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For those interested, the DH OOH Review has come up with stringent quality standards in primary care. It won't help A&E much this year...but it is expected to be functioning in full by 2004. The first point is about access and availability. More primary care centres accessible to all parts of the community, and closer integration with A&E by centres in or near departments. Telephone answering - all calls within 90 seconds! Triage - categorizing all patients within 20 minutes. Visiting/ Appointment standards: urgents within an hour, less urgent 2hours, routine (but still requiring an OOH face to-face) 6 hours. Individual training and accreditation in OOH skills, including emergency care and telephone skills. An obligation to provide sufficient resources (manpower etc) to make this all happen. Extended opening at peak times - we have already been told to open Boxing Day morning so we will effectively have just Sunday and Monday (24th&5th) off. There was an acceptance that the time had come to stop modelling patients to the service, but to model the service to the patient. Inappropriate attendees to GP and A&E can still be politely told where to go.......but there is a clear responsibility on the OOH provider to provide an adequate and high quality service. The government has even promised extra funding - though they'll undoubtedly still take it away from us some other way! But! Does that mean that once categorized as "emergency" i.e. less than an hour to doctor contact such cases will now be directed to A&E? If so, we'll see less emergencies than we currently do, and more other cases. It ain't going to get lighter. Finally, Adrian (speaking in a most definitely not patronising way!!), surely the problem in inner cities is simply not enough GP's per patient? I enjoy practicing medicine, not insolvable social problems, getting beaten up by drug addicts, spending hours in traffic to do one visit, premises regularly burgled or vandalised......My initial experiences of general practice while in teaching hospitals is that it was very poor....something of a paradox considering the very high standards of medical care from the hospitals. But I now know this was because of recruitment, case mix, and under-resorting. Most reject their own OOH care because it simply isn't safe to do so in far too many cases. GP/A&E co-operation in such cases must be the way forward? Sadly won't help this year, so I'm sure we can expect a few "you're crap" "oh no we're not" exchanges...............anyway it's therapeutic as long as its good humoured! Jeremy (GP)