Question: What is significant about the introduction of the new GMS GP contract in April?

Peter Hunt: The government spent a very long time negotiating a new contract for GPs over the last 12 months and as part of the new contract, doctors have accepted new regulations concerning their working practices.

As part of that, the government have agreed that doctors should no longer be obliged to work after 6.00pm on weekdays or on Saturday mornings.

So with regards to the out of hours part of their job, which since the formation of the NHS up to the present day has been non-negotiable, GPs will now be able to choose whether they do any work in that period of time.

Question: What consequences does this have?

Peter Hunt: The contract means that many will be thinking about not working out of hours in the future and there are two issues raised by this.

Firstly, there is the need to maintain adequate cover so that the patients don't see a reduction in service by making sure that there are structures in place which maintain that service.

The second part of it is to make sure that we take the opportunity to re-design how these services are provided so that all of the stakeholders involved in them actually have an appropriate role to play in the management of them.

This will include the GPs themselves, but it will also include the nurses, paramedics, patient transport and NHS Direct staff. In addition, there is the possibility of the general public being involved in helping to manage the strategic direction of their local Primary Care OOH services.

Question: How do you think this will work on the ground and in practice? Will there be a smooth transition?

Peter Hunt: There's going to be a mixture of approaches adopted.

What we've designed is a model that can be adapted to local needs.

In some areas, there won't be a strong desire in the first instance for example for the public and local communities to be involved, but in others there will be a very strong one to go that far right at the beginning.

The important thing is that all of the different stakeholders who are currently providing the service, who at the moment are not part of the GP-Co-operative structure, will be able to play an appropriate part under the new model that we've designed.

So there is a great deal in it for the vast majority of people who actually provide this type of primary care service.

Question: Where else should the principles of mutuality be extended in the NHS?

Peter Hunt: Well there was a lot of debate last year around foundation hospitals and many people didn't really understand why the government had approached acute hospital trusts as being the first place to involve local communities.

Its just that that was the first place they picked - it didn't mean that they didn't also think that you could look at a whole range of service levels for involving communities and different types of health care workers.

From our point of view, we've always felt that primary care in its entirety was an appropriate level at which to involve communities because that's where you have your long term health care relationship.

Let's face it, most people don't necessarily want to have a long term relationship with acute hospitals because it means that either they or someone they know is quite ill.

However, they will have a long term relationship with their local GP surgery; with health visitors if they've got kids, and a whole range of locally provided services.

So its seems to us appropriate, that we should look at all of those services for seeing where the public can be usefully involved.

Question: Do you think the government 'watered down' the original proposals for foundation hospitals too much? Is Whitehall still in control?

Peter Hunt: Well one thing that wasn't amended, in fact it was strengthened as the bill went through parliament, was the democracy angle.

From our perspective, the democratisation of foundation hospitals has become the main part of the story.

We've been working with a number of foundation applicants and from our perspective they are extremely positive about involving local communities and involving their staff in decision making processes.

So although lots of people were sceptical about all this, for those of us who've been very close to the people actually designing the new governance structures, I'm very confident that even the critics will be very pleasantly surprised.

They will see that these foundation hospitals can genuinely represent the people that they are serving.