Background Access to health professionals is a key UK NHS priority, and meeting access targets is rewarded through the new General Medical Services (GMS) contract in the UK. We sought to determine the current state of appointment provision in Wales and any changes resulting from the need to meet indicators in the new GMS contract. We undertook a postal questionnaire study of practice managers in all general practices in Wales. Findings Valid responses were received from 396/505 (78.4%) practice managers. 361 (93.1%) practices reported that they had achieved the target for 2004/05. 104 (26%) practices reported that they were 100% open access/advanced access. The most frequent changes reported in response to the new GMS contract were offering more open or advanced access slots (237, 60%), more GP phone consultations (167, 42%), introducing a telephone triage system (100, 25%), introducing a minor illness clinic (76, 19%), and employing or training a nurse practitioner (59, 15%). 83% practice managers believed that patients were able to get an appointment at the time they need it either 'all of the time' or 'most of the time', and 70% that patients were able to get an appointment with the GP of choice either 'all of the time' or 'most of the time'. Conclusion This survey has demonstrated the current extent of appointment provision in Wales, and how changes have been driven by incentives. Whether these changes are in the best interests of either patients or doctors, or both, remains to be seen.