The NHS is not meeting targets to see patients who need emergency GP care outside normal office hours, a BBC investigation shows.
Family doctors no longer have to provide out-of-hours services
GPs have been allowed to hand over responsibility for out-of-hours care to primary care trusts since October.
Data from 21 PCTs obtained by Radio 4's File on 4 programme found one in four was not meeting the target of seeing 90% of patients within an hour.
In some areas the target was met in only 13% of cases.
The investigation found areas in London and the Midlands were the worst hit.
In one case over Christmas, an 84-year-old woman had to wait 10 hours after her family called for a GP when she was suffering from a chest infection.
Forty-five minutes after the GP left, the woman died from pneumonia.
The findings come after hospital consultants have complained more people are being seen by accident and emergency departments because they cannot see a GP.
The arrangements were brought in under the GP contract.
Many GPs have opted out of providing the service and PCTs are now using GP co-operatives, which are not-for-profit bodies of doctors and nurses , private bodies or in-house teams for weekend and night-time cover.
But the National Association of GP Co-operatives has complained PCTs are under-funding individual co-operatives by about 10%.
Health Minister John Hutton said funding to PCTs had doubled to help meet the targets.
And he said: "It is the responsibility of PCTs to make sure these standards are being complied with, and where they are not being complied with, for action to be taken at an appropriate level."
But he admitted the system was not perfect, although he maintained it was improving.
David Hinchliffe, chairman of the Health Select Committee, said he was aware of problems and hoped in the future the service would be on a "much firmer footing".
But he said out-of-hours services needed to be regulated more.
"I happen to believe that the out-of-hours provision is such an important element of the work that is being carried out through PCTs.
"It should be part of the assessment of their performance. It is crucially important we ensure that changes that have taken place are monitored nationally and that people can look at comparative performance from area to area."
And Liberal Democrats health spokesman Paul Burstow said: "The new arrangements for out of hours services are causing problems in many areas of the country.
"Patients are confused, and often end up in A&E inappropriately, putting more burden on hospital services.
"More needs to be done to ensure out of hours care can be provided in the community. "
Shadow Health Secretary Andrew Lansley said out-of-hours services needed to be "responsive" to patient need.
File On 4: BBC Radio 4, Tuesday 29 March, 2005 at 2000 BST, and repeated on Sunday 4 April, 2005 at 1700 BST.