As the parties unveil their pre-election health manifestos, GPs may well be wondering what difference it will make to them - GPs in England, that is.
In Wales, Scotland and Northern Ireland, devolved governments determine health policy independently of Westminster.
On some inflammatory issues the major parties speak with one voice, including scrapping practice boundaries and backing private providers.
Both approaches, says Derbyshire LMC secretary Dr John Grenville, carry costs 'when the NHS has to save £15-£20 billion'.
The Tories enticed the crowds in January with Our reform plan for the NHS.
Vote hunger preserves a free-access NHS, driven by clinical need. 'I'll cut the deficit, not the NHS', David Cameron says on the hoardings.
The health think tank the King's Fund points out: 'Much Conservative policy represents a continuation of the current government's policies.'
The Tories pledge to protect health spending in real terms, but cut management costs by one third.
Opening up the NHS to 'new, independent and voluntary providers' will force efficiencies, the party says.
Primary care will be more 'patient and outcome focused'. QOF payments will depend more on outcomes. GP pay will be linked to 'the quality of results'. But patient-reported outcomes are subject to 'woolly inaccuracy' says Dr Grenville.
Under the Tories, consortia of GPs will hold real budgets and commission services from any accredited provider. The 'huge worry', says Dr Grenville, is that a cash-strapped DoH will hand GPs inadequate commissioning budgets.
No health manifesto has been published by the Liberal Democrats yet, but their general principles are set out in The NHS: A Liberal Blueprint and Protecting and Improving the NHS: Change that works for you.
The party tackles health inequalities with plans to pay a deprivation premium and link incentive payments more directly to prevention.
Out-of-hours, it will 'ensure local GPs provide out-of-hours care'. They also want a national language and competence test for every doctor wishing to work in the UK. Patients will also have the right to email their GPs.
The Liberal Democrats want much less NHS bureaucracy. This is nothing new, says Dr Grenville.
They will halve the size of the DoH, cut the amount spent on health quangos by one fifth and cap chief executive pay.
They will scrap strategic health authorities, the National Patient Safety Agency and the IT agency Connecting for Health.
Meanwhile, the Labour party has promised that cash for patient care (95 per cent of the NHS budget) will rise with inflation until 2013. SHA and PCT costs will be cut by 30 per cent over four years.
As for the market, there is still uncertainty whether the NHS is the provider of choice. Smaller practices will be expected to work together and share services. GPs will get greater involvement in commissioning out-of-hours.
So, do the three parties' policies go any way towards solving problems at the heart of primary care? Dr Grenville doesn't think so.
'Someone has to provide a solution for the fact that GPs are both purchasers and providers. The solution could be vertical integration, but it has to be community-driven,' he says.
|STAND-OUT POINTS FROM PRE-ELECTION HEALTH MANIFESTOS|