickness benefits to which you are entitled and which you have claimed and received because of the period of sickness and any relevant benefits received under the terms of private sickness insurance policies. 15. Compassionate Leave In the event of any urgent domestic distress, compassionate leave may be granted. It is usual for this period not to exceed five days, but since much may depend on the individual circumstances, the period may, at the discretion of the Partners, be extended by a further three days. 16. Statutory Maternity / Paternity Leave and Pay Page 13 When an employee receives information from a medical source that she is pregnant, it would be very helpful if the employee would notify the practice manager as soon as her pregnancy is confirmed. If requested to do so, the employee should provide a certificate to confirm her pregnancy. You will be entitled to any Statutory Maternity/Paternity Rights and pay for which you qualify. If appropriate, any entitlement to Statutory Maternity Pay (SMP), will be deducted from full pay received as set out below. Subject to the same statutory conditions, you will also be entitled to your normal full pay for a period of 18 weeks following the date on which you actually leave work in preparation for having your baby. This is entirely separate from your right to paid sick leave set out in Clause 13 above. Payment will be subject to you having been employed by the Practice for 2 years prior to the start of maternity leave. Payment will also be subject to your returning to work for the Practice on the same basis as before for at least three months. If you do not fulfill this condition, you will be liable to repay the whole amount of maternity pay received, less the normal amount of SMP to which you were entitled. You should make yourself aware of the requirements of the statutory maternity scheme, particularly in relation to your return to work, e.g. the giving of proper notices at the appropriate times to the Partners as your employers. The main requirements are set out in Booklet PL 958 (Rev8) "Maternity Rights – a guide for employees", published by the Department of Trade and Industry, available free from the Job Centres. 17. Parental Leave and Dependant"s Leave As per the relevant legislation, you are entitled to parental leave and dependant"s leave. Please note there is no entitlement to pay in this circumstance, and that the amount of time off needs to be agreed. 18. Pension Hours that are worked in the Practices (i.e. Northgate and Maidenbower) are pensionable under the NHS Superannuation Scheme. Although you are not employed by the NHS, you may join the NHS Pension Scheme (if you are eligible to do so) and you would be contracted out of the State Earnings Related Pension Scheme. If you join, your pension will be computed as practitioner service. You will be taken into the NHS Pension Scheme on appointment and your salary will be subject to deduction of contributions of 6%. Details of the Scheme are given in "NHS Pension Scheme: Your Guide" and the "Benefits for Practitioners" which may be seen at the surgery premises. 19. Period of Notice When terminating your employment you are required to give three months" notice in writing of your intention to terminate your employment. Similarly, you are entitled to receive in writing the same minimum period of notice. Page 14 For the avoidance of doubt there will be no entitlement to an additional period of notice extending beyond the expiry date of the fixed period of this contract. 20. Application of Minimum Periods These arrangements shall not prevent: 1. the Practice or a practitioner from giving, or agreeing to give, a longer period of notice than the minimum; 2. both parties to a contract agreeing to a period different from that set out; 3. either party waiving its rights to notice on any occasion, or accepting payments in lieu of it; or 4. either party treating the contract as terminable without notice, by reason of such conduct by the other party as enables it so to treat it at law. 21. Outside Activities Any medical duties or appointments outside the practice area must not compete with the Partners" Practice or impinge on your contracted duties with them. This applies equally whether such duties are remunerated or not. The Partners" consent does not imply any responsibility on their part for your acts and omissions in the course of such activities. 22. Convictions/Offences This employment is exempt from the provisions of the Rehabilitation of Offenders Act 1974. You are not therefore entitled to withhold information requested by the Partners about any previous convictions you may have, even if in other circumstances these would be regarded as "spent" under the Act. You are therefore required to provide this information before starting work. Concealment of such information may result in your dismissal. You are further required to report forthwith to the Partners any convictions or offences with which you are charged, (including traffic offences) while you are an employee of the partners. 23. Records You are required to keep proper record of attendance, visits by and to any patients, telephone consultations and all such other records as are required by NHS legislation or are reasonably required by the Partners. 24. Confidentiality Subject to the necessary sharing of information with other health professionals, with the informed consent of the patient, you are required to preserve the absolute confidentiality of the affairs of the Partners and of their patients and of all matters connected with the Practice, and this obligation shall continue in perpetuity. A breach of this requirement during your employment will be grounds for dismissal, subject to the provisions of the Disciplinary Procedure. Page 15 25. Prohibited Acts You shall not: 1. hold yourself out to be in partnership with the Partners, or 2. pledge the credit of the Partners. 26. Telephone You are required to keep your residence connected to the public telephone service. 27. Professional Registration Evidence of professional registration with the NCCPA or equivalent is required before commencement of duty and is required to be maintained during your employment. It is your responsibility to ensure that you are registered at all times. Failure on your part to maintain such registration, including suspension or erasure from the Register and the imposition of conditions upon your registration, will entitle the Partners to suspend you on full pay immediately and thereafter to terminate your employment. 28. Medical Indemnity The Practice will pay all costs associated with Medical Indemnity. 29. Practice Meetings You are required to attend and participate in regular Practice meetings including those relating to clinical governance issues. These will usually be held weekly at lunchtimes. If these meetings are held outside normal working hours, reasonable notice will be given. The practitioner is also required to participate in and operate clinical governance methods and systems approved by the relevant Primary Care Trust (PCT), eg medical audit or quality assurance initiatives. The Practice undertakes to provide the practitioner with copies of all local PCT policies and procedures, notice of local educational meetings, and professional compendia, such as the British National Formulary (BNF) and Monthly Index of Medical Specialities (MIMS). 30. Staff Appraisal and Performance Review Your line manager and/or the lead Medical Care Practitioner will conduct your Appraisal. This is intended to be supportive and to be an opportunity to review your educational needs and objectives. You should provide your personal development plan for discussion. Your performance will be discussed with you at least once a year by your line manager and/or one of the partners. This is an opportunity to discuss your job and other matters if you wish. 31. Retirement The retirement age for this employment is 65. Page 16 32. Termination of Employment This Agreement shall be subjected to termination forthwith by the Practice (in line with Practice employment procedure) if the practitioner: 1. has his/her name removed from the NCCPA Register or equivalent. 2. conducts him/herself in a manner which results in his/her name being suspended from the NCCPA; 3. has his/her name removed or suspended from a list maintained under the List Regulations; commits any gross or persistent breaches of the individual"s obligations under this Agreement and such a power of determination shall be exercisable notwithstanding that on some earlier occasion the Practice may have waived or otherwise failed to exercise their rights to termination under this clause; or 4. is guilty of illegal substance abuse or habitual insobriety. 