The government has come under attack for 'failing' to meet a key NHS waiting target and the cost of its flagship health helpline.

The Conservatives say falling numbers of GP practices are meeting a target of offering patients an appointment within 48 hours.

The government has also been criticised for the cost of calls to NHS Direct, which are 25% more expensive than a visit to the GP, according to official figures.

In the NHS Plan, published in 2000, the government said all patients should be able to see their GP within 48 hours by 2004, and another primary care professional, such as a practice nurse, within 24 hours.

When the GP service is under such strain it is inevitable that improving access is far from easy to achieve

Dr John Chisholm, British Medical Association

The government has met its interim target that 60% of patients should have 48-hour access in March this year, but it pledged that, after that date, the figure should be 90%.

The Conservatives say the number of practices able to meet the target has actually fallen since last year.

They say that in March, 75% of practices met the target, compared to 78% in December 2001 and 80% in September last year.

The Conservatives also highlight a survey by East and West Dorset community health councils which 42% of patients waited two days or more to see their GP in 2001, compared with 20% in 1998.

Consultation numbers

The cost of NHS Direct, the 24-hours nurse-led helpline has also been criticised.

In health questions in the House of Commons, Richard Ottaway, Conservative MP for Croydon queried the comparative cost of a call to NHS Direct and a visit to the GP.

Nurses offer advice to patients over the helpline

The average cost per GP surgery was calculated by dividing the total cost of family doctor services for 2001-02 by the number of consultations in surgeries, by telephone and in the patient's home.

The cost of NHS Direct was calculated by looking at the number of calls the service received in that year, and dividing it by the total cost.

The average cost of each call to the NHS Direct was then estimated at �18 - �4 more than the cost of a visit to the doctor.

Dr Liam Fox MP, Shadow Secretary of State for Health, said: "Patients desperate to see a GP are being forced to wait longer and longer to do so.

"Labour have moved further and further away from their target throughout their time in office."

He added: "The Conservative Party and GPs warned that this target was unrealistic."

Dr Fox called for a full review of how NHS Direct operates - and whether its staff could be better deployed to help patients.

'Falling costs'

But a spokeswoman for the Department of Health told BBC News Online: "The average cost of a call to NHS Direct in 2001-02 was about �17.92, although this is expected to fall significantly in the future as call volumes rise.

"The National Audit Office have found half of all callers are directed to forms of care they would not have chosen and this tends to be care of a lower level and cost of interventions.

"More than half of NHS Direct costs are saved in this way."

She added: "Nationally, improvements have been seen in the length of time patients are waiting to see their GP."

In order to meet that target, she said, the 60% target had been set.

"The results of our latest survey shows that we have met this interim target nationally by 15% and we are confident that we are on course to meet the NHS Plan target of 90 % by 2004."

Dr John Chisholm, chairman of the British Medical Association's GPs Committee said: "When the GP service is under such strain it is inevitable that improving access is far from easy to achieve."

He added: "NHS Direct has an important place in the national health service and we remain hopeful that it may help in time to reduce inappropriate demands on GPs, although the firm evidence that this is happening is still lacking.

"What these figures show is how amazingly cost effective the general practice service is in the UK, but in order to maintain and improve the quality of care GPs deliver, a substantial investment is essential."

Dr Evan Harris MP, Liberal Democrat health spokesman, said: "NHS Direct is a very expensive service at a time when the NHS has very limited capacity.

"So far there is no evidence to show that NHS Direct is relieving pressure on other parts of the health service."