The public have praised NHS Direct

The Commission for Health Improvement (CHI) said some centres did not meet targets for answering and dealing with calls.

But the CHI's first annual report on NHS Direct in England and Wales praised it for providing good quality guidance.

The service handles half a million phone calls and half a million internet inquiries a month.

Since NHS Direct was established five years ago, it has received more than 20 million calls.

Most calls are made in the evenings and weekends when GPs' surgeries are closed, and a quarter concern children under five.

Patients ring up about a wide variety of health issues, including faddy diets, ovarian cysts, contraception and strokes.

Success has meant increasing demand for the service and capacity problems for some call centres Jocelyn Cornwell, Commission for Health Improvement

The CHI found the most common questions included: 'How should I feed my baby?', 'What is the male pill?', 'Can I get impotence drugs on the NHS?' and 'How do I find an NHS dentist?'

Its report said callers found helpline staff to be polite, professional and reassuring, and added that demand for the service was increasing.

It was also praised for giving staff the chance to work flexibly, with more than 60% working part-time.

'Well regarded'

The CHI did find, however, that some call centres were missing, or close to missing, national performance targets.

Centres should answer 90% of telephone calls within 30 seconds, deal with 90% of calls where patients report symptoms within twenty minutes, and lose fewer than 5% of calls.

Other targets - to process 90% of health information calls within three hours, and ensure less than 0.1% of calls are answered with the engaged tone - are being met, the report said.

Public satisfaction with the service doesn't necessarily mean that the quality of the advice was good Helen Parker, Which?

Jocelyn Cornwell, CHI's acting chief executive, said NHS Direct was well regarded by the public and patients, and was proving "very successful".

"It is now the first port of call for anyone who needs medical help, but is unsure of which part of the health service is best able to help them," she said.

"Success, however, has meant increasing demand for the service and capacity problems for some call centres.

"There are also complex management arrangements, which can create confusion over the development of policy, practice and performance and a lack of clarity over roles and responsibilities.

"For NHS Direct to build on its success and popularity, these issues need to be resolved."

'Saving lives'

Helen Parker, editor of Which? magazine, said an investigation it had carried out into NHS Direct had found "fundamental problems" with the service.

She said staff often failed to spot potential emergencies and patients waited "too long" for medical advice.

"It clearly showed that public satisfaction with the service doesn't necessarily mean that the quality of the advice was good," Ms Parker said.

"Most people are not medical experts - which is why they call NHS Direct in the first place - and few have the expertise to tell whether or not they've been given good medical advice.

"In fact, high satisfaction levels are more likely to relate to how friendly the staff were or how reassured the patient felt."

But Health Secretary John Reid said NHS Direct provided an excellent service, which had helped saved lives.

"Each week, 3% of people who ring NHS Direct do not recognise the severity of their symptoms and are transferred to the 999 ambulance service," he said.

The service also played an essential role in reassuring people about their health, he added.

A spokeswoman for the British Medical Association said NHS Direct worked best when it was "fully integrated into primary care, operating alongside general practice services".