33. Health and Safety It is the Practice"s policy to provide as safe and healthy working conditions as possible, and to enlist the support of all employees towards achieving these ends. It is recognised that overall responsibility for health and safety rests with your employer. However, it is asked that employees be fully aware of the potential health and safety hazards within the Practice environment. The main hazards that staff should be aware of are:- Medical instruments, needles etc., in consulting and treatment rooms, Equipment blocking passageways and fire exits, Other items causing an obstruction or posing a potential risk to staff and patients. Page 17 APPENDIX 1 PRACTICE RULES A. Confidentiality All information concerning patients, staff and the Practice business is strictly confidential. It must not be divulged, except where a patient has given his/her informed consent for this to occur. Breach of confidentiality constitutes gross misconduct and will normally result in summary dismissal, subject to the provisions of the Disciplinary Procedure. B. Access to Medical Records Both attached NHS and directly employed Practice staff, e.g. Health Visitors, Community nurses, Midwives, may have access to our patient records at the discretion of the Partner concerned or yourself via the reception staff, but patient records must not be removed from the building. Access to records may not be given to any unauthorised person. Request to view records should be in writing. Medical records written and retained by NHS GPs are completed on cards which expressly state that they remain NHS property. Records relating to private patients remain the Doctor"s own property. The complexities of the legal position of medical records are discussed in the British Medical Association (BMA ) publication, "The Rights and Responsibilities of Doctors". The Courts can order disclosure of information and the Access to Medical Reports Act 1988 gives patients access to reports compiled for insurance and employment purposes when the examining Doctor is the patient"s own Doctor. There are stipulations about the retention of copies. The Access to Medical Records Act 1988, effective from 1 November 1991, also allows patients and their personal representatives certain rights in relation to their own health records. Guidance on both Acts is available from the Association to BMA members. In any event, you should take steps to make yourself aware of the Act"s provisions. C. Repeat Prescriptions Receptionists or dispensers may accept written requests for repeat prescriptions providing the patient is on regular medication. All other requests will be referred to a Doctor or Medical Care Practitioner. No prescription will be issued until it has been checked and signed by a Doctor. The maximum period for reauthorising repeat prescriptions is six months, unless the patient is seen for a medication review. (There are a limited number of exceptions e.g. COCP, HRT and thyroxine prescriptions). D. Health and Safety at Work It is the Practice policy on health and safety at work to provide working conditions as safe and healthy as possible and to enlist the support of all employees towards achieving these aims. Whilst the overall responsibility rests with the Practice, all staff have a legal duty to take reasonable care to avoid injury to themselves or to others by their work activities and not to interfere with or misuse any clothing or equipment designed to protect health and safety. Particular care must be taken when disposing of contaminated or infected materials, to ensure that it is held securely within an appropriate container and that its nature is properly and clearly identified. Page 18 Examples of the main hazard of which staff should be aware are: 1. medical instruments and equipment, particularly needles and glass items; 2. prams, bicycles, shopping trolleys, toys; 3. possibly contaminated blood specimens or other material 4. certain solutions used for sterilizing purposes 5. the use of any electrical equipment, and spillages This list is not exhaustive. The rules governing the despatch of specimens are as follows: Where possible, all microbiology specimens should be collected on the morning of dispatch. The collection is late morning at Maidenbower and mid-morning at Northgate, Monday to Friday only. Patients should be instructed to put any specimen they collect themselves with the relevant labelled specimen bottle. The specimen should not be placed directly into the microbiology bag. Specimens should not normally be left in the fridge overnight. In the exceptional circumstance where this is necessary, the specimen should be collected as above and a written message should be left on the courier"s bag to ensure the specimen is not forgotten the following day. The receptionists should also be informed. All specimens should be treated as an infection / contamination risk, and appropriate infection control procedures should be observed at all times. Non-clinical members of staff should not be requested to transfer specimens into a different container. They do not have the training in infection control procedures. Under normal circumstances such transfers are not appropriate anyway. E. The Building A member of the Practice staff will always be present in Maidenbower and Northgate surgeries from 8.30 a.m. until 6 p.m. when the telephone calls are transferred to the "Out of Hours" service. No member of the public is to be allowed onto surgery premises unless a member of staff is present. Any damage to Practice premises by staff or patients should be reported immediately to the Business Manager and recorded as appropriate. F. Patient Enquiries Information about hospital reports and test results may only be given to patients with the permission of a Partner or another clinician. G. Requests for Home Visits All requests for home visits will be recorded at the time of receipt on the computer. If the Receptionist concerned is in any doubt about the necessity or urgency of a home visit, the request will be referred to a Partner or yourself. The Receptionists have been instructed not to refuse requests for home visits on their own initiative. Any requests for visits after 12 p.m. will be brought to the attention of the doctor responsible at each surgery. H. Telephone Messages Page 19 All messages will be recorded on Microsoft Outlook on the computer with date and time of receipt. The staff have been told that failure to record any message and/or failure to bring an urgent message to the attention of a Doctor or nurse will be considered a breach of discipline by the member of staff concerned. Any such breaches should be reported to the Business Manager. You must not take disciplinary action in this or any other matter on your own initiative. All your telephone consultations with patients should be recorded by you on the clinical computer system. I. Accepting Patients on the Lists Any person who has recently moved into our practice area may be registered with the Practice. Anyone who is already registered with a Doctor in the practice area and wishes to transfer to the Practice will be referred to the Business Manager. J. Treatment Lay practice staff have been instructed not to advise or prescribe treatments for patients in a medical capacity. Any such requests will be referred to a Partner, yourself or a nurse as appropriate. Items prescribed for, or treatment given to, patients must be recorded in their notes. K. Complaints Any complaint by a patient regarding conduct or service will be referred to the Complaint"s Manager. Written notes on the problem should be made at the time of the complaint. You are required to notify the Partners of any complaint made directly to you or referred to you by the lay practice staff. In the event that a complaint is made directly to you, you are required not to make any presumption about guilt or lack of guilt on the part of a member of staff. The complaint will be investigated and responded too according to the NHS complaints procedure. L. Appointments The arrangements in the Practice will be explained to you. Appropriate entries will be made on the clinical computer system. If a patient indicates some degree