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Highs and lows: The 2004 new GMS contract

Dr Kailash Chand, former GP in Oldham, Lancashire and now chair of NHS Tameside and Glossop, remembers the massive impact of the new GMS contract.

Before 2004 we had what I called the ‘John Wayne' contract. Our attitude had to be 'I've gotta do what I gotta do' and we worked 365 days a year, 24 hours a day, seven days a week.

But we were exploited by patients and the Government. As a result, the variation of standards in general practice was huge. Some practices were excellent, others were frankly rubbish, and the 2004 contract was a genuine and honest attempt to address that.

But even at that stage there were flaws. It was good to get rid of out-of-hours but in my view even at that time I did not think we should give up total control, and we did not handle the opt-out well.

Continuity of care was the jewel in the crown of the NHS and by giving up out-of-hours we compromised that.

Dr Kailash Chand