The nine million patients a year who use the services were kept waiting for calls to be answered and 85 per cent of out-of-hours surgeries missed targets for urgent consultations, according to the National Audit Office. Primary care trusts (PCTs), which took on the services after GPs were allowed to opt out, were given insufficient funds by the Department of Health, increasing their financial difficulties.

The findings are published as NHS hospitals and PCTs — responsible for planning and commissioning healthcare — are struggling with deficits and laying off staff. Better organisation of the out-of-hours service could have saved the NHS up to £134 million in 2005-06, the audit office says.

The Department of Health had drawn up a list of 13 “quality requirements” for after-hours care, hardly any of which were met. For example, only 2 per cent of PCTs were able to answer patients’ calls within 60 seconds, and only 23 per cent began clinical assessment of patients within 20 minutes of their arrival at a medical centre.

Fewer than one in ten surgeries could prove that they had assessed patients within 20 minutes of their making an urgent out-of-hours call for help, and fewer than one in six could provide emergency face-to-face consultations at a centre within an hour, or an urgent consultation within two hours.

As for visiting patients’ homes, only 13 per cent of out-of-hours centres were able to arrange urgent consultations within two hours, and only 25 per cent could arrange less urgent consultations within six hours.

But, despite these problems, the audit office found no evidence of serious incidents or deaths and says that, a year after they took on the service, “out-of-hours providers are beginning to deliver a satisfactory standard of service”.

The changes came about in 2004 when GPs were given the right to opt out of 24-hour care. By giving up £6,000 a year they could hand over responsibility for patients from 6.30pm to 8am on weekdays, and on all weekends and public holidays. Nine out of ten did so. However, £6,000 did not represent the full cost of the service — as the Government knew. It was an amount reached in negotiation with the British Medical Association (BMA). The real figure was believed to be £9,500 a GP, or a total of £322 million in 2005-06. This was the sum provided to the PCTs— but the actual cost proved to be 22 per cent higher, or £392 million.

In addition, PCTs lacked the “experience, time and reliable management data” to pick up the service. It was not even clear whether out-of-hours services should be restricted to urgent care, an issue that remained unresolved.

However, direct comparisons are difficult because nobody really knew how well or badly the old system worked.

Chris Shapcott, the director of value-for-money studies at the audit office, said that PCTs were dealing with numerous other issues, such as changes to GP contracts and the payment-by-results reform. “The out-of-hours system probably did not get the attention it deserved in some areas,” he said.

The audit office added that there appeared to be a discrepancy between patients’ experiences and the PCTs’ views of the care that they were offering, “suggesting that providers are currently not capturing negative feedback”.

Hamish Meldrum, the chairman of the GPs committee of the BMA, said that the old service had been unsustainable. “The finding that the costs of providing out-of-hours services were higher than the Government anticipated will not be a surprise to the thousands of family doctors who, in former years, provided it on the cheap to the NHS,” he said.

Lord Warner, the Health Minister, said that the report “confirms the NHS is on the right track towards providing quality round-the-clock GP services”.

Times Recommends

• The day they dropped a bomb on the banks
• Methodist minister sent herself hate mail
• Japanese insect to be used to fight knotweed