I apologise to patients who experienced difficulties contacting the North Yorkshire Emergency Doctor service over Christmas. The NHS faced unprecedented demand over the festive period. NYED itself received double the usual number of calls from patients.

At times call patterns were four times greater than previously experienced.

We recalled staff from holiday to try to cope with the extra demand, and I can only apologise that, despite these efforts, the volume of calls (7,500 over five days instead of the expected 4,000 calls) led to delays.

We are holding discussions to learn from this winter's experience. I am sure one lesson will be the need to help patients understand how the health service deals with out-of-hours calls. For example, home visits by GPs are no longer the starting point but are one of a number of possibilities.

The GP's role is to decide how the patient can receive the most appropriate care as quickly as is medically necessary. Based on the caller's description of the problem, the GP may decide:

It is very urgent and that an ambulance should be called.

While the patient should attend hospital, the problem is not urgent and an ambulance need not be called. The GP may contact the hospital to say a patient is on their way.

Hospital care is not needed, but the patient should to go a primary care centre (emergency surgery), where the GP has all the facilities available for effective care.

A home visit may be needed where the patient's medical conditions is serious and the patient is bed-ridden e.g. by terminal illness.

That on the advice from the GP by telephone, the patient can be safely cared for at home.

GPs have to decide the appropriate response to a patient's medical needs, if other lives are not to be put risk.

The public would be rightly concerned, if through a lack of prioritisation, an ambulance needed for a road accident victim was attending a non-urgent call.

Mark Cockerton,

General Manager, NYED,

Monkgate Health Centre,

Monkgate, York.

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.