Last week saw the emergence of a 'discussion brief' buried on the website of the Conservative Policy Forum, a group that contributes ideas for the next two years of the coalition and the 2015 manifesto.
Among other things, this discussed implementing a cap on the number of times patients can visit general practice in a year.
The outcry has been vocal and understandable, but distracts from real NHS issues and genuine solutions. A policy limiting general practice appointments would clearly breach the core NHS principle of access based on clinical need. It would hit those with children and with long-term conditions hardest, particularly elderly people with co-morbidities. Ultimately, it would be impossible to implement and down to surgeries to police. Its practicalities barely warrant scrutiny. How many appointments would be allocated each year and could you carry some over if you failed to use up your quota? Would certain patients receive a greater number of appointments than others, based on age or health status? If you used up your visits would you be turned away at the door, no matter what symptoms you were displaying?
Where do politicians think patients would go if refused access to general practice? Directly to A&E, of course, which is precisely where ministers do not want patients with non-urgent conditions to head as their first point of call.
This proposal is less 'controversial' than 'poorly thought through', revealing ignorance and generating fear. The worrying thing is not so much that it is likely to be put in place but that it has been put up for discussion at all.
It shows how little insight the people formulating government policy have into the health system and highlights their lack of understanding of the way services are run and used. It also belies ministers' belief in a patient-led NHS, undermines the NHS Constitution and puts cost ahead of need.