Primary care trusts will have to negotiate with family doctors over how to implement extended hours locally after the overwhelming majority of GPs voted to accept the government’s proposed deal.

Practices will provide 30 minutes of consultations outside core hours for every 1,000 patients. Consultations are meant to be pre-booked and delivered in 90-minute blocks by one GP. But PCTs will have some leeway to vary these arrangements and to include existing extended hours provision.

GPs have urged them to be flexible. Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, said: “We are calling on PCTs to work very closely with their local medical committees and GPs, to be as flexible and reasonable as possible in their implementation and indeed to find a way around the intransigence which appears to be here in the centre.”

PCT Network director David Stout said: “What’s been agreed isn’t something that can be imposed. It’s a nationally agreed contractual device to put something in place. You can’t make GPs do it, they have got to want to do it, so there is a degree of negotiation still to be done by PCTs with their local practices and I am sure they will want to do that as flexibly as will make sense.”

The BMA wants PCTs to allow more than one GP at a time to provide extra hours for safety and efficiency reasons, and to be flexible over the minimum time blocks.

The deal specifies that consultations should be with a GP, but the BMA wants PCTs to consider extending the hours for nurse appointments in tandem to provide services such as cervical smears, phlebotomy and travel vaccines.

Dudley PCT chief executive Mark Cooke said he had met with GPs and the local medical committee already to talk about extended hours. “We want them to collaborate with themselves and also with us to make sure we get the right services in the right place.”

Collaboration might mean passing on extended hours to other practices or practices working together to provide it from the same building. The PCT is also considering setting up a local enhanced service to involve nurses in extended hours.

Northamptonshire teaching PCT director of commissioning Richard Alsop said his organisation was likely to be flexible, particularly about doctors working alone.

Last week, health secretary Alan Johnson publicly denied the BMA’s claim to HSJthat the government’s push on extended hours was to “punish” the association and GPs for having done well from the previous contract.