In this week's British Medical Journal (BMJ), two experts debate the issue of whether GPs should take back responsibility for out-of-hours care.
Roger Jones, Professor of General Practice at King's College London, argues that the 2004 GMS contract has led to a situation in which the best-trained GPs concentrate their efforts on daytime care, while patients who become ill at night risk being seen by less experienced doctors.
Professor Jones says: "I am not suggesting that GPs resume out-of-hours responsibility for their entire professional life. And I am certainly not supporting the view that surgeries should be open at all hours for routine care – this entirely misses the point.
"However, during vocational training and in the early years of practice, seeing patients in their homes, assessing acute medical problems, and making appropriate decisions about treatment and hospital referral should be regarded as core aspects of training and professional development, just as they are in hospital medicine."
Having covered out-of-hours care himself, Professor Jones does not underestimate the difficulties of re-engaging with personal out-of-hours care, but he is convinced that, for many doctors and patients, a return to a more personal approach to 24-hour responsibility would reap enormous benefits.
On the other hand, Dr Helen Herbert, Chair of the RCGP in Wales, writes that it is precisely because GPs want the best care for patients that the 2004 contract change was made.
She describes her experience of covering out-of-hours care, often in a state of exhaustion, and argues that sleep-deprived people should not be making life-threatening decisions.
Dr Herbert says GPs are blamed unfairly for the state of out-of-hours services when the responsibility for commissioning and providing these services resides with primary care organisations.
She points out that where out-of-hours care is properly organised and resourced, it works well, and many studies have shown high satisfaction with the care provided.
"The profession made the difficult decision to withdraw responsibility for out-of-hours care to ensure the safety of our patients and recruitment of future generations of doctors," Dr Herbert writes, "but we must maintain responsibility for these values by providing excellence in preventative care and by influencing the providers, commissioners, and policy makers to ensure provision of the high standards of care that we expect for our patients."