The NHS could be doing much more to improve patient care, the leader of the country's GPs says.
The new GP contract came into effect in April
Dr John Chisholm said NHS managers were failing to take the opportunity to modernise the NHS.
In a speech at the British Medical Association's annual GP conference, he accused bosses of being too timid.
Hundreds of GPs are attending the two day conference in London - the first since the new GP contract was introduced across the UK in April.
Dr Chisholm said the introduction of the contract was an enormous opportunity to improve healthcare.
But he said primary care organisations (PCOs), which control 70% of the NHS budget, were failing to do all they could.
"The contract gives enormous opportunities for PCOs to expand and develop primary care, to reform emergency care, to improve chronic disease management, to reconfigure services, to shift services from secondary to primary care, to take pressure off the hospital service, to reduce outpatient referrals and emergency admission to hospital.
"The failure to grasp those opportunities has been unsatisfactory and unacceptable."
The new GP contract was billed as one of the biggest changes to the way doctors work since the NHS was founded more than 50 years ago.
Under the deal, spending on primary care will increase by one third to £8bn by 2006.
GPs can now opt-out of providing care to patients out of hours - in the evenings and weekends.
Many are expected to pay primary care organisations to do this work for them. The change is being phased in over the next six months.
GPs are also being encouraged to offer more specialist services, which have traditionally only been available in hospitals.
Others will be allowed to opt-out of providing some services to patients, if they are struggling with their workload.
Dr Chisholm said the contract was delivering real improvements for doctors and patients.
He said the deal, which sees a large proportion of GP pay linked to the quality of care they provide, would help to improve public health.
He added: "Grassroots GPs are already seeing real benefits, including extra income and the out-of-hours opt-out."
However, a small minority of doctors at the conference criticised the recent changes.
"Where is the rise in average income," asked Dr Eric Rose, a GP in Buckinghamshire. "I haven't seen it and nor have many of my colleagues."
However, doctors at the conference rejected his call for the contract "to be renegotiated in its entirety".
Dr Hector Spiteri said the contract was putting practices under financial pressure.
"We are losing staff," he said. "Our aspirations and hopes are being completely destroyed."