By Jane Dreaper BBC News radio health correspondent

But out-of-hours medical care has been changing for some time - and now it's more likely to involve a phone consultation with someone in a call centre.

Medical advice is usually given over the phone

The most recent changes to the system mean that under the new GP contract, family doctors have handed over responsibility to local primary care trusts.

A report by the National Audit Office highlights how most services in England appear to be failing to respond to patients' calls in good time, and it says the services are costing more than had been anticipated.

Wendy, who's recently widowed and is aged in her late 50s, has always looked after her health. But earlier this year she was sent home from work feeling unwell.

Over the period of a fortnight, she had a scan and blood tests.

Patients very rarely complain, and therefore when people do complain you have to take it very seriously Dr Jamie MacLeod, former head of a GP out-of-hours doctors' group

On a Saturday morning - a time identified as a pinch point by today's report - Wendy's condition was deteriorating and, at home on her own, she rang her doctors' out-of-hours service.

"There was no suggestion anyone would come out and see me - I was just told basically if I needed help again to ring 999," she says.

"Our conversation was very short and I felt almost as though I'd been a nuisance calling."

'Unsustainable'

Wendy's daughter helped admit her to hospital later that day. She was suffering from liver failure and pneumonia.

Wendy, who lives in North Yorkshire, went to the top of the transplant list and was given a new liver at the end of the week.

She is still getting treatment and so doesn't want her identity revealed, but she feels the out-of-hours service should have paid more attention to her condition.

"I feel let down. I feel very angry and I feel it's very wrong - it shouldn't be like that, there should be a better service available."

The National Audit Office says the new arrangements haven't compromised patient safety, and the government points out that most people are satisfied.

The health minister, Lord Warner, said: "Evening and weekend services today are greatly improved.

"The change in out-of-hours services was inevitable, because the old system was unsustainable, and patient safety has been protected.

"We're now taking vigorous action to ensure that all parts of the NHS reach the standards of the best."

'One size' does not fit all

But county councillors on North Yorkshire's health scrutiny committee believe that people like Wendy, in rural areas, aren't getting a good enough out-of-hours service. And there are fears for the level of cover in urban areas too.

Selby and York Primary Care Trust wasn't involved in Wendy's case, but its response times are not what they should be - and the NAO report highlights how that appears to be the case in many parts of England.

Dr David Geddis does some night shifts for the PCT, as well as serving as its medical director.

He insists the new system is better, with more nurses becoming involved: "Previously we had a 'one size fits all' approach - with a doctor always going to be the person seeing the patient.

"Now we have a choice of professionals, such as nurses or emergency care practitioners - and sometimes the training the professional has had makes them a better person to be able to support some people in an out-of-hours setting."

Although many GPs were very glad that their new contract relieved them of the responsibility of 24-hour cover, some feel the new services aren't up to scratch.

Dr Jamie MacLeod used to run the emergency doctors co-operative which covered the whole of North Yorkshire before the out-of-hours system changed, and he's keeping a close eye on developments.

"I believe the current rate of complaints is nearly five times what it used to be, and I feel that patients are getting a raw deal," he said.

"Patients very rarely complain, and therefore when people do complain you have to take it very seriously."