Will it encourage a market in out of hours care?

It has taken three substantial rounds of negotiation, two ballots, and the threat of industrial action for the government to acknowledge general practitioners' desire to opt out of the 24 hour commitment to patient care. In a reversal of government policy,1 2 agreed unanimously be the General Medical Services Committee, general practitioners will be offered the opportunity to divest themselves of out of hours work.3 If they can find another principal on the medical list of a family health services authority and agree a fee between themselves they may transfer all of their out of hours responsibility.

As two thirds of general practitioners have already made clear their wish to opt out of 24 hour commitment,4 the market of general practitioners willing to assume their colleagues' out of hours responsibilities will come from the remaining third. There is no restriction of list size placed on doctors making this extra commitment, and no limitation is …