Background National standards for delivery of out-of-hours services have been refined. Health service users' preferences, reports, and evaluations of care are of importance in a service that aims to be responsive to their needs. Aim To investigate NHS service users' reports and evaluations of out-of-hours care in the light of UK national service quality requirements. Design Cross sectional survey. Setting Three areas (Devon, Cornwall, Sheffield) of England, UK. Method Participants were 1249 recent users of UK out-of-hours medical services. Main outcome measures were: users' reports and evaluations of out-of-hours services in respect of the time waiting for their telephone call to the service to be answered; the length of time from the end of the initial call to the start of definitive clinical assessment (call back time'); the time waiting for a home visit; and the waiting time at a treatment centre. Results UK national quality requirements were reported as being met by two-thirds of responders. Even when responders reported that they had received the most rapid response option for home visiting (waiting time of up to an hour'), only one-third of users reported this as excellent'. Adverse evaluations of care were consistently related to delays encountered in receiving care and (for two out of four measures) sex of patient. For 50% of users to evaluate their care as excellent', this would require calls to be answered within 30 seconds, call-back within 20 minutes, time spent waiting for home visits of significantly less than 1 hour, and treatment centre waiting times of less than 20 minutes. Conclusion Users have high expectations of UK out-of-hours healthcare services. Service provision that meets nationally designated targets is currently judged as being of good' quality by service users. Attaining excellent' levels of service provision would prove challenging, and potentially costly. Delivering services that result in high levels of user satisfaction with care needs to take account of users' expectations as well as their experience of care