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Out-of-hours medical cover for Scots patients is "not sustainable" in its current form because nearly all of the country's GPs have opted to stop making house calls when their surgeries are closed.

A report published today by Audit Scotland says changes to GP contracts, which allowed doctors to opt-out of providing out-of-hours cover if they wanted to, had put increased pressure on other parts of the NHS.

It showed that 95% of Scots GPs had decided to stop treating patients outside office hours within eight months of the new contracts being introduced. As a result, nurses, paramedics and staff manning the NHS 24 phone line are now relied upon to help patients who become unwell late at night.

Audit Scotland has now urged the Scottish executive and NHS boards to invest more money and make urgent changes to the system to ensure patients are able to get 24-hour medical cover in the future. "Out-of-hours services are under continuing pressure as fewer GPs are re-providing services," the financial watchdog's report says. "New ways of working are required as there is a significant risk that current models of service delivery are not sustainable in the long term."

The report also revealed that only one in 10 GPs believes out-of-hours patient care has improved since the new system was introduced, with more than half saying it has not.

Audit Scotland's findings were last night welcomed by doctors' leaders, who said it proved the government had failed to realise the full implications of implementing the new GP contracts in April, 2004. Dr Dean Marshall, the chairman of the British Medical Association's Scottish general practitioners committee, said: "This report highlights some of the fundamental issues that have hindered NHS boards from developing integrated services for out-of-hours care.

"BMA Scotland would welcome the opportunity to be involved in discussions on how the various service providers can work together to deliver out-of-hours care in the long term and to consider the potential for wider improvements to unscheduled care for patients across Scotland."

The report says that in 2006-7, NHS boards spent nearly £68m providing out-of-hours cover, with those in rural areas having to spend a greater proportion of their overall budgets. It also warns that "there is no coherent national approach to monitoring the performance of out-of-hours services".

Despite the gloomy outlook, however, more than 80% of patients who were surveyed said they were happy with the service.

Caroline Gardner, the Deputy Auditor General for Scotland, said: "The Scottish executive should look to healthcare professionals other than GPs and consider how to extend their roles and skills."

Margaret Watt, of the Scottish Patients' Association, said the NHS was increasingly becoming a "part-time service".

She said: "The service is meant to be available on demand, but increasingly that's not the case."

Shona Robison, the Deputy Health Minister, said the executive was already exploring ways of encouraging greater co-operation between NHS 24, the ambulance service and health boards.

"In order to maintain and improve the delivery of out-of-hours services, the Scottish government will work with boards to extend the roles of nurses, paramedics and others in delivering the service," she said.