The deal will make it easier for GPs to set up primary-care emergency centres to which patients will be asked to travel at night and at weekends, instead of the doctor simply offering advice over the telephone or visiting.
In return, family doctors will retain their 24-hour responsibility for patients - something that, two years ago, almost three-quarters of them said they wanted to drop.
The new package 'clarifies' doctors' terms and conditions of service, making it plain that they and not the patient will decide whether, where and when a patient receives an out-of-hours consultation. But home visits will remain.
Dr Mawhinney said: 'Where there is doubt, I fully expect GPs to err on the side of caution and make a visit.' Patients will still be able to take doctors to service committee hearings if they are denied a visit which they believe they should have received.
The move follows a trebling in demands on GPs for night visits to almost two million over the past three years - and the development of GP co-operatives in which fewer doctors are on duty at night. Some already work from night surgeries to which patients are asked to drive or get a taxi.
Dr Mawhinney said he still expected GPs to take account of patients' 'social setting' - access to a car, or whether they have others they cannot leave in the house - in deciding whether they should travel. But he argued that both GPs and patients would gain from the deal. 'It is not in the patients' interest that they should be served by GPs who are permanently tired and exhausted,' he said.
Where primary-care centres are created - some eight exist already - patients will in general have to travel further than to their local surgery. But Dr Mawhinney argued that the centres offered 'a new option for patients'.
Dr Ian Bogle, chairman of the British Medical Association's family doctors' committee, said: 'There will still be a role for home visits, but I am convinced the new arrangements will reduce this need. For the good of the patients and doctors, we must return to a situation where out-of-hours calls are for emergencies only.'Reuse content