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Dr David Gilbert, from Stockport LMC, told conference about Mastercall, a GP cooperative that still provides services locally at a cost of two pence per patient, or £7 a year for the 9,000 patients it covers and an eight per cent referral rate to secondary care. It has a complaint base of 0.03 per cent, Dr Gilbert said.

NHS Direct by contrast has a cost of £25.70 per contact per year, with referral rates of over 34 per cent to other primary care providers and 32 per cent to accident and emergency departments.

'Is it any wonder that their complaint rate is high when the provider is a company that is more concerned with profit than with the provision of a high quality out of hours service?'

This government's obsession with access is leading to the demise of the role of the GP as gatekeeper of care in out-of-hours provision, Dr Gilbert said.

Dr Carl Hobday, from Kent, the medical director of an out-of-hours provider, told conference that GPs were 'pushed out so the government could achieve their goals of competition and the sham of choice through privatisation.'

Dr Kevin McBride introduced a note of regret when he reminded delegates that 'it was us who voted to drop out-of-hours'.

Until then 'we had an unassailable position at the heart of primary care'.

'But with the loss of three quarters of the hours in the week and with the packaging of the product, the door was opened in a way that was inconceivable before for others to march in and start to dismantle our profession.'

'If we had that vote again I would like to think we would be more careful about such a central part of our heritage, but in the meantime, laying the blame entirely at the door of the DoH is inaccurate.'

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