What ideas like NHS independence lack is not the eye-catching headline or even the fine detail but the implementation and local connection

This year is undoubtedly going to be big in health. Health has consistently been polling as the number one issue with the public, and is likely to hold the keys to number 10. As a consequence both Gordon Brown and David Cameron are looking to position themselves to reinvent the challenges facing just about every health economy in the Western world: ageing demographics and associated long-term conditions.

Politics wouldn't be politics without the so-called Wednesday test, surviving prime minister's questions with pithy craft, creating both soundbites and political capital. Undoubtedly this is what has led to the talk of an independent NHS. The proposals centre around an independent body taking responsibility for setting budgets, performance monitoring of the commissioning process, taking account of patient opinion and implementation of guidance and technology.

All well and good, but I have recently been educated in the Thursday test - are there are enough headlines from the Wednesday spectacle? - and the Friday test. This, according to a former minister, asks whether once your idea has been kicked around like a football, cut into soundbites, trampled by amendments in encounters with the other side and put back together there is anything worth implementing at the end. All this can be very exciting, conducted at frenetic pace and I'm sure from limited exposure partially resembling scripts from The West Wing.

Choices at the crossroads
As a healthcare professional I would argue there is one ingredient missing from most things that spring from Whitehall, strategic health authorities or even primary care trusts: engagement with the professions. What ideas like NHS independence lack is not the eye-catching headline or even in the fine detail, it is the implementation and local connection. Before you roll your eyes, anticipating another consultation or pandering to the providers, we need to understand what should really spring from the grass roots.

As a society and preferably led by the colleges and professions as a whole we need to define what we mean by professionalism. We are at a crossroads and in my view GPs and consultants have two choices: either to follow the status quo, attempt to ignore practice-based commissioning, Connecting for Health and the budgetary consequences of payment by results and seeing what ensues, or to decide that some of these could be important facets of healthcare leadership and the delivery of patient care.

Likely inevitabilities of the former would seem to be more in the way of service cuts and a downward spiral of morale and disconnection. For the second to work we need to truly define what it means as professionals to work in the public services.

A helpful definition of professionalism was created in a paper produced between the Royal College of Physicians and GPs: 'Professionalism that signifies a set of values, behaviours and relationships that underpins the trust the public has in its healthcare staff.' This sentiment is not new or isolated. The King's Fund has commented along the same lines and such themes also emanate from the nursing and surgical professions.

Evolution of an ethos
These values around treating patients to professional ethos of quality go much further than the target-driven and contractual standards we have today. Chief medical officer Sir Liam Donaldson in June commented in Better Doctors, Safer Patientshow these kind of values should be integrated into appraisal and licensing.

My prescription in 2007 suggests we can only solve current predicaments by the evolution of a professional ethos that leads to clinically driven commissioning, professionally led systems of appraisal, development of patient opinion and peer-set performance outcomes.

All four of these share the same truth: they would all be far better led by the professions than by central direction.

Dr Andrew Jones is a GP in Stamford and policy adviser to Stephen Dorrell. He is also director of PBC at UnitedHealth Europe.