The majority of GPs believe that out-of-hours care has deteriorated since primary care trusts (PCTs) took control of the service in 2004, according to a new study.
Under a new contract which was brought in that year, family doctors were allowed to opt out of providing round-the-clock care for patients if they agreed to take a £6,000 annual drop in wages.
But the system - which sees PCTs use a mixture of in-house teams, cooperatives and private firms - has come in for repeated criticism.
The research, carried out by Pulse magazine, reveals that 60% of 880 GPs surveyed believe the standard of services has slipped over the last three years, while just over one in 10 (12%) said they think services have improved.
And almost half (44%) of GPs questioned said patients have complained to them about out-of-hours care in the last year.
Meanwhile, the poll found that the workload of those GPs working out-of-hours has gone up 75% since PCTs took over.
A separate study of more than 3,000 patients also found that one in five received "poor" or "very poor" care the last time they sought help out-of-hours.
Some 47% said their care was "good" or "very good", but almost half of patients surveyed said they feel "less safe" since PCTs took over, compared with 7% who feel safer.
Richard Hoey, deputy editor of Pulse, said: "The government keeps insisting out-of-hours care is improving, but that's not the message we're getting from doctors or patients."
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