While eight out of ten people are apparently satisfied with the services, the lack of national leadership and benchmarking has resulted in huge gaps between the most efficient and inefficient areas.
The NAO pointed to PCTs fielding GPs to work in call centres, duplication of services, and poor local tendering, as examples of NHS money being spent without any benefit to patients.
As well as the action plans, PCTs and out-of-hours providers will be invited to 'master classes' to ensure the NHS grasps the changes required.
Health minister Lord Warner said: ‘We are now taking vigorous action in partnership with the NAO to ensure all parts of the NHS reach the standards of the best, both in terms of the quality of patient care and the value for money their services deliver.
If PCTs running the least efficient services upped their game, the NHS could save well over £50 million for re-investment in other services. Getting all PCTs to be as cost-effective as the best would save even more - to well over £100 million. It is clear that if all PCTs had commissioned effectively the NHS could have lived within the extra £322 million provided for out-of-hours services in 2005/6.’