Does the Department of Health know what it is doing on GP access?

The interim report from junior health minister Lord Darzi on his review of the NHS, published last month (for the background, click here), set a benchmark of at least 100 new GP practices opening up in the communities where they are most needed, beginning with the 25 per cent of primary care trusts with the worst provision.

This built on a commitment to tackle poor provision made in the Our health, Our Care, Our Say white paper published in January 2006.

Yet almost two years later the government has still not worked out a definition of what 'under-doctored' means, betraying a worrying lack of ministerial grip on primary care policy (for the full story, click here).

This failure lends weight to claims that publication of Lord Darzi's interim report was rushed through for reasons of political expediency, as part of the aborted plans for a general election.

Lord Darzi's strategy to bring in the private sector to fill service gaps is likely to come under sustained attack, from groups as disparate as the British Medical Association and those who are opposed on principle to independent sector provision.

Ministers are weakening their position by throwing together a policy without giving it sound foundations, such as spelling out what constitutes poor primary care provision and how the new services will be funded long term.

Detail needs to be published long before Lord Darzi's final report next summer - otherwise it would be two and a half years since the access promises were first made, and presumably many more months would elapse before local people experienced an improvement in services.

Little wonder that shadow health secretary Andrew