IT WILL be business as usual for the out-of-hours GPs' service in North Yorkshire, despite the recent financial difficulties of North Yorkshire Emergency Doctors.

Since the end of last month, management of out-of-hours services across North Yorkshire has been operated by Hambledon and Richmond Primary Care Trust.

NYED was commissioned by the trust to operate the service when responsibility for it transferred to trusts in April last year.

After NYED went into administration at the end of January, management of the service transferred to Hambledon and District PCT.

The trust says the change will make no difference to the service provided to patients in North Yorkshire.

The Government decided that responsibility for GP out-of-hours services should become the responsibility of primary care trusts in April last year.

The key aims of the change were to make the service more efficient; reward practices for the quality of care, rather than simply for the number of patients seen, and to ease doctors' workloads in order to attract more GPs into family practices.

In Wensleydale, this transition has been controversial. Because the terrain is difficult and many dwellings are remote, critics have raised concerns about the new set-up.

Wensleydale's out-of-hours services operate largely out of a clinic based in Catterick Garrison, with a satellite clinic at Asygarth.

Dr Vicky Pleydell said that the new system had several advantages: "I think in the end the patients get a better service. Now, when they call, they always get a call back from a doctor."

She explained that under the old system, if the doctor was out, the patient might have spoken to the doctor's spouse, who would have had to make a decision about how urgent the call was.

Now patients always speak to a trained call handler, who will refer the patient to the nearest primary care clinic - for most patients in Wensleydale, this is at Catterick Garrison.

The call handling services are provided by Tees, East and North Yorkshire Ambulance Service on behalf of Hambledon and Richmond PCT.

A doctor calls the patient back and will make the decision to give advice over the telephone, arrange for the patient to go to the clinic, make a house call or arrange for hospital treatment, calling an ambulance if necessary.

"Very few people don't want to come - if you offer people access, most people will come down," said Dr Pleydell.

"Most people just want to be seen and are very happy to come."

Dr Pleydell said all the doctors involved were committed to seeing the service got off the ground.

"The most important thing about this service is I do think it is safe. Emergency stuff goes to 999. One of our jobs is to pick out the calls that are urgent."

She said that the average GP's workload had increased with advances in modern medicine.

"We now have drugs to treat many more things. Consultants in hospitals used to do all the things we can do now. Advances in technology have brought so many more drugs and so many more things GPs can do for people."

She said it was important to speak to patients wherever possible in order to make an accurate diagnosis.

"Some of it is real emergency stuff, and some of it is stuff that can't wait until Monday, but isn't life-threatening."

In the case of children, Dr Pleydell said that she always invited the parent to bring the child in.

"Some people genuinely need the service on a regular basis. Very few people will call needlessly.

"We have a lot of patients here with are young families who have no extended family and part of our job is to help them understand when to call and when not to. What we need to find out is why people call the out-of-hours service so regularly.

"We are here to help them understand and teach them about they need to look for in an emergency."

The doctor on shift at the centre is supported by a driver operator, who will drive the doctor to house calls so that the doctor is free to talk on the telephone. Driver operators can also answer the telephone at the centre and generally assist the doctor non-medically.

Dr Pleydell said that this arrangement was safer, particularly for female doctors, as they now never went out alone.

She also said the change had improved the work-life balance for many doctors.

"When I first started at the Catterick clinic, either I or my husband was on call every day and every weekend. That is tremendously intrusive into you private life. We couldn't go anywhere as a family."

But the service is still busy - there are on average about 30 calls per five-hour shift.

"The nights are generally very quiet. But some nights you don't get to bed at all. In the end, that is the job you do."