Abstract
A new contract for general practitioners (GPs) was introduced in the UK on 1 April 2004 which has implications for secondary care. In particular, the contract means that GPs can opt out of out-of-hours care, and accident & emergency services have voiced their concern that their workload may increase as a result. The new contract provides the potential for a rise in GPs' salaries by two means: through the provision of the Quality and Outcomes Framework which includes the management of 10 common chronic diseases; and through 'Enhanced Services', which are a series of optional 'extra' more specialised services with national specified standards that can be commissioned by primary care organisations (PCOs).