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Paying for Sunday GPs, responsibility for out-of-hours, and other unanswered questions

By Richard Hoey

The King's Fund's debate between the party health spokespeople provides an opportunity to finally get some answers, says Pulse editor By Richard Hoey

Up to now, this election has all been about ‘the economy, stupid', dirty, swindling politicians and, of course, Nick Clegg's ‘hopey-change' thing.

What the election hasn't been about is policy detail, and in particular it has barely touched upon health policy, bar the odd pledge to make GPs work seven days a week.

That was partly the plan, for the Conservatives at least – they hoped that by pledging to ring-fence the NHS budget, they could neutralise an issue that has traditionally been an area of Labour strength.

But there is still so much that needs placed in the election spotlight, not least the cosy consensus between the parties that cuts to management and consultancy fees will be enough to deliver the billions of pounds of ‘efficiency savings' required, without touching the frontline.

Our investigation this week suggests otherwise.

The hope is that tomorrow's debate at the King's Fund between the three main spokespeople – Andy Burnham, Andrew Lansley and Norman Lamb – could give the NHS its moment centre stage.

I was having a think about the questions I would most like raised in that debate – those that would best tease out the difference between the parties, and provide GPs, and everyone else interested in health, with a firm basis for how to cast their vote.

How about these?

1) What assessment has been made of the demand for routine GP services across the weekend, and of how much it will cost? What services currently provided by the NHS will be dropped in order to pay for it?

2) Who do the parties feel should be responsible for delivering out-of-hours? Would any problems be delivered at a commissioning GP's door? And what is the difference, really, between commissioning, ‘direct involvement' and actually being left to cover on-call shifts?

3) All the parties accept that practice boundaries must go. Would practices be allowed to close their lists if overwhelmed with new patients? Would transitional support be provided for those that lose patients? And how can they guarantee that a system where PCTs delivered home visits would not descend into exactly the same chaos as out-of-hours?

4) When the Conservatives say the overall NHS budget is protected, does that mean all savings from management costs will be reinvested, and if so what will they be spent on? And when all parties demand efficiency savings, how will they be assessed to ensure there is no impact on the front line?

5) Will revalidation definitely survive the cull on NHS budgets? If so, will there be funding for remediation of doctors who would otherwise face five-figure bills? And if not, and they refuse to pay up, does the health service have enough doctors to cope?

6) Do the parties have a plan to sort out the mess that is funding of nursing homes? Could any of them guarantee dedicated GP cover for a particular home, or a revamped system of support by geriatricians or specialist nurses?

7) Do the parties believe the global sum system for distributing cash to practices needs to be reformed? If so, and more money is to be handed to practices in deprived areas, then would practices in more affluent areas face a pay cut?

8) Do the parties think GPs are overpaid or, after the various pay freezes, underpaid, or on about the right amount? Do they have a target average partner pay figure in mind, and will they be prepared to cut GP pay further to get them to it?

Those are a few questions for starters, but I'm sure you have some too. It would be great to hear them.

By Richard Hoey, Pulse editor Watch the debate here

Watch health secretary Andy Burnham go head-to-head with his Conservative and Lib Dem opposite numbers, Andrew Lansley and Norman Lamb from 11am on Thursday 22nd April by clicking here.