Until 2004, general practitioners were responsible for the care of their registered patients 24 hours a day and seven days a week. They did not have to provide that care themselves but remained responsible for arranging and coordinating it. As a result of the new GP contract, most general practitioners have now opted out of this responsibility and are contracted to work for the NHS from 8 am to 6 30 pm and for only five days a week. Since these changes, out of hours care has become more expensive and less efficient, with a profusion of different arrangements across the country. Attempts are being made to replace GPs with a multitude of people from different disciplines, and care is being fragmented proportionately.

How did we get into this mess? There is no doubt that GPs were becoming overwhelmed by an increasing out of hours workload, with people being encouraged to expect that medical care should be as convenient and accessible as a supermarket. However, the government is seeking to portray GPs …