of urgency, then arrangements will be made for him or her to consult a Doctor at the earliest possible time. M. Personal Property The Partnership cannot accept responsibility for articles of personal property lost or damaged on their premises whether by burglary, fire, theft, or otherwise, and you are advised to effect your own insurance cover against all risks. N. Accident or Injury at Work Any accidents to a member of staff or a member of the public must be reported to the Business Manager immediately. A factual statement covering to the fullest possible extent all the circumstances of the accident is required to ascertain the cause and prevent its recurrence. All reports of accidents to staff and members of the public whilst on/in the surgery premises, must be recorded in the Accident Book held in the office. O. Public Liability Page 20 The Practice is required under the Employers Liability (Compulsory Insurance) Act 1969 to take out public liability insurance. The insurance policy is displayed on the notice board. You should acquaint yourself with the policy details. P. Medical/Hospital Appointment Full time staff with prior approval (of the Partners in your case) will be allowed paid time off to attend medical or dental appointments. The Partnership requests part-time members of staff to attend pre-arranged medical or dental appointments outside their normal working hours. Pregnant staff have a statutory right not to be unreasonably refused paid time off for ante-natal care. Q. Job Title Although you have been given specific duties and a job title, you may be required to take on other medical duties within the Practice, as and when the need arises, by arrangement. R. Change in Terms of Employment Any future changes in the terms and conditions of your employment will be confirmed in writing following agreement. S. Product Liability The Partnership has certain responsibilities when supplying medicines and appliances to patients whether in the surgery treatment room, in emergency consultations or when dispensing. The Practice may be liable in law if the product being dispensed is defective and damage results from the use of a defective product in circumstances where the supplier of the product cannot be identified. You must therefore: 1. Adhere strictly to the labelling regulations which apply to all dispensed medicines,and 2. Keep accurate records (invoices etc.) of sources of supply of all products and ensure that they are retained for a period of 11 years. T. Practice Security All staff are responsible for the security of the buildings within which they work. This includes both working at Maidenbower, or Northgate surgeries. If a breach of security has been discovered, the member of staff concerned will be contacted and should, where possible make every effort to ensure that this breach is rectified as soon as possible. This may require the member of staff having to return to the centre to ensure this. This return will not be subject to payment by the practice and expenses for this are not claimable from the practice. Failure to return if requested may be seen as serious misconduct, or seen as an action that is likely to bring the practice into disrepute. Staff who lock up at the end of the day in the practices are responsible for ensuring that all windows are locked and that the alarm system is activated upon their leaving. To further help this, all staff should ensure that their own work places are secured when they are vacated at the end of the day. U. Staff Use of e-mail and Internet Facilities Page 21 The use of the practice e-mail and internet facility is strictly for practice purposes only, and you should not under any circumstances use the e-mail and internet system to transmit any material which is offensive or obscene, untrue or malicious, in breach of copyright, or defamatory. You should understand that any such use of the e-mail and internet system is likely to constitute gross misconduct, and be liable to disciplinary procedures and summary dismissal. You should further appreciate that messages sent over the e-mail and internet system could give rise to legal action against the practice. You should note in particular that breach of confidentiality could arise from transmission of messages via the e-mail and internet system. The practice therefore reserves the right to retrieve the contents of messages for the purposes of monitoring whether the use of the e-mail and internet system is legitimate, to find lost messages or to retrieve messages lost due to computer failure, to assist in the investigations of wrongful acts, or to comply with any legal obligation. V. Financial Responsibilities of Staff The practice can take no responsibility for any debts that staff accrue during work time, if the debt is unrelated to their working practice. Any loss of money or income that these debts may result in, may be deemed to be the responsibility of the member of staff, and therefore will not be paid by the practice. This does not include any transaction with suppliers to the practice for goods or supplies in the normal business of the practice. W. Staff Handbook Please refer to the Staff Handbook for other rules generic to all staff. If you are unsure about any rules you are advised to seek clarification and further explanation from the Partners because failure to observe them may result in disciplinary action. Page 22 APPENDIX 2 Disciplinary Rules and Procedure Preamble Rules and procedures are necessary for promoting fairness and order in the treatment of individuals in matters of discipline and assist a Practice to operate effectively. Rules set standards of conduct and performance at work; procedures help to ensure that the standards are adhered to and also provide a fair method of dealing with alleged failures to observe them. Disciplinary procedures should not be viewed primarily as a means of imposing sanctions. They should also be designed to emphasise and encourage improvements in individual conduct. Individuals will be informed of the complaints against them and be given an opportunity to state their case before decisions are reached. They have a right to be accompanied by a professional colleague (other than a Partner), or a representative at all stages in the procedure. Any warnings given in this procedure will be deemed to have lapsed after one year, subject to satisfactory conduct. Disciplinary Procedure The following Disciplinary Procedure will apply: Counselling: If your conduct or performance at work are causing concern, you will first be asked to attend to discuss the matter with the Senior Partner. There will be no formal record retained. It is hoped that this informal counselling will resolve any possible difficulties and lead to the required improvement. Verbal warning: If following this, there is continued cause for concern, there will always be a further formal meeting. You will be given adequate written notice of the meeting and the allegation against you will be clearly set out in writing. You will be able to reply to the allegations during the meeting. If, following this, disciplinary action is deemed appropriate, a verbal warning will be given and confirmed to you in writing. The nature of the misconduct or failure in performance will be stated and the nature of the disciplinary action taken will be specified. The likely consequences of further misconduct or failures will be indicated, along with the period of time given for improvement. Written warning: If, following this, there is continued cause for concern, a further disciplinary meeting will be convened on the same basis as before. A warning given after a hearing at this stage will be a formal written warning. If no improvement is forthcoming, it may result in your dismissal. Final written warning: A further disciplinary meeting will be convened on the same basis as before. Where there is a failure to improve or change behaviour following the first written warning, or where the infringement is sufficiently Page 23 serious, a final written warning will be given. Failure to improve or modify behaviour following this is likely to result in your dismissal. Dismissal: If there is no improvement, you may then be dismissed following a further hearing convened on the same basis as before. The person with the power to dismiss you is Dr Thomas, who has been delegated this power by Dr Anderson. Appeal: Where circumstances permit, the right of appeal against disciplinary decision