HAVE we become a nation of hypochondriacs? If not, why are so many Scots seeking emergency medical attention? Whether it is dialling 999, phoning NHS 24 or turning up at A&E, more of us are using out-of-hours services than ever before? NHS Scotland is so puzzled by the trend that it is to commission independent research.

This issue is not simply about the rising number of elderly people because the percentage of over-85s being hospitalised is also double what it was 20 years ago. Some who would have died are being kept alive by advances in modern medicine, but just as relevant appears to be the number of frail elderly living alone. This is partly because of fractured or simply widelyspread extended families. Often granny no longer lives round the corner. And local networks of informal carers have weakened as more women take paid work outwith the home. In addition, the move towards care in the community, though generally popular, means many who would have been institutionalised are now struggling on at home, with not always adequate support from care services. With nowhere else to turn, emergency medical services get the fall-out. Unless we are prepared to invest more in emergency medical services, perhaps

we should be asking whetherwe really have enough resources to look aftervery frail people in their own homes.

Younger age groups are also using out-of-hours services far more than they used to. Again, the background is complex. Despite major investment in community health partnerships and much talk of delivering more care and treatment at a local level, it is a plain fact that many people have difficulty accessing care through theirGP practice. The new GP contracts must be seen as a wasted opportunity in this respect. Allowing family doctors to contract out of out-of-hours cover completely has left a mismatch between surgery times and the requirements of a population with the longest working hours in Europe. Problems using a cumbersome appointments system can also act as a perverse incentive to use emergency medical services. NHS 24, though recently much improved, has had difficulty coping with the resulting demand. One suspects part of the problem is the very availability of the service. Many who

hesitated to call their family doctor at 3am, find it all too easy to pick up the phone to NHS 24, in today's 24/7 culture of instant gratification. Add to this a tendency for pharmaceutical companies and the mass media to medicalise minor ailments which previous generations tholed or shrugged off.

The answer to the overuse of emergency medical services may lie more in public education than ever-increasing budgets. We need a balance. Nobody wants a return to the bad old days when patients at death's door suffered in silence rather than waking theirGP, but by the same token we should be educating patients not to cry wolf about their health when they should be taking a painkiller and resting in bed until they feel better.