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Patients will get choice, whether they vote for it or not

By Richard Hoey

Labour and Conservatives both continue to obsess over GP access and patient choice, but amidst all the healthcare consumerism there are ideological differences

Being a journalist has its upsides, but there's some dirty work involved too.

Today, for instance, I've been reading the newly released Conservative manifesto, and Labour's document released yesterday, to find out what our politicians have to say about primary care.

If I was the type to judge a book by its cover, I might conclude that there really were deep philosophical differences between these two parties.

Labour's front page displays a rather bizarre, communist-style vista, complete with hard-working family in traditional upright socialist pose.

The Tory document, meanwhile, is a sober, conservative, blue – and its title places the stress firmly on the individual, offering an ‘invitation to join the Government of Britain'.

If only the respective health policies were quite so distinctive… but they're not - both parties firmly pitch their pledges at the patient as health consumer.

They support choice, competition, an end to practice boundaries, the option for patients to hold personal budgets… and more responsive healthcare.

Take weekend opening for example (much as most GPs would rather they didn't have to). Labour pledges to ‘ensure everyone has the right to choose a GP in their area offering evening and weekend opening'.

And the Conservatives, not to be outdone, promise to ‘ensure every patient can access a GP in their area between 8am and 8pm, seven days a week'.

They don't mean quite the same, but the basic message seems clear enough. The convenience culture is going to remain firmly on the primary care agenda.

Still, if ease of access really is the question, the parties do at least have rather different solutions to answering it.

Labour isn't supposed to do targets any more, but it still can't resist promising a new wave of Darzi centres… pledging to ‘expand further the availability of GP-led health centres open seven days a week 8 til 8 in towns and cities'.

In fact, there's no shortage of targets in the Labour manifesto, even if these days they're phrased as patient ‘rights' – to get cancer test results back in a week, and to go private in they don't receive hospital treatment within 18 weeks.

There is also a key, and slightly alarming, pledge to make all hospitals Foundation Trusts, and then to empower them to take on an increasing role in primary and community care.

The Tories, meanwhile, intend to set the overall policy arc, but it will be up to GPs to get on with filling in the detail.

They will ‘strengthen the power of GPs as patients' expert guides through the health system by giving them the power to hold patients' budgets and commission care on their behalf'.

And they will ‘scrap the politically-motivated targets that have no clinical justification'.

Sounds promising, although what becomes of the non-politically motivated targets that do have clinical justification is less clear.

And of course there is a downside to all that power and responsibility. More outcome-based pay, and more ratings… individual doctor ratings, in fact, rather than the current practice-based system on NHS Choices.

So OK, we're not faced with a heroic clash between two grand and utterly conflicting ideologies.

But there is choice here all the same. Plenty for patients, but some for voters too.

By Richard Hoey, Pulse editor Follow the latest with Pulse's election tracker Pulse election coverage