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Its survey published this week found that the number of GPs signed up to provide evening and weekend cover fell from 1,696 to 1,440 in the 12 months to April 2007.

The public sector watchdog found five out of six NHS boards, which are responsible for out-of-hours provision, had difficulty filling rotas and warned that unless a national pay scale was introduced, many would have no choice but to offer more pay to tempt GPs back. In rural areas, the watchdog said, GPs have NHS boards over a barrel.

However, Scottish GPC chairman Dr Dean Marshall argued that the number of shifts on offer had been cut back rather than the number of GPs wanting to do the work falling.

He said: 'There's been a lot of cost cutting by the health boards. I know a lot of GPs who would like to do the work but they are giving more work to nurses because they're cheaper.'

Thirty-eight per cent of the country's GPs responded to a survey about the impact of the 2004 GMS contract, which allowed most practices to opt out of 24-hour responsibilities.

Around 600 patients who had used out-of-hours services in 2006 and the NHS boards were also surveyed for the report.

Audit Scotland portfolio manager Claire Sweeney said: 'We've highlighted a dramatic change in many areas of primary care in Scotland, which makes it hard to compare the state of the service to the way it was before. But we did feel there was a real discrepancy between areas over the amount GPs are paid for out-of-hours work. In areas without the big co-ops to draw on and for unusual shifts such as Christmas day, it's noticeable. A pay scale would be helpful to stop costs escalating.'

Pay for out-of-hours shifts in Scotland is much higher than in England. In Scotland, GPs who elect to work evening and weekend shifts earn an average £12,000 extra per year, Audit Scotland found. In England GPs top up their salary by an average £9,500. Audit Scotland says the gap will widen unless pay is regulated.

Although 57 per cent of GPs said morale had improved, only one in 10 GPs said out-of-hours care had improved - 52 per cent said access had worsened.

But Dr Marshall said higher pay was a trade off for the downsides to living in an isolated community.

He said: 'There have always been problems in remote areas. Ultimately, it is supply and demand and, unless they are talking about ramping it up so GPs in inner-city areas get the same fees, it is unworkable.'

OUT-OF-HOURS GPs

Number of GPs working out-of-hours in Scotland in April 2007: 1,440

Source: Audit Scotland.

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