A committee of MPs have termed the shake-up of the out of hours health care system in England as "shambolic" that only led to longer waits and higher costs.
The public accounts committee claimed that the new health care providers are spending 22% more than before yet have not met many key targets.
AdvertisementIn 2004 most GPs had opted out of the organisation of the service in 2004 after which PCTs took over in 90% of cases.
The NAO mentioned that the PCTs had little experience of running such services and were poorly prepared for the transfer between April and December 2004.
As a result many contracts were signed late or not at all. Where external providers took over the service, contracts were not signed in two thirds of cases by September 2005.
This has led to insufficient monitoring of official service standards.
The NAO report also found only 21% of trusts were able to show that they had given a face-to-face consultation at a patient's home within one hour for urgent cases.
About of half of the PCTs simply did not have the information making it difficult to be sure that patients' safety had not been compromised.
The NAO did report that the service was now beginning to reach a satisfactory standard although one in five patients was still shown to be unsatisfied.
The report also raised concerns about the costs of the new service which rose from the Department of Health estimate of Ł322m to Ł392m in the first year.
The financial impact of this increase in cost has been considerable for PCTs, the report said.
Dr Hamish Meldrum of the British Medical Association has called for a better integration of services as well as planning.