People using the healthcare telephone advice line NHS Direct are highly satisfied with the service, according to the financial watchdog the National Audit Office.

But its report into the service which was launched in 1998 says some callers have to wait too long to speak to a nurse and it is not being used by some parts of the community like the socially disadvantaged and ethnic minorities

Surveys have shown callers have at least 90% satisfaction with the service.

But the NAO said the helpline must widen the use of the service after finding younger people, over 65s, ethnic minority groups and people with disabilities were either less aware of NHS Direct or used it less.

Costs offset

It praised the helpline for its good safety record, and said local evidence suggested it could help reduce demand on other parts of the NHS outside normal working hours.

It has also been able to offset around half its running costs by encouraging people to use the health service more appropriately.

Sir John Bourn, head of the NAO, said: "It was a significant achievement getting NHS Direct up and running in less than three years.

"The service is valued by those who use it and, according to the evidence available, is starting to meet its aim of directing people to more appropriate forms of healthcare.

"The challenge now for NHS Direct is to meet the expected rapid increase in callers and to set a clear future direction for the service."

Growth predicted

NHS Direct has been available across England and Wales since November 2000. The service is also available online.

It received 3.5m calls in 2000 and 2001 and cost �80m to run. Call volumes are set to double in 2001 to 2002.

But in the year to September 2001, only 64% spoke to a nurse within five minutes, with one in five callers waiting more than 30 minutes for a nurse to call them back.

Professor David Haslam, chairman of the Royal College of General Practitioners Chairman welcomed the report's findings: "The system appears to provide a useful out of hours service and has helped to reduce GPs' workload.

"However, there is no way NHS Direct can match the continuity of care provided by general practice".

'Encouraging findings'

Dr John Chisholm, chairman of the BMA's GPs' committee said: "We know from experience that NHS Direct works best when it is closely integrated with GP services."

The NHS Chief Executive, Nigel Crisp, said: "It is encouraging to see that the NAO found that lessons were learnt quickly as the service was piloted and implemented.."

But Dr Evan Harris MP, Liberal Democrat health spokesman, said: "This report politely castigates the government for rushing in an expensive project without adequate piloting, without adequate evaluation and without adequate setting of objectives.

"It has cost �80m without producing any significant impact on the rising demand on accident and emergency departments. NHS Direct has saved only an estimated �45m from reducing calls to GPs."

He added: "Worse still, the report recognises that 80% of the nurses were recruited from the NHS - mainly from the hard-pressed and short-staffed accident and emergency departments."