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There is a tension between GPs not wishing to become responsible for OOHs, as in the old GP contract, yet retaining sufficient interest and control to ensure high quality services. A way to overcome this is to have local GPs involved in the management and delivery of OOHs services and the only way to make this happen is to ensure that rates of pay are sufficient to compete with other opportunities and to make those payments pensionable. Where this isn't the case, services will be staffed by nurses and doctors from out of the area. When OOHs services fail to deliver quality care, the outcomes for patients can be significant, and even tragic, and the knock-on effect to other services can be crippling. I would hope that the GPs working in CCGs will ensure sufficient funding is made available to support sustainable 24/7 urgent primary care services that are fully embedded within the local primary and community care community.