THERE is a sense of pride around the Dorset Emergency Care Service, which provides out-of-hours cover for 500 family doctors throughout Dorset. Pride for a job well done under often difficult circumstances.

When it was launched more than seven months ago, the service got off to a rocky start. On the first weekend, the volume of calls was around three times greater than expected.

Norma Lane, associate director of the service, recalled: "It was the first time I had ever worked 34 hours on the trot. Demand was at least 15 per cent higher than we ever anticipated the moment we went live."

Although changes to the call waiting system and more staff have eased those early problems, the service continues to be busy. So far it has dealt with more than 73,000 patients, including 12,500 in April alone. Formal complaints are fewer than one in 1,000.

"The biggest factor that's influenced the rise in activity for out-of-hours has been the demise of Saturday morning surgeries," said Norma.

"Lots of practices used to open for emergencies, but people would ring to make appointments, or for repeat prescriptions or vaccinations. It's that legacy we're still dealing with."

Calls between 6.30pm and 8am on weekdays and throughout weekends and bank holidays now go to DECS office at Dorset Ambulance HQ in St Leonards, where trained call handlers answer in an average of seven seconds. They take down details of cases before passing them on to doctors, who ring back to ask a few more questions before deciding on the best option.

If the doctor feels the situation is an emergency, he or she can arrange for an ambulance to be sent out to the patient straight away.

Otherwise, patients may be given medical advice over the telephone; asked to attend one of 12 local treatment centres around the county; or told to wait for a home visit from a doctor, nurse, or paramedic.

A continuing frustration for staff is the number of people who abuse the system.

"The fact that the out of hours service has 'emergency' in the title should be a reminder," said emergency care practitioner Matt Harrison, who has a background in accident and emergency nursing. "People access the service when there has been a 36-hour history of illness and they haven't see their GP."

ECPs can treat minor injuries and ailments, carry out procedures such as suturing and catheterisation, administer antibiotics in people's homes and even refer directly to specialists.

"It frees up A and E attendances, but the patient still gets the level of care needed," said Matt. "It's far more interesting for me."

North Dorset GP Dr Mark Mac Kenzie, who works shifts for the service, says some people exaggerate their symptoms to receive a home visit. "There's no concept of what an emergency is," he said.

"They will tell blatant lies to get you out there. They don't care that we're an emergency service.

"They just want the convenience of 24-hour access. Patients say 'If you don't come and see me, I'm going to call 999'."

At the treatment centre in the Royal Bournemouth Hospital, Dr Linda Eve stressed that it was not a drop-in clinic.

"It's an emergency service for problems that arise out of hours, not ones that should have been dealt with during the day.

"The reason is to protect the system from being overloaded and give priority to patients who really need our help.

"Patients are concerned that it's a second rate service. It's not. It's as good a service as they will get during the day."

The Dorset Emergency Care Service number is 0845 600 10 13. Out-of-hours non-emergency medical inquiries can be made to NHS Direct on 0845 4647.

First published: May 10