NEARLY £7.5million was spent last year by Glasgow health bosses in providing out-of-hours care.
The cost of running the GP service shot up by more than a quarter, from £5.84m in 2004.
However, official figures show it is good value, with the lowest cost per patient anywhere in Scotland.
It works out at just £7.61 for patients in the Greater Glasgow area compared to £43.63 for those in Argyll and Bute.
The difference in cost is explained by the large and densely populated area covered by Greater Glasgow compared to Argyll's dispersed population.
Doctors in the Glasgow area who provide the service earn £45 an hour for a call-out on a weekday evening rising to £60 if the call is overnight.
The total cost for Scotland for the service was almost £68m last year.
The Audit Scotland report found that since responsibility for out-of-hours care services was shifted in 2004 from GPs to NHS boards, 95% of Scotland's GP practices have opted out of providing 24-hour care to their patients.
It says most patients are satisfied with NHS out-of-hours care.
But it warns that with fewer GPs covering the out-of-hours period, there is a "significant risk" the service is unsustainable in its current form.
Under the present system of out-of-hours care, GP practices can opt out of providing out-of-hours care though GPs can then choose to deliver some out-of-hours work to NHS boards for a fee.
However, the number of doctors doing this work is steadily dropping.
The report says NHS boards and the Scottish Executive need to invest in extending the roles of nurses and paramedics.
Deputy Auditor General for Scotland Caroline Gardner said: "Since the changes to out-of-hours services, NHS boards have worked hard to maintain the care patients have traditionally experienced.
"The Scottish Executive should look to healthcare professionals other than GPs and consider how to extend their skills.
"Meanwhile, NHS boards should continue to develop how they work with partners, such as NHS 24 and the ambulance service."
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