The way people obtain health advice at night has changed

Night and weekend services have been transformed in England in recent years, with GPs opting out of providing care.

But the consumers association Which? said patients often found themselves passed between GP cover, NHS Direct and A&E after polling over 1,600 patients.

However, the survey showed that despite the problems eight in 10 patients were satisfied with care. Doctors and ministers said services were improving.

The poll, which was supported by in-depth interviews with patients using services in six areas, found a third of adults had used out-of-hours care.

It is not acceptable that people are facing long waits for care Michael Summers, of the Patients Association

The majority of contact came via A&E departments, NHS Direct and GP out-of-hours cover.

In the past, patients tended to rely on on-call doctors, but since 2004 the overwhelming majority of doctors have opted out of providing night and weekend cover.

In most cases, they have been replaced by co-operatives of GPs, paramedics and nurses.

Despite the overall satisfaction rating, common complaints by patients were that they would face long waits before they got to see a health professional and that they would often be referred from service to service.

The poll also showed patients were confused about where to go for help, with nearly one in three saying they would not know how to contact the GP cover.

Advice

Three quarters did not know the NHS Direct number, while 7% had not heard of the telephone and internet advice service at all.

Which? said primary care trusts should be promoting the availability of services on their websites more.

Which? policy adviser Frances Blunden said: "When people decide to seek out-of-hours care, they are often distressed and concerned and may also be unwell or in pain.

"They want a quick response and reassurance, but often getting to the point of care where someone can provide face-to-face treatment involves several stages, sometimes with long waits in between."

Patients Association chairman Michael Summers agreed standards varied, especially in rural areas where services tended to be more scarce.

"It is not acceptable that people are facing long waits for care," he said. "We need to get a grip on this."

But Dr Michael Dixon, chairman of the NHS Alliance, which represents primary care professionals, said: "There have been problems, but I think PCTs are beginning to resolve them."

A Department of Health spokesman said: "All out-of-hours services must now be delivered to national standards, regardless of where a patient lives.