The Tories are holding their cards close to their chest. Partly this seems to be a desire not to frighten the horses; partly it is because, with the election still seven months away, policy is still being developed.
But, as we are wrapping up our 40-minute interview, shadow health minister Mark Simmonds admits that there is another reason: 'No one is quite sure what the macroeconomic situation is going to be.'
The party has promised not to cut the health budget. But he adds: 'There is still uncertainty about the amount of money that is going to be in the system.'
Pay and quality framework
This is already visibly driving health policy. The party has promised a pay freeze for all doctors in 2011/12 - and Mr Simmonds will not commit to following the advice of the independent Doctors' and Dentists' Review Body.
'Of course we will listen to it,' he says, 'but that does not mean we will always agree with it.' The final decision will rest with the chancellor.
A policy the party is committed to is rewriting the funding formula that distributes money to primary care organisations. 'There is a direct correlation between the age of a population and the burden of disease that is not reflected in the current formula,' says Mr Simmonds.
Labour has 'deliberately over-emphasised socio-economic deprivation... to transfer resources from rural areas to their urban heartlands', he says. A Tory government would give age a bigger role in the formula.
Although the Tories cannot promise a pay rise, they do promise to return some of the professional status GPs have lost under Labour. 'It is quite an extraordinary achievement,' Mr Simmonds says, 'to have increased GP remuneration while at the same time alienating GPs by using them as a kicking stool.'
The Tories have a number of tricks up their sleeve to address this. They would redesign the QOF to remove some of the box-ticking and link it directly to patient outcomes. Mr Simmonds is reluctant to pre-empt the decisions of NICE, but points to cash paid for taking blood samples as an example of what might be for the chop.
The party also expects GPs to play a big role in its centrepiece public health policy - 'taking primary care to the people', through schools, occupational health schemes, or calling patients in for screening, says Mr Simmonds.
Perhaps most significantly, a Tory government would give GPs control of the NHS purse strings, by making practice-based commissioning compulsory and based on real budgets. This, Mr Simmonds is keen to stress, is not a return to fundholding; practices would be forced to put the work out to tender, rather than simply keeping the cash themselves.
The idea has been widely criticised. Many have questioned whether GPs have the skills or the will to do it, and health minister Mike O'Brien has suggested it could force practices out of business.
But Mr Simmonds denies practices would be forced to take risks they are not ready for. Those who did not want to commission could bring in others to do it on their behalf. GP consortia are the most likely result - although it may also mean employing PCTs, other practices or even private firms.
Patient choice
The Tories' other big idea is giving patients 'real' choice. Dual registration has been ruled out on cost-effectiveness grounds, but the party supports DoH plans to abolish practice boundaries. 'They copied us,' notes Mr Simmonds. 'If they had done it when we suggested it we would be a lot further along the track.'
He denies this could force GPs to travel 50 miles for home visits. 'I do not anticipate an enormous number of patients going outside traditional practice boundaries,' he says. 'But it should be the patient's choice.'
Making that choice involves giving patients more information. A Tory government would force the NHS Information Centre to sell its data to any willing provider, to create competition for NHS Choices. It would extend the data collected to cover patient outcome and things like opening hours.
Mr Simmonds warns the Tories may even publish data on individual GPs' performance.
But overall he insists the party aims to empower GPs to innovate on behalf of their patients and 'look after them as they would like'. He adds: 'If we free them up in that way, they will respond to the challenge.'
