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Tories striking a familiar pose

As Gordon Brown finally takes office, the Conservatives reveal strikingly similar plans for general practice

As Gordon Brown finally takes office, the Conservatives reveal strikingly similar plans for general practice

'When Labour came to power in 1997, the first thing they did was to scrap the reforms of the last 10 years,' David Cameron told the NHS Confederation conference last week. 'Now 10 years on they are slowly and painfully trying to get back closer to the system they inherited.'

The next Conservative government would 'have a duty not to subject the NHS to further unnecessary reorganisation', he vowed.

Perhaps that is why much of the content of the Conservatives' white paper NHS Autonomy and Accountability bears an uncanny resemblance to the policies of the current Government, from putting the spotlight on GP opening hours to asserting a commitment to the cause of practice-based commissioning.

An important element of the Conservative white paper – and a U-turn on previous party proposals – is to enshrine a key Labour principle in law: that the NHS should be funded through general taxation and that NHS money should only be spent on NHS patients and not be used to bolster private health insurance.'Modern healthcare demands both patient engagement and professional freedom,' Mr Cameron says – and it is in the second part of this statement where perhaps the biggest difference between the two parties lies.

After kicking around the idea of distancing ministers from the nuts and bolts of running the NHS, Labour has decided against it. Health secretary Patricia Hewitt earlier told the conference 'one independent board is frankly a distraction'.The Conservatives are backing an independent NHS Board of clinicians and managers. '

Ministers will be responsible for the overall framework of the NHS,' Mr Cameron says. 'This includes the total amount of money that goes in and the standards of treatment that come out.'

Politically driven central targets proscribing processes rather than outcomes would be scrapped and GPs paid a capitation payment, for outcomes delivered under the QOF and for services delivered under enhanced commissioning powers.

The white paper says payment for performance under the QOF 'will incorporate a greater emphasis on actual outcomes for patients, including patient self-reported outcomes'.GPC chair Dr Hamish Meldrum welcomes much of the paper but says: 'We need to see an awful lot more detail.'

The Conservative's plans for PBC, he says, 'look remarkably like fundholding, although they stress it is not the same'.The Tories also say they do not intend to renegotiate the contract, but, points out Dr Meldrum, in the same breath they talk about wanting to see GPs opening longer. 'The actual specifics of how they are going to do it they don't address.'

Dr Meldrum says he would be concerned if the Conservatives wanted to base GP pay on secondary-care-type outcomes.

'You are potentially talking about rewarding GPs for things that are not in their control. The idea that if you are stuck in one part of the world you can suddenly ensure that your cancer services are as good as another, or start referring all your patients, is a bit naive.'

Dr Michael Dixon, chair of the NHS Alliance, says an emphasis on outcomes would make sense provided it took into account inequalities and geographical differences.

'We have had a time when we have looked very much at process with the QOF and increasingly we need to start looking at outcomes.'While the emphasis on autonomy might appeal to many GPs, Dr Dixon says it might be a mixed blessing as it would come with the added bureaucracy of accounts and budgets.

What seems to be happening in health politics is an 'interesting convergence of the policies of both parties', Dr Dixon says. 'Maybe that is a good thing.'

Mr Cameron seems to think so. With proposals so close to Labour's, he can be pretty sure many of the policies will be implemented in some form, even if not by his Government.

Perhaps Mr Brown, who has been infamously trying to widen the Labour umbrella to include other parties, might consider Andrew Lansley for the health secretary's job in his forthcoming reshuffle – or even Cameron himself.

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