at any stage in the disciplinary procedure will be to the Partner or Partners not previously involved in the case. Appeals must be submitted in writing within 14 days of the date of the disciplinary decision. Serious misconduct: There are varying degrees of seriousness of misconduct, so this procedure may be commenced at any stage, depending on the severity of the misconduct. A few examples illustrative of gross misconduct which would justify summary dismissal are: serious breach of confidentiality; theft or abuse of medicines. In some circumstances where serious misconduct is alleged, the member of staff concerned will be suspended on full basic salary pending an investigation and hearing. Accompanying Person: You have a right to be accompanied by a single companion i.e. a friend, colleague or representative at any hearing constituted under the disciplinary procedure. Page 24 APPENDIX 3 Grievance Procedure A. If you have any grievance relating to your employment you should raise this initially with the Senior Partner, who is Dr Thomas. Minor grievances may be raised orally, but serious grievances must be in writing. B. A meeting will be held between you and the Senior Partner or another nominated by the Senior Partner. C. The grievance meeting will be held within one week of the grievance being received. D. Where the grievance is not resolved at this stage, you will be entitled to have your grievance heard by the Partnership as a whole, whose decision in the matter will be final. E. You are entitled to be accompanied by a single companion, i.e. a friend, colleague or representative at any hearing constituted under the grievance procedure. Signed: …………………………………………………. For the Employer This ……………………… day of ……………………………. 200 I acknowledge receipt of the terms and conditions of employment and agree to be bound by them. I understand that you will retain a signed copy of the Terms and Conditions of Employment. Signed: …………………………………………………. Employee This ……………………… day of ……………………………. 200 Revision Feb 2005 Page 25 SUPERVISING PHYSICIAN"S RESPONSIBILITY FOR SUPERVISION OF PHYSICIAN ASSISTANT SUPERVISING PHYSICIAN ____________________________________________________ (Name of Physician) SUPERVISION REQUIRED. The physician assistant (PA) named in the attached Delegation of Services Agreement will be supervised by the supervising physician in accordance with these guidelines of the Physician Assistant Regulations, which have been read by the physician whose signature appears below. MEDICAL RECORD REVIEW One or more of the following mechanisms, as indicated below, by a check mark (x), shall be utilized by the supervising physician to partially fulfill his/her obligation to adequately supervise the actions of the physician assistant named ___________________________________________________________. (Name of PA) _____ Examination of the patient by a supervising physician the same day as care is given by the PA. _____ The supervising physician shall review, audit, and countersign medical records written by the PA when the supervising physician is consulted regarding patient care. _____ The physician shall select for review those cases that by diagnosis, problem, treatment, or procedure represent, in his or her, the most significant risk to the patient. BACK UP PROCEDURES: In the event this supervising physician is not available when needed, the following physician(s) has (have) agreed to be a consultant(s) and/or to receive referrals: ____________________________________________________ (Name of Physician #1) ____________________________________________________ (Name of Physician #2) _____________________________________________________ Date Physician"s Signature Page 26 Page 27 DELEGATION OF SERVICES AGREEEMENT BETWEEN SUPERVISING PHYISICIAN AND PHYSICIAN ASSISTANT PHYSICIAN ASSISTANT _____________________________________________________ (Name) SUPERVISION REQUIRED. The physician assistant (hereinafter referred to as PA) will be supervised in accordance with the written supervisor guidelines of the Physician Assistant Regulations. The written supervisor guidelines are incorporated with the attached document entitled, "Supervising Physician"s Responsibility for Supervision of Physician Assistants." AUTHORISED SERVICES. The PA is authorised by the physician whose name and signature appear below to perform all the tasks set forth in subsections (a), (d), (e), (f), and (g) of Section 2 of the Physician Assistant Regulations, when acting under the supervision of the herein named physician. (In lieu of listing specific lab procedures, etc. the PA and supervising physician may state as follows: "Those procedures specified in the practice protocols or which the supervising physician specifically authorises.") 1. The PA is authorized to perform the following laboratory and screening procedures: Those procedures specified in the practice protocols or which the supervising physician specifically authorises. 2. The PA is authorized to assist in the performance of the following laboratory and screening procedures Those procedures specified in the practice protocols or which the supervising physician specifically authorises. 3. The PA is authorized to perform the following therapeutic procedures Those procedures specified in the practice protocols or which the supervising physician specifically authorises. 4. The PA is authorized to assist in the performance of the following therapeutic procedures Those procedures specified in the practice protocols or which the supervising physician specifically authorises. PRACTICE SITE. All approved tasks may be performed for care of patients in this office or clinic located at: 1. Maidenbower Square, Harvest Road, Crawley, West Sussex, UK 2. 9 Woolborough Road, Crawley, West Sussex, UK EMERGENCY TRANSPORT AND BACKUP. In a medical emergency, telephone 999 to summon an ambulance. Tell the ambulance crew where to take the patient and brief them on known and suspected health condition of the patient. Page 28 PHYSICIAN ASSISTANT DECLARATION My signature below signifies that I fully understand the foregoing Delegation of Services Agreement, having received a copy of it for my possession and guidance, and agree to comply with its terms without reservations. ______________ ________________________________________________ Date Physician Assistant"s Signature ________________________________________________ Physician Assistant"s Printed Name ______________ ________________________________________________ Date Supervising Physician"s Signature ________________________________________________ Supervising Physician"s Printed Name Page 29
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Comfort Suites Savannah North
115 Traveler's Way
Port Wentworth, GA 31407
Phone: (912) 965-1445
Fax: (912) 965-1446
Old Town Trolley Tours
A fun and comfortable way to see the Historic District in style, this reliable outfit operates tours of some of Savannah's most popular attractions. The trolley will pick you up at your hotel, with departures every half hour throughout the day. A wide variety of tour packages are offered, including a very popular "ghost" tour that highlights the city's history of other worldly encounters.
234 Martin Luther King Blvd
Savannah, GA 31401
+1 912 233 0083
Earn valuable points toward free nights.

subset: commoncrawl


text:
February 27, 2015
That's my back yard this afternoon. The bugs have started to come out, and I've been seeing songbirds, and the yard guys have come to mow the lawn twice so far this year, and I think we're going to get an early spring.
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February 02, 2015
Alouette makes my favorite Garlic-and-Herb cream cheese. They used to make cream cheese flavored with black pepper, which was wonderful, but they don't any more. A couple of days ago it occurred to me that I could make it for myself, so today I tried it.
It's easy to underestimate the amount of cheese and overestimate the amount of pepper, I found. I ended up adding pepper several times, ultimately about six times this much.
After giving it a thorough mixing, put it in a plastic container and refrigerate for several hours. The flavor components that make fresh-ground black pepper taste so good are mostly oil-soluble, so it takes a while for them to leech out into the cheese. Over the course of several hours I mixed it up about three times, and the last time I added a bunch more pepper because it just didn't taste like enough.
Serve on Ritz Crackers (the bachelor chef's best friend). And how did it taste? Excellent. The pepper flavor was distinct but didn't overpower the cheese flavor, and it left a nice mild burn in my mouth without making me scream in pain. This was ridiculously easy and the result was very tasty.
If I can do it, you can do it.
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December 18, 2014
US Weather Bureau is predicting 2-5 inches of rain for here Saturday night. That should be fun. (Also 5-8 inches in the Coast range.)
Where that won't be fun is if the Willamette goes out of its banks. It won't affect us here, but the creek ought to get pretty lively!
UPDATE: I wonder if this will be as bad as the Chrismas Flood? Probably not, but it may come close.
UPDATE: I was only 10 when the Christmas Flood happened, but it's got special meaning to me. It was the second part of a 1-2 punch to hit the Northwest, coming just about a year after what we call the Columbus Day Storm.
About 1961, my parents bought a lot in SW Portland, moved a trailer house onto it, and began building their dream house. Now when a lot of people say "We're building a house" they mean they hired a construction company. That's not what we did. My dad actually designed the place and drew all the blueprints, and worked on it evenings and weekends and vacations. My grandfather, who was a carpenter, came up to help as much as he could, and friends of my dad would sometimes come over and help. My brother, who was 12-13 years old at the time, did a lot of work and me, 8-9, I did as much as I could. We had the foundation poured and the basement covered by the main floor, and managed to put up all the outer walls and got the roof over it, and covered the whole roof with plywood. But there weren't yet any internal partitions by October, 1962.
And then we got the storm of the century, and it blew the house down. I was in the bathroom when it happened so I didn't see it go. But shortly thereafter my folks began to worry that the trailer might roll over in the wind, and so we walked to our neighbor's house and asked them to put us up for the night.
We spent a week living at my uncle's house in NE Portland because his electricity didn't go out. It took us several months to tear everything apart and restack all the lumber, and then to put the walls and roof back up again.
We were a lot further along by a year later when the second punch of the 1-2 whammy happened. It was bad for the state, but it didn't actually affect us at all. (Our lot was on the edge of the Tryon Creek Valley, so the water just ran off and we never saw anything.
But I remember in 1964 people beginning to wonder if we'd get slammed again. (We didn't.) By then we were living in the house and had sold the trailer.
UPDATE: Oh, boy; they've updated the forecast:
That last is me.
And if those estimates are even close to accurate, every river in the western third of this state is going to flood.
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November 23, 2014
We just had a thunderstorm, and the creek has gone from a trickle to a flood.
The part the beavers built, on the far right, is standing up to the challenge. The part left over from the now-failed culvert on the near left isn't doing so well; I'm expecting a failure there. It's just soil, with only grass roots for structure, and I expect it eventually to wash away.
The water flow in this creek varies enormously with the weather. Not as much so as some of the dry washes in Arizona, which can be bone-dry for years and then suddenly fill completely with water in just a few minutes, but still rather amazing.
Our creek isn't alive, of course, but watching it is like watching a living being.
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November 11, 2014
So I just opened my deck door because I wanted to take a clean picture of the creek:
And it's forty-brrr degrees out. And one of my neighbors has a charcoal grill going and is grilling some meat. I could definitely smell it.
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October 28, 2014
My Oregon ID card was due to expire on my birthday (Thursday) so today my brother took me to DMV to get it renewed. (Acquisition of the wheelchair and slippers was part of the preparation for this mission.)
Actually, he took me there twice. The first time we found out that the rules had changed and I had to produce another piece of ID, so we had to return to my apartment to get my birth certificate.
It wasn't very crowded, and the woman who was managing the line recognized us as having been there earlier, and moved me to the front of the line -- which was nice of her. And it all went briskly. From start to finish, an hour and a quarter. (That's timed from when I left my apartment the first time to when I returned to it, so it includes two round trips in his car.) The actual time in DMV was less than 15 minutes.
Who says all government bureaucracies are terrible?
UPDATE: But when they took my photo they asked me to take off my glasses. So it doesn't look like me, because I always wear glasses. I can't see without them.
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October 27, 2014
My brother came over today and took me on a shopping mission. It's the first time I've been out of this apartment since last Spring. My problem was that my feet have swelled up, and my shoes didn't fit any more, so I was stuck here.
We went to Beaverton Pharmacy, and I bought a wheel chair:
We also went to a shoe store and I bought a pair of slippers which were big enough to fit my feet.
Coincidentally, it's my birthday this week, and this is a really good gift. To me it represents freedom. I can now get out of this place, at least once in a while, and go further than the corner of the parking lot (which is about as far as I can walk anymore). I can go to restaurants. I can go to the transit mall and catch the train to my doctor's office. I can make it across Canyon to the Fred Meyer pharmacy for my prescriptions.
He also let me get a treat:
At my request we went through the drive-through lane at McDonalds. I've been dreaming about the taste of a Big Mac for a long time, and just now I got to taste it again, for real. It was just as good as I remembered. (It's the first time in about three years that I've had one.)
So today has been a good day.
UPDATE: No advice, please.
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October 22, 2014
It's been raining pretty hard today, and now the runoff is overtopping the entire culvert.
It's not supposed to be like this; there are two big concrete pipes under the culvert which are supposed to carry the water, but they've been completely clogged up for years. Unfortunately, fixing them would either require scuba gear or a back hoe.
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October 17, 2014
The main function of my phone (HTC Droid DNA) is to solve the "I've fallen and I can't get up!" problem. (And the "I've had another stroke" problem.) I'm proud to say that since my stroke I haven't lost my balance enough to fall, not even once. But I've come close a couple of times, and it's a genuine fear, especially as I'm gradually losing control over my left leg. So I keep my phone with me as I move around the apartment, to make sure that when something bad happens, then if I'm seriously hurt I can call for help. It's always within arm's reach. (Even in bed -- my stroke happened while I was asleep and another one could do the same.)
The only apps on the phone I use are the timer app (when I'm cooking) and Accuweather, neither of which are particularly power hungry. Accuweather is only supposed to phone home when I invoke it, for instance, and when it does it doesn't actually say much. The phone has a healthy battery, and I'm used to having it go from 100% charged to about 90% in one day.
Starting a couple of weeks ago, it began to drop a lot more than that. The phone is nearly two years old and maybe the battery is losing the ability to hold a charge? Well, that wouldn't change so radically so fast. So I looked at the power consumption tracking info frames, and it showed my wifi being a big power consumer, and wifi running when the phone was off. Oh, dear; have I become infected with an Android virus? Am I now part of a botnet?
Yesterday I found out the real answer: the phone popped up and said, "I've downloaded a patch; wanna install it?" I let it, so now I'm up to date, and now the power consumption is back to what I'm used to.
This is the fourth patch since I got the phone, and the other three times it asked permission before downloading, which happened immediately and only took about 20 minutes. (Then it asked permission to install, which took maybe ten more minutes.) I'm not sure why it did the download surreptitiously this time.
So now I'm running Android 4.4.2 and the latest HTC stuff, maybe. I'm grateful that Verizon is still putting out patches for my phone because I read somewhere that Verizon doesn't sell HTC phones any more. Kind of a shame.
UPDATE: I just looked at Verizon's web page, and I'm wrong. They are still selling HTC phones. What I read was that all "Droid" phones are now Motorola, and I overinterpreted that. (And anyway, Motorola Mobility, the phone group, now belongs to Google.)
So what distinguishes a "Droid" from any other kind of phone?
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October 15, 2014
This is Safeway's house brand of mozarella sticks. They're really good, too; 7 minutes in a 450 degree oven, and they're great!
But I like the name. Not too many house brands (or any other product, really) are willing to pun like this.
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text:
|Property type
|Minimum Stay
|2 nights
Welcome to our Vacation Home! Whether you're skiing Tahoe or mountain biking Peavine, you'll love our spacious, comfortable 3 BR, 2 BA home with modern decor. You'll wake up in the morning to views of Evans Canyon and Peavine Mountain. There's a large deck, great for entertaining. Sleeps 6, with a large couch that could sleep 1-2 more.
The mountain bike trails are literally in our back yard, and the nearby ski resorts are: Mt. Rose, Incline Village, Squaw Valley. There are also excellent road routes in the area for cycling.
We're from Minneapolis originally, but head West every winter to avoid the cold. We love the mountains and spend as much time as possible mountain biking, road riding, skate skiing, and doing hot yoga. We spend time in the Bay Area, Reno, Colorado, and Palm Springs.
Faith Vokovan purchased this house in 2012
We spend time in the Bay Area and grew to love Tahoe, so we chose Reno since it's the closest bigger city with an airport and modern conveniences.
The single reason we bought this home is because it sits atop Evans Canyon and overlooks Peavine Mountain, which has 40+ miles of mountain bike trails. For bikers, it was a no-brainer. The house itself is very cozy and comfortable, perfect for entertaining, and hosting a group.
We met up with friends for the weekend and stayed at this home. It is in a great location and close to everything. Downtown is only a few minutes away. The bedrooms were nice and the beds were comfortable. We enjoyed the home and it was equipped with everything we needed for the weekend.
We rented this wonderful home to pull our family together for Christmas. The house is very comfortable, nicely appointed, well maintained and was centrally located to many activities. The owners were very easy to work with and I'd rent again next time I need to go to Reno!
Our family rented this lovely house for son's graduation from UNR. It was perfect for our family of 6. Beautiful and very organized.
We loved this lovely home in the foothills. It is close enough to downtown, but just the perfect distance away to be restful and relaxing. The neighborhood is quiet and safe. There is a deck on the west side of the house, overlooking the foothills. We were lucky enough to observe a pair of red-tailed hawks soaring over the canyon. We would recommend this property to anyone wanting a nice home to rent, away from the noise and traffic of the city. If we find ourselves in the Reno area again, we will definitely book this location.
This was our second time staying in the house and it was just as lovely and wonderful as the first. We appreciate the comfort and generosity of this house immensely -- it truly feels as if we're staying at a friend's home for the weekend.
We had 6 people stay in the house while we were at Hot August Nights 2014. The house was clean and well stocked. I thought the guest bedroom I stayed in was very comfortable and I loved that there was a desk in it since I ended up having to work every day I was there. The wifi worked great and I never had any issues. The BIG screen TV in the living room was a big hit as well as having tvs in each of the guest rooms. The kitchen is well equipped and I loved havng all the spices and other food available left by past guests and I also contributed as I left as well.
If I have to say anything negative would be the shower controls in the master bedroom and the landscaping of the front yard. It is one of those multi-nozzle plus rain shower (which I thought about purchasing for my home shower many times). It was a little difficult to operate at first (and everytime for my 80-year old parents) but once you got the hang of it, it was okay. The smaller nozzles hurt as it felt like you were being stung (so I won't buy it for at home). The front yard lawn is dead and not sure if that is because they aren't watering because of the drought or not. But that is it for negatives.
I liked being able to get away from the hustle and bustle of being in Reno and the activities to escape to the house.
The fact that I could bring my dog was the best! thank you!
Reno has a lot more to offer than just casinos, with its friendly people and excellent food choices. Among our favorites are Brasserie St James and Campo, or the trendy new 'bottle shop', Craft, for cocktails and specialty beer.
|Rental Period
|Minimum Price
|Additional Nights
|Weekend Night
|Monthly *
|Event Price
1 Dec 2014 - 31 Mar 2015
2 night minimum stay
for 2 nights
15 May - 15 Sep
2 night minimum stay
for 2 nights
My Standard Rate
2 night minimum stay
for 2 nights
|Cleaning Fee
|$95 + Tax
|Refundable Damage Deposit
|Tax Rate
|Rates are subject to change until your reservation is confirmed.
* Approximate monthly price. Actual pricing will depend on the days of the month you stay.
Please Note: The owner of this property accepts payment in the original currency specified (USD), before use of conversion tool. The conversion tool is provided for your convenience only. The owner may accept other currencies if specifically agreed in advance.


text:
Test Code UOXY Oxycodone Drug Screen, Random, Urine
Includes qualitative determination of codeine, morphine, and morphine glucuronide in urine. Also detects hydromorphone and oxycodone.
Performing Laboratory
Bronson Laboratory Services-Chemistry
Specimen Requirements
Specimen Type: Urine, random
Container/Tube: Plastic urine container
Specimen Volume: 5 mL
Collection Instructions: No preservative.
Specimen Transport Temperature
Reference Values
Sensitivity: 100 ng/mL and higher
High levels of other opioids may also be detected.
Day(s) Test Set Up
Monday through Sunday
Test Classification and CPT Coding


text:
Sign-In Kiosks to Improve Office Efficiency
Our Kiosks replace the sign in sheet & sort customers
Check-In Systems are a great way to improve customer service and reduce reception overhead. Our Check-In kiosks use an Apple iPad, an Android tablet or a touch screen PC to replace the paper sign-in sheet. Customers will sign in and directly notify a person or department without interrupting anyone. The sign-in process is fast, simple and your staff is notified instantly. This reduces your customer service response time, improving the customer experience. Your staff knows the person's name and exactly what they need even before they greet them.
Touch Screens are the latest technology to improve Customer Service!You can replace the sign in sheet with an Apple iPad, Android based tablet or touch PC for a low cost, efficient Check-In System. When your customer signs in, they instantly notify your staff without interrupting anyone. The information is automatically sorted, then presented on existing office computers. Your staff can then respond faster, having the needs of the person up front. Customer information is stored for long term statistics and reporting giving management valuable documentation as to workloads and trends.
Apple iPads make great electronic sign-in sheets!The Apple iPad is a very stable and low maintenence touch screen that everyone is familiar with. Customers are familiar with the touch and feel of cell phones and tablets. This means they have no reservation about using it. We frame it in a secure kiosk stand and it can be mounted on the wall, set on the counter top or used as a stand alone kiosk.
IT staff will love the low maintenance and top security of the IOS platform. Since there is no data stored on the device, the security risk is at it's lowest. If it breaks, it is easy and cheap to replace compared to full blown PC based kiosk systems.
Get more from your sign-in sheetAn electronic sign-in sheet saves all your data and gives you long term reporting abilities. After all, computers are supposed to make the job easier. With a database of names, dates and timestamps the kiosk can produce valuable reports about traffic flow, wait times, customer needs and staff performance. How would you like to know the average wait time or time to service a specific customer need? With a customer check-in system, its a simple report.
Check In Systems Products
Medical Check-In is designed to reduce interruptions and paper while meeting HIPAA Compliance. Having a patient kiosk allows your patients to sign in at the door instead of the counter where your receptionist may be having a private conversation with another patient. Furthermore, your sign-in sheet information is stored for long term reporting and management reports. With this information, you can track patient traffic, office efficiency and staff performance.
Every retail business that serves customers as they walk in, needs a method of organizing the customers. Faster is better wen it comes to the customer experience. A sign-in system sorts the customers by department and need. Your employees can respond quicker if they are notified directly. Don't forget the valuable reports that a Check In system can provide. Having statistics of customers needs compared to date and time stamps can document traffic flow, staff needs, and performance.


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The 300mm focal length has always been popular with professionals and advanced amateurs due to the combination of magnification, portability and close-focusing. 300mm is about the longest lens that can be hand held (in daytime lighting situations). The Tamron 300mm f/5.6 manual focus lens for Nikon is a nice compromise in size and speed.
This lens has a Prong that will meter couple to the older Nikon 35mm SLR camera such as the Nikon F/F2 and Nikkormat FTN cameras.
- Classic rugged construction
- Built-in retractable lens hood
- Built in rotating tripod collar


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Just left Washington DC where I attended the Location meets social networking event. Extremely interesting and just a little scary (but no need to panic). Will have a complete report within a few days.
Check out ConnectSafely.org
Advice and Tools
- 10 Rules for Safe Family Cell Phone Use
- About photo sharing apps and services (Instagram & Snapchat)
- Archives
- Bullying & cyberbullying articles
- Bullying and Cyberbullying Resources
- Child Safe Search
- Child Safety on the Information Highway
- Family Contract for Online Safety
- Family Contract for Smartphone use
- Resources for Youth in Crisis
- Safe Kids Song
- What to do if your child is looking at porn
Search SafeKids.com
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- 1StudentBody – 1SB.com A network for high school students


text:
(AP) Work is beginning on a new pedestrian bridge over the Mohawk River in Amsterdam.
When complete, the $16.5 million Mohawk Valley Gateway Overlook bridge will connect the city's southern neighborhoods and the Erie Canalway Trail with the city's downtown north of the river.
Much of the history of New York's scenic Mohawk Valley has been recounted time and again. But so many other stories have remained buried, almost lost from memory. Enter Bob Cudmore and his new book - Hidden History of the Mohawk Valley: The Baseball Oracle, the Mohawk Encampment and More.
The man called the baseball oracle correctly predicted the outcome of twenty-one major-league games. Mrs. Bennett, a friend of Governor Thomas Dewey, owned the Tower restaurant and lived in the unique Cranesville building. An Amsterdam sailor cheated death onboard a stricken submarine.
Not only people but once-loved places are also all but forgotten, like the twentieth-century Mohawk Indian encampment and the Camp in the Adirondacks, where Kirk Douglas was a counselor. Local historian Bob Cudmore delves deep into the region's history to find its most fascinating pieces of hidden history.
HERKIMER, N.Y. (AP) — Police say they're searching an upstate New York village after exchanging fire with a man suspected of killing four people and wounding two others.State police Superintendent Joseph D'Amico says SWAT teams and other officers were fired on from an abandoned building in Herkimer early Wednesday afternoon while looking for 64-year-old Kurt Myers.


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NBA Basketball - Preview
|Detroit Pistons vs. Washington Wizards
The Detroit Pistons and the Washington Wizards will both be gunning for a victory on Saturday when they meet at Verizon Center. Last time out for Detroit, they were a 110-89 loser as they battled the Jazz at home. The Pistons failed to cover in the match as a 7-point favorite, while 199 combined points moved the game UNDER for totals bettors. Last time out for Washington, they were a 96-93 winner as they battled the Bulls at home. The Wizards failed to cover in the match as a 5-point favorite, while 189 combined points moved the game OVER for totals bettors. Detroit:
Team record: 16-23 SU, 17-22 ATS
The total has gone OVER in 19 of last 24 games
When playing on Saturday are 3-7
Team record: 19-19 SU, 20-17-1 ATS
Current streak: won 3 straight games.
The total has gone OVER in 5 of last 6 games
When playing on Saturday are 5-5
Detroit home to LA Clippers, Monday, January 20
Washington home to Philadelphia, Monday, January 20


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A new mini and repotting the other one...
About a month or so ago I got a mini from my mother. There were 4 plants in a 4" pot and I repotted it into a 10" pot. Well, today I got another mini, again 4 plants in a 4" pot. I want to plant them all together in one pot. The largest I have is a 14" pot. Will this size work for all the plants? Also, how do I divide the plant up? Do I just gently pull them apart? What about my other mini that I have in the 10" pot. Is it too soon to do something like this with it? I don't want to kill it, it's doing so well!
Any advice/help is greatly appreciated!!!
With that many plants, you could easily put them in a half whisky barrel with plenty of room to spare.
When you transplant an actively growing plant, you always run the risk of having them wilt slightly if the tiny feeder rootlets are damaged in the process. Keep them well watered and the plants should recover nicely.


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NY Times: "Excellent!"
Zagat Guide: "Where Bellport's Elite Meet"
About the Chef and Restaurant
"At The Bellport I go
for the big taste," says Taylor Alonso,
"nothing subtle, nothing hidden."
European-trained Cordon Bleu Chef Taylor Alonso and his wife, Patricia
Trainor set their sights on Bellport after years in Manhattan, England,
and Washington, D.C. At first, Chef Alonso's presentation's of food
appear to be simple, but with closer study, Alonso's dishes reveal his
talent. It is a great chef who makes an actually complex dish look
simple, appealing to the eye, and of utmost importance - great tasting.
Alonso accomplishes all three.
The restaurant is located in its namesake town of Bellport. It is decorated with the art collected over the years by Taylor and Patricia. The decor is instantly recognizable as sprightly, airy, and enormously receptive. The culinary offerings are countrified, yet presented with flair. From time to time, artist friends show their work at this unpretentious and casual restaurant.
The Bellport's culinary delights have also been featured at The Great Chef's of Long Island Annual Benefits as well as being featured in House Beautiful, Victoria, Self, and Country Home magazines.
Signature Dishes Include
The much-heralded Jumbo
Lump Louisiana Crabcakes
Good Ole' Buttermilk Fried Chicken
Corn Crusted Oysters
Further, The Bellport offers daily selections of Pastas & up to the moment Fresh Fish
Easter Brunch - Sunday, April 5th
|Join "The Bellport" for the first blush of spring, Easter Sunday, April 5th. They will be featuring a special Prix Fixe menu with an exciting assortment of spring favorites. In addition, The Bellport will also be offering their regular lunch and dinner a la carte menus, so there's bound to be something for everyone to enjoy. Reservations are encouraged. Click here for more information, including the menu.
|New Winter Hours: Now Closed On Wednesdays
|During the winter months, the Bellport is closed on Tuesdays and Wednesdays.
|Thursday Night at The Bellport
|Thursday Night. What can we say about Thursday Night other than it's the high point of the week for us. For at least 7 or 8 years now, The Bellport Restaurant's co-owner, Taylor Alonso, chef, singer, and outrageous guitar player, has been holding a musical jam at The Bellport every Thursday evening starting at between 9:30pm and 10pm and usually going to about 1am. Click here for more information and to listen to some of the music
|Monday Evening Recession Special
|"The Bellport, now in its 22nd year, would like you to join them for their "Monday Evening Recession Special!" You will enjoy 3 gorgeous courses, Caprice du Chef Taylor. The Prix Fixe dinner is $22.95 and is served from 5:30pm to 9pm on Monday evenings. The Bellport's regular menu is also available so stop down for a wonderful meal as only The Bellport can provide.
THE BELLPORT is located steps away from
The Gateway Playhouse.
Monday, Wednesday and Thursday, 5:30pm - 10:00pm
Friday and Saturday, 5:30pm - 11:00pm
Sunday, 4:00pm - 9:00pm
Lunch / Brunch:
Sunday, 11:00am - 4:00pm
Normally Closed on Tuesdays
Now Closed on Wednesdays Through the Winter
The Bellport
159 South Country Road
Bellport, NY 11713
Phone: 631-286-7550


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Filling in for George, Richard Syrett welcomed Richard C. Hoagland for a discussion about evidence for nuclear war on Mars, disclosure, and how our solar system appears to have been 'remodeled' for life (additional Hoagland links: heae.biz, northatlanticbooks.com). Open Lines followed.
Initially, scientists thought that Comet ISON disintegrated after its encounter with the sun earlier today. More here.


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By Bill Graziano
on 11 March 2001
| 0 Comments
| Tags: DBA Sites
Umachander is a SQL Server MVP and has quite a collection of interesting scripts on his web site. Definitely worth a visit. Follow the link to Umachander's SQL Server Script page...
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5:02 am
Thu March 20, 2014
Tattoo Of Handgun Triggers Call To Police
By David Greene
Originally published on Thu March 20, 2014 6:37 am
Good morning, I'm David Greene.
Michael Smith, of Norridgewock, Maine, has a really convincing tattoo of a handgun on his lower stomach. This week, he woke up to a crew cutting trees outside. He marched out to tell them to stop with his shirt off. A bit later he woke up again, to a SWAT team with rifles trained. The tree cutters had mistaken his tattoo for a real gun tucked in his belt.
Smith told the police, quote, "I got plans today. I don't want to get shot." He was not charged.
You're listening to MORNING EDITION. Transcript provided by NPR, Copyright NPR.


text: We have just returned from a short stay at Hay Barton. Jill and Blair greeted us with big smiles and went out of their way to make sure that we had everything we needed. Our room had a very large and comfy bed and the bathroom was luxurious. Add to this all the trimmings, such as sweetly scented toiletries, homemade... More


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Shop now and get Free Value Shipping on most orders over $49 to the contiguous 48 states, DC and to all U.S. Military APO/FPO/DPO addresses.
We want to ensure that making a return is as easy and hassle-free as possible! If for any reason you decide that your purchase just isn't for you, simply return the item within 30 days of receipt and we'll cover the cost of return shipping. Learn more about our Return Policy.
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text: 000 AWUS83 KTOP 282221 RWSKS KSZ001>105-291200- KANSAS STATE WEATHER SUMMARY NATIONAL WEATHER SERVICE TOPEKA KS 445 PM CDT SAT MAR 28 2015 .Tonight...Mostly clear west to partly cloudy east. A chance for showers northeast. Lows from the lower 40s northeast to the upper 40s southwest. .Sunday...Mostly sunny west to partly cloudy east. A chance for rain showers northeast in the morning. A slight chance for rain showers southeast. Highs from the middle 60s northeast to around 70 southwest. .Sunday Night...Partly cloudy statewide. Lows from the middle 30s northeast to around 40 southwest. .Monday...Mostly sunny statewide. Highs from the upper 60s southeast to the upper 70s northwest. .Monday Night...Mostly clear statewide. Lows from the upper 30s northwest to the middle 40s southeast. $$