New contractual arrangements to encourage practices to opt back in to 24 hour responsibility and to support general practitioners who choose to discharge this responsibility personally would have many benefits. The change would begin to redress the increasing separation of daytime, surgery based care from out of hours care provided by deputising services. These arrangements would also improve general practice training; greatly increase the quality and appropriateness of out of hours care, particularly in terms of hospital admissions and appropriate use of services by patients; and enhance patient safety by improving the communication of important clinical information. They would be widely welcomed not only by patients but also by other sectors of the medical profession, and are also likely to be cost effective.