NHS 24 is criticised for overly relying on the "call-back" service

The Scottish Executive-ordered report said the use of the procedure was "by far" the most problematic issue.

It also highlighted the need for arrangements to be made to cope with the extra pressure over winter.

The recommendations were made in the final report of former ambulance chief Owen Clarke who led the review.

It called for radical changes to be made once the challenges of the winter period had been dealt with.

Some of the most problematic issues have existed over most of the history of NHS 24 and cannot be resolved overnight Owen Clarke

Mr Clarke said: "NHS 24 can recover from the setbacks of the past. It can fulfil its role helping health boards deliver a quality service. But what it needs is radical thinking - and support to do that.

"Some of the most problematic issues have existed over most of the history of NHS 24 and cannot be resolved overnight.

"The Board of NHS 24 needs to think radically, to look beyond the original design blueprint which no longer matches the needs of today."

The report identifies a string of problems that have plagued the service, including difficulties in recruiting nurses, the way calls are handled and the relationship between NHS 24 and other parts of the health service.

It also included the impact on the service of changes to GPs' contracts relating to out-of-hours work.

'Unscheduled care'

The report said that in "enthusiastically promoting its existence", the service probably failed to explain to the public that in out-of-hours-periods, it was meant mainly for callers in urgent need of help.

The cumulative effect of all these factors had at times "overwhelmed" the service," it added.

"Once NHS Scotland has got through whatever this winter brings, there should be a quite radical review and overhaul of the ways in which NHS 24 contributes to unscheduled care, particularly out of hours."

Key recommendations include:

• Ensuring that arrangements are in place to cope with the extra pressure over the winter period and especially over the festive season.

• To continue to reduce the use of call-back.

• To continue to improve access to the services provided by NHS 24.

• To continue to improve the way in which patients are "handed over" from NHS 24 to the appropriate out-of-hours service.

• To consider improving primary care service provision out of hours (e.g. Saturday mornings) to help reduce demand on NHS 24 services.

• To improve public information

• To consider how performance monitoring of NHS 24 could be improved.

The report also recommended there should be more efficient management in the technical aspects of call-handling at the service's three centres, and callers from remote and rural areas should be given priority.

For NHS 24, the urgent challenge of preparing for the winter period remains our number one priority George King NHS 24

An interim report, published in June, said the service had been plagued by a lack of leadership, staffing shortages and the rush to set it up in the first place.

NHS 24 chairman George King said: "There is no quick fix but I welcome the report's immediate challenge to see NHS through the coming winter and its longer-term focus on the design of the service which sets a target date of March 2007 to see call-back reduced to a manageable level.

"For NHS 24, the urgent challenge of preparing for the winter period remains our number one priority."

The report said the service had been 'overwhelmed'

Mr King said NHS 24 was currently reviewing how it delivered its service to patients.

Health Minister Andy Kerr said the service had faced "a tough year" and the new management team had moved quickly to respond to pressures.

"I believe that the foundation has been laid for sustained performance improvement going forward," he said.

"However the report also underlines that there is still a lot to do."

The issue of lengthy waits for call-back has dogged NHS 24 since its creation and we are pleased that this has been recognised as a priority for action, Dr David Love BMA

Dr David Love, joint chairman of the BMA's Scottish GP Committee, welcomed the report and the fact that GPs' concerns had been recognised.

"The issue of lengthy waits for call-back has dogged NHS 24 since its creation and we are pleased that this has been recognised as a priority for action," he said.

"This problem must be addressed as delays in dealing with these calls can have a knock-on effect on the ability of out-of-hours organisations to respond during peak times."

Anne Thomson, Acting Director of RCN Scotland, added: "One key area that urgently needs to be addressed is the heavy workload that many nurses within NHS 24 currently have to deal with."

Quicker response

Shona Robison, the SNP's health spokeswoman, said: "Given these findings, NHS 24 and this executive still have a long way to go to restore public confidence in the service, and to meet the challenges set out in the report, but it can do so with the continued professionalism of its staff and improved management at all levels."

The Tories' health spokeswoman, Nanette Milne, said: "There is still a serious shortage of workers in NHS 24 and the body is still too centralised. That is not acceptable for such a flagship policy of this government."

The findings of the review were welcomed by the family of Aberdeen schoolgirl, Shomi Miah, who died from meningitis in October last year.

They claim a quicker response from NHS 24 could have saved the 17-year-old's life and are currently attending a fatal accident inquiry into her death.

Shomi's brother Kajal, 25, said: "As a family we are happy that something is taking place and being done about NHS 24.

"It shows us that our concerns about the failings and faults in its system are being recognised and hopefully corrected, so what happened to us does not happen to anyone else."