OUT of hours GP services have come under "chronic stress" in Scotland, according to an official review which has recommended a major shake-up of the system.

The probe into the way patients are looked after in the community when GP surgeries are shut, found services are "fragile" and warned the situation will "worsen" without immediate action to attract doctors to careers in general practice.

However, it also said in future patients would not automatically see a doctor when they had pressing health problems during evenings and weekends - instead proposing mixed teams of nurses, pharmacists, therapists and social care staff based in "urgent care hubs".

Even fire fighters, with training in resuscitation techniques, could have a bigger role to play in some areas.

The report also said the public and professionals were confused about how to use out of hours (OOH) systems, and suggested a high profile information campaign. It stresses OOH services are for "urgent" health problems - rather than issues which can wait until morning - through-out.

The review, chaired by Professor Sir Lewis Ritchie, was ordered by the Scottish Government amid concern health boards were finding it increasingly difficult to find enough GPs to cover OOH shifts.

Family doctors were able to give up responsibility for providing medical cover during evenings and weekends under a new contract which was introduced in 2004 and Sir Lewis' report says: "This has resulted in a number of unforeseen and adverse consequences - including insufficient participation of GPs in OOH services."

The report notes younger doctors who started work after the contract came in are the least likely to help man OOH clinics and warns about the impact on staffing levels as the older generation retire.

Increasing exposure to OOH work during training, providing mentors for those who are new to the service and making OOH jobs more attractive are among the remedies suggested.

Dr Sian Tucker, co-chair of the National Operations Group which represents OOH staff, said: "We are delighted that this review has launched because we wanted it to evaluate the challenges out of hours were facing and the feeling we were an invisible service. People did not know we existed."

The report, commissioned earlier this year, acknowledges this, saying: "Specific lack of recognition of these services within (health) boards results in a ‘Cinderella’ service with underinvestment and chronic stress in the system."

Involving the internal NHS watchdog Healthcare Improvement Scotland in monitoring standards for OOH care are among the measures suggested to address this.

The report also recommends creating specialist palliative care support specifically for patients at the end of their lives so they do not go through the same NHS 24 phone system as everyone else if they need medical advice. It calls for falls services, which exist in a number of areas to look after the frail if they fall without being injured, to become standard.

Better sharing of patient records is also discussed.

Sir Lewis said while his remit was to look at OOH care, the model of GPs leading a team of mixed professionals in urgent care centres matched the vision for daytime GP surgeries.

Health Secretary Shona Robison said £1m had been made available immediately to fast-track test sites for the urgent care hubs. She said: “We are already taking a comprehensive range of actions across all areas of our health service in order to meet the changing demands and the recommendations in Sir Lewis’ Review will build on this, helping ensure a more effective and sustainable service for the future."

A plan on implementing the proposals will be published in the spring.

The review was released on the same day as research showing GPs in Scotlands most deprived communities receive £10 less per patient than those in more affluent areas. Ms Robison has said she is "sympathetic" to the need to address this funding issue.

The key points from the OOH Review are:

* In future OOH care will be delivered by a GP-lead team including nurses, other health professionals, paramedics, social services and voluntary agencies in urgent care hubs.

* A national workforce plan to prepare for this should be rapidly drawn up.

* GPs should spend more time in OOH during training and be encouraged to work in the service

* OOH staff should have rapid access to specialist paediatric doctors and paediatric medicine should be part of their training.

Meanwhile, a "potential agreement" has been reached between the British Medical Association (BMA) and the Government which could lead to strike action being suspended, the Health Secretary has said.

Jeremy Hunt told MPs in the Commons there had been a "time-limited" agreement for further talks, where the BMA would suspend strike action if the Government agrees not to impose a new contract on doctors.