Out of hours primary care

without reference to patients' views, with no attempt to involve users in their planning and operation, and with limited efforts to assess patient satisfaction.Without evidence to support a need for uniform standards of service and care, and without a clear idea of what those standards should be, they are likely to maintain their independence of action, as practice rotas have always done.Uniformity is not necessarily a virtue in circumstances where needs and demands for care differ.The importance of flexibility in order to address local needs and circumstances, particularly where services are poor, lies at the heart of the recent government white paper on primary care. 18However, equality of access to uniformly high standards of care is an important goal for primary health care, and increasing variability in the organisation and delivery of out of hours services should not lead to increasing inequality.