Nearly half of GPs believe patient care has suffered following a shake-up in the way night and weekend cover is arranged, a BBC survey suggests.
Family doctors no longer have to provide out-of-hours services
A year after most GPs in England opted out of providing out-of-hours cover, 45% said standards had dropped, with patients facing long delays.
But 85% of the 500 GPs surveyed thought their own quality of life had improved.
The British Medical Association said when looking at day and night care together, patients had benefited.
However, patient groups said care had worsened, with the NHS being designed around staff rather than the public.
The new GP contract was introduced in April last year, but it was not until the autumn that the majority of family doctors were able to opt out of out-of-hours work when local health bosses arranged alternative provision.
In total over 95% of doctors stopped providing the service, with co-operatives of GPs, paramedics and nurses replacing them in most areas.
The survey, carried out by research group doctors.net.uk for the BBC to mark the one-year anniversary of the reforms, also found a third of doctors thought the move had led to increased demand on local A&E services.
One doctor said: "I have seen many misdiagnoses, mainly over-investigation and over-treatment of trivial ailments."
The reform of GP care has long been controversial, with patients critical of the new arrangement's reliance on non-doctors.
Simon Williams, director of policy at the Patients Association, said: "The NHS is increasingly being designed around the needs of staff, not patients.
"This is wrong. It is taxpayers' money that is being spent and the patient must come first.
"Instead, when a patient needs help out of hours, they face a trip down to A&E or long waits on the phone. Care has undoubtedly got worse."
But Dr Peter Swinyard, of the British Medical Association's GP committee, said patient care had improved.
"We have got to think about the whole of patient care rather than just the out-of-hours period.
"When we were doing out-of-hours care, patients were being seen by tired and stressed doctors. That was not good for care.
"The big revolution has been that doctors are now alert during the day, and specialist care is available in the night."
And the Department of Health said it was "pleased" the survey showed GP working lives were improving, but denied it had been at the expense of patients.
A spokesman said: "The new arrangements are also providing improvements in local out-of-hours services for patients."
The following comments reflect the balance of opinion we have received:
If patients need to use the out of hours service in this area, they face a trip into town to attend a special surgery. That is all well and fine IF they have a car. If they don't then they are faced with phoning for a taxi, with the associated wait and expense ... and then phoning for another once they have been seen, presumably.
Jan, London, England
I went to an out of hours centre feeling very unwell and was sent away as the nurse said there was nothing she could do for me. The following week I spent three days in hospital with pneumonia. I have no confidence in the system .
A. Sibley, Rushden, England
I am a GP. I work 60h a week. It is physically impossible for me to do night shifts on top of this. It's not rocket science. The government has been told for years there is a shortage of GPs
Other healthcare professionals have to work nights so why should GPs have been allowed to be the exception to this? Is this because they have a lot of political clout? Most patients feel worse at night and that is when a lot of calls for help are made. I know this as I used to be a Paramedic until last year. There should be no such thing as 9 to 5 medicine. The real scandal is at weekends and Bank Holidays, there is little or no proper cover for these periods.
Mark Saunders, Standlake, UK
As a GP, I am tired of the media putting blame constantly on the medical profession. The public/patients have a major part to play. The change of family dynamics such as loss of the extended family and increased expectations which see patients run to their GP for the most trivial of self limiting illnesses - have just a big a part to play for the current situation. The bombings of 7/7 highlight how amazing the doctors and NHS staff are in this country. They do not receive enough credit.
Dr Afrosa Ahmed, London, UK
We've seen the standard of out of hours care increase significantly. We now have a dedicated out of hours clinic at Northwick Park Hospital, where you are referred by NHS Direct. So we have one number to call, a nurse calls us back within an hour, and after diagnosing over the phone to filter out unimportant issues which can wait for the next business day, arranges an immediate appointment with the Harmoni clinic (that's what the out of hours service is called). Every time I have been there, the wait for a doctor is in minutes (I think the longest I have waited has been about 10 minutes), and the service provided is absolutely superb - truly exemplary. This is what health-care should look like.
Simon Kapadia, Wembley, Middlesex
In my recent experience the out of hours cover provided was inadequate in terms of accessibility and medical competence. I knew what the term "doctor" and "nurse" meant, but I do not know what the term "medical specialist" or "medical professional" means. I have been given little reason to trust the people so designated with my family's emergency care. Without GPs in the front line of medical care, it is inevitable that the burden will switch to the already overworked A&E departments of hospitals.
David Shorthouse, Timsbury, Hants
I contacted NHS Direct two weeks ago on a Saturday. My phone call back from local services came in 20 minutes, and within a very short while a paramedic, followed by an ambulance, arrived. I was in hospital within an hour. This compares to two days before when it took two hours to get through to my local surgery, and then another four hours for a doctor to call, during which time my condition was roaring away and I was worsening. All I needed was antibiotics, and quickly. If the GP route had been quicker, I may not have ended up needing out of hours services but when I did, they were excellent, at our local DGH.
Chris Clark, Eastbourne, E. Sussex
Have called the out of hours doctor on a number of occasions over the last 12 months for both my children and elderly relative that lives with us and is diabetic. The consultation over the phone has quite often helped stem worries and proved that the doctor isn't actually required. This has worked well for us, we are willing and able to go to the clinic with the children, and the doctor will do home visits for mum.
Pam Spencer, Stretford, England
The new out-of-hours service is better for all concerned. An alert clinician attending with mobile communications, giving him/ her access to diagnostic decision support technologies has to be an advance on than the old system. That often required dragging a tired doctor out of bed and without immediate access to information. They then often had to work a full day after that - no wonder most have opted out!
David Bilcliffe, Ashford, Kent, UK
I think the changes have been good on the whole. There is now much more choice of when and where to be seen e.g. in walk in centres + the option of discussing difficulties with good quality nursing staff over the phone. This may lead to over testing + diagnosis like the person in the article says but rather that than misdiagnosis and over treatment as has been the norm before. The way forward now would be for GPs to recognise that opening the surgery at week ends for both proactive and reactive care would be a step in the right direction too.
JC, Merseyside, UK
I, and many GPs I know, are sad that we cannot practically provide on-call for those who really need it. Some of the most rewarding moments of my career have been from the out-of-hours work, but these became so flooded with unrealistic demand for trivial problems that it became impossible to meet that demand in addition to the ever-increasing daytime burden of work.
GP, West Yorkshire