DoH policies are crystal clear. Aren't they?

Right, let's try to get government health policy straight once and for all. Okay?

According to the DoH, modern primary care is about access and throughput. At least this is the message I took from the National Audit Office report last week plus various statements from health ministers.

Certainly, it seemed to be what Lord Ara Darzi was implying when he praised the 'fabulous' relationship between patients and GPs but went on to suggest this would end in his polyclinic world of the future.

Meanwhile, the minister with responsibility for primary care, Ben Bradshaw, was even more specific, telling the All Party Parliamentary Group for Health that patients valued convenience over continuity of care.

Not everyone might have liked the message, but at least it was consistent - big is beautiful, access is king, polyclinics are the future. Continuity of care, the personal relationship and practices being adapted to local needs were out.

So we all knew where we stood. Wrong.

At the weekend, the health secretary Alan Johnson made a speech to the Labour Party Spring Conference. 'The days of patients being the passive recipients of one-size-fits-all service are over,' he said.

'We must make the NHS more personal,' he said.

He even said the DoH would listen to clinicians when they put forward 'a clear case to change services to save patient lives'.

So, let's try again. The NHS must be more personal. So, therefore, continuity of care is important and must be developed in the future? GP care is good?

One-size-fits-all healthcare is over. Then obviously the polyclinic plans that will see Macclesfield have a polyclinic imposed just one mile from an existing GP-developed multi-practice, multi-service centre are to be scrapped. Aren't they?

The end of the one-size-fits-all ethos must also of course, result in an immediate revision of the extended hours plans so that rural and urban areas can develop appropriate but different access solutions.

These will probably involve some form of extended hours but in a way fitted to each community, rather than an ill-thought-out blueprint that is not a good fit anywhere.

After a week of speeches and statements, ministers have managed to contradict each other and muddy the policy waters even further. They've delivered some great sound bites but nothing that adds up to a cohesive policy beyond 'we want stuff the public likes'.

If this is what they can achieve in a single week, who knows where the NHS will be after a full term of office.

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