Patients can be assured that when they are ill they will be treated

Dr John Chisholm

However, the Liberal Democrats denounced the plans as "deeply disturbing".

Its health spokesman Dr Evan Harris said the move would confuse patients.

"The fact that GPs are no longer going to provide cervical screening, contraceptive services and vaccinations as part of standard care is deeply disturbing.

"This shows how short staffed the NHS is. Patients will be faced with a maze of treatment outlets. This is not so much reform as regression," he said.

Service changes

Under the terms of the new contract, medical services provided by GPs will be divided into three areas:

• essential services provided by every practice
• additional services widely provided but allowing practices in difficulties to opt out
• enhanced services provided by some practices which choose to opt in

While most practices would be expected to provide "additional services" - such as immunisation clinics, contraception, cervical screening and chronic disease management - some doctors could opt-out.

According to the BMA, they would be able to decide not to provide these services in "exceptional circumstances", such as being overstretched or not having enough practice staff.

However, they would then lose out on financial incentives if they decided not to offer these services something which was also criticised by Dr Harris.

"The continued use of incentive payments, like incentive target payments for vaccine distribution, raise serious ethical questions," he said.

"Money alone should not influence the choices doctors make about care."

24-hours responsibility

The proposed changes would also mean, for the first time, GPs will no longer have to take 24-hour responsibility for their patients.

Responsibility for care outside normal working hours will pass to a local primary care organisation.

Dr John Chisholm, chairman of the BMA GP Committee, backed the changes and said the vast majority of doctors would offer additional services.

He added: "There is a dire shortage of GPs and they are being asked to do too much work with insufficient resources.

"The current situation simply cannot go on. The new contract framework allows GPs to control their workload, but patients can be assured that when they are ill they will be treated."

The BMA has spent months negotiating the contract with the employers' organisation the NHS Confederation.

GPs had warned that they were prepared to take industrial action if steps were not taken to deal with what they say has been a burgeoning workload for primary care.

Rewards

Dr Gill Morgan, chief executive of the NHS Confederation, said the contract would "properly reward GPs and help them improve services for patients".

Professor David Haslam, chairman of the Royal College of General Practitioners, said: "Enabling GPs to choose the level of service which they offer will ease workload pressures whilst allowing them to work on improving the quality of the service they offer to patients."

The contract details will be sent out to GPs next week. They will vote on the proposals in June with a result expected the following month.

In the meantime, the BMA will continue talks on the details of the contract and a timetable for its implementation.