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Audit Scotland says that the country's out-of-hours services risk becoming unsustainable unless NHS boards and the Scottish Executive invest in extending the roles of nurses and paramedics.

Responsibility for out-of-hours services shifted from GP practices to NHS boards in 2004. Since then, 95 per cent of Scotland's GPs have opted out of providing 24-hour care to patients.

GPs can still provide out-of-hours services to NHS boards for a fee. However, the number of GPs 'reproviding' services in this way is steadily dropping, particularly in rural areas.

The report acknowledges nurse-led helpline NHS24, but says that services will need to use more nurses and paramedics to bridge the gap.

Nurse practitioner Liz Davidson, who works part-time for NHS Grampian's out-of-hours service, said she was concerned that it would be difficult to attract more nurses to these types of roles.

She said that the education and training required, unsocial hours and problems with pay could put nurses off. She said her role had yet to be banded under Agenda for Change.

'I enjoy my job, but we are having to battle for acceptable pay at the moment,' she explained.

'We are trying to highlight the fact that we are doing a responsible job and filling the gaps for GPs, but we are still being paid on the old Whitley scale, which does not acknowledge and reward clinical expertise or knowledge.'

Ann Thomson, RCN Scotland acting deputy director, said that more should be done to resource, develop and support nurses to take on extended roles.

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