A York mother who believes her dangerously ill baby was failed by North Yorkshire emergency doctors has been invited to a special meeting to discuss her fears about the service.

The doctors' service is defending its record in the light of recent cases highlighted in the Evening Press where doctors allegedly refused to go out and see patients on request.

Ann Thomas tried to call out the emergency doctor two months ago when her then 15-week-old baby contracted meningitis.

Her tiny son's temperature had rocketed to 104 degrees and his body was stiff. Ann immediately suspected meningitis, from which she has suffered herself.

But she was told a doctor could not go out to her home in Geldof Road, Huntington, and she should take Kavanagh into the Monkgate Health Centre.

Fearful of wasting any more time, she bundled up her baby and took him straight to York District Hospital's casualty department, where he was seen by a paediatric doctor in 20 minutes.

Two months on Kavanagh is now gradually regaining his health, but his mother worries that his young life was endangered by the doctor's unwillingness to make a house call.

She says she is pleased with the response to her letters of complaint and will be meeting representatives from the emergency doctors, North Yorkshire Health Authority, a lay conciliator and an independent medical advisor as soon as possible.

"I was very direct in my second letter and they have obviously taken heed," said Ann.

"They say they would like to discuss what has happened in further detail and I am pleased they are taking it seriously and seem keen to do something about it.

"I'm going to arrange the meeting as soon as possible and then just take it from there."

The service says it cannot comment on individual cases because of patient confidentiality, but today defended its record and said the vast majority of patients were satisfied with the service they received.

A Sunday in the life of an emergency doctor

North Yorkshire's Emergency Doctors service has come under fire in recent weeks for refusing to go out and see patients. Here the doctors defend their record and Janet Hewison joins one York GP at work during a Sunday shift for the service.In today's consumer world, you can ring your bank at midnight or buy a packet of cornflakes from the supermarket at 3am in the morning. But according to doctors with North Yorkshire's out-of-hours service, the consumer culture which has developed over the last two decades mean that the demands of patients are sometimes impossible to meet.

Chairman of North Yorkshire Emergency Doctors (NYED) Dr Jamie MacLeod said: "People's expectations about everything have been increased by the type of society we have. If a supermarket wants to stay open longer, it can put a penny on the price of a tin of beans, we can't do that."

The Government hopes to introduce a telephone service called NHS Direct across the country by the year 2000 where qualified nurses will answer inquiries from patients and give them appropriate advice or refer to them to a doctor or hospital if necessary.

In the meantime GPs in North Yorkshire run an out-of-hours service which tries to cater for everyone who needs urgent medical attention, paid for 77 per cent by them and 23 per cent by the health authority.

"The number of out-of-hours calls have risen from a third of a million in 1968 to 2.5 million in 1997," said Dr MacLeod.

In the years leading up to 1992, it was common for a GP in North Yorkshire to be working one night in three and one weekend in three.

The original service, set up to cover York in 1992, consisted of 40 GPs, and in April 1996 it expanded to cover North and East Yorkshire and there are now 11 bases.

Setting up the service solved the problem of doctors' overwork, but the profession still has a recruitment crisis with newly qualified doctors preferring to go into hospital medicine.

And the demand for call-outs continues to rise. The director of the service Dr Pat McGrann said he had recently had a call from someone wanting him to go out and attend to their pet dog.

However, although the service receives more than 10,000 calls a month, only one or two patients say they are dissatisfied with the service.

The doctors' own figures show that 96 per cent of people think the doctors' cooperative service is working well.

DR Stuart Calder is one of 433 doctors who work shifts for the North Yorkshire Emergency Service. Based at Clifton Health Centre, Dr Calder does one shift every 10 days.

8am This particular shift starts when he and driver Andy Clarkson set off for Huntington to see an elderly man who had a chest infection.

8.31am Another call comes through to see a woman in her 30s suffering from abdominal pains. She also lives in Huntington. There are two cars based in York and the system works so one car tends to call on patients calling from one side of the city. Dr Calder finds the woman has an abdominal abscess and gives her antibiotics.

8.53am An urgent call comes in and Andy drives round to Haxby where a woman in her 40s is having a heart attack as Dr Calder arrives. He gives her intravenous drugs and calls an ambulance to get her to hospital. Although it was not needed in this case, each car does carry a defibrillator.

9.15am The next call is to a nursing home in the Hull Road area where a lady in her 80s has just had a stroke. Dr Calder finds it has affected her speech badly. He gives her medication to calm her down and arranges for her own doctor to call the next day. After each call Dr Calder returns to the car and using a mini computer types in what he has done and arranges any follow-up visits. A printer in the back of the car prints out any new calls which have come in.

9.35am Back to Huntington again where Dr Calder visits a woman in her 70s who had surgery in hospital two weeks ago. She has not opened her bowels for a week, so Dr Calder uses manual removal - usually a nurse's job - and gives her a suppository.

10.21am A lady in her 60s is the next patient and is suffering from vertigo. She can't stand up and is vomiting. Dr Calder gives her an injection to settle down her condition.

11.30am To another nursing home, this time in Haxby, where a woman in her 80s with gall stones and jaundice is in pain. Dr Calder gives her an injection for the pain.

12 noon Another woman patient has vertigo and needs help. The Clifton woman in her 70s is planning to go on holiday the next day and asks Dr Calder if she can still go. He tells her she can't and gives her tablets.

1pm The family of a farmer living alone in a village outside York arrive to pick him up for lunch to find him breathless and call out Dr Calder. He arrives to find the man, in his 60s, has an acute irregular heart rate. It turns out a chest infection has put a strain on his heart and Dr Calder gives him digoxin, a drug derived from foxgloves, to steady his heart beat. He also gives him antibiotics for the infection. The farmer says he hadn't wanted to bother a doctor.

2pm Dr Calder visits a woman in her 80s in the Hull Road area and finds she has got unstable angina. He arranges for an ambulance to take her straight to hospital.

2.45pm A call comes through to the centre from Scotland from relatives of a man in his 90s in Wigginton who has a bad cough. The man tells Dr Calder he has been coughing for three nights and thinks it is a fuss about nothing. He has actually got pneumonia and Dr Calder sends him straight to hospital.

3.10pm The neighbour of a woman in her 20s contacts the centre to say he is worried she may commit suicide. She has been talking about hurting herself and when Dr Calder talks to her he decides she should be admitted to Bootham Park Hospital to be seen by a psychiatrist and arranges for this to be done while the neighbour sits with her.

3.40pm Dr Calder's final call is to a woman in her 90s in Haxby who has an infection in her arm which is causing her pain. He finds she has already been given antibiotics by her own doctor but says he will check her doctor will be calling to see her in the next day or two and tells her the pills will soon start working.

Dr Calder said after a long career as a GP he still loved getting out to see patients and during shifts could be called out to as far away as Coxwold, Tadcaster and Wheldrake.

He said the advantage of the old system was that a GP could always see his or her patient through all their crises but it had got to the point where he was working 110 hours a week.

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