Improved access to family doctors may not be all it is cracked up to be.

I want to take you back to the gap between the two major party conferences at the end of September. We had several extraordinary days where headlines were traded on who could come up with the most radical ideas to rejuvenate access to family doctors.

But look at the independently run patient experience survey that reported in July. When I read the questions I thought GPs were about to get pummeled, but the results showed that nationally 86 per cent of people could get through on the phone, 86 per cent could get an urgent appointment and 84 per cent were satisfied with the opening hours. So is GP access the real problem or is it the general integration and timeliness of the whole health system?

Expanding access

High-quality primary care is essential to deliver excellent healthcare in a state-funded system.The Fairness in Primary Care tender process is due to make a decision that should introduce greater independent provision in under-doctored areas. Some areas of the country, for example, only have around 40 GPs per 100,000 people, while others have double this number.

This principle is set to be extended further with the Darzi interim review promising 100 practices in PCTs with the lowest quartile of GPs.

The Conservatives' plans are set out in The patient will see you now, doctor and explore the possibilities of capitation by aligning total budgets at practice level with the responsibility to commission out-of-hours services. Technically, this principle could be extended to accident and emergency and walk-in centre attendance.

The issue of compulsion seems to have been avoided so far by both sides. A universal service open seven days from eight until eight is going to need to pretty rigorous competition and capitation to turn practices run like corner shops into supermarkets. Some unanswered contractual questions definitely remain.

More of the same?

The real question is what enhanced GP access will resolve? The government is hoping it will lead to greater productivity but risks following the 'more of the same' approach taken with public spending.

Presumably, patients will be happier if they can get same-day appointments. The Confederation of British Industry will get their 38 million lost working hours. And if the hours are right, A&E attendance and ambulance calls may even start to fall.

The flip side is that patient expectations will rightly rise, and people will present with more minor illnesses with greater referral numbers to exclude serious complaints. The structure of outpatient services and hospitals will remain the same, with fixed tariffs and little information or competition to drive secondary care choice.

The 2007 comprehensive spending review announces that public spending growth for the next three years will be around 4 per cent a year in health. This will be the lowest level of spending growth for around eight years and suggests the tighter fiscal future the NHS faces.

We seem to be missing the point - access will be popular but will do nothing for public health, patient engagement or reforming the health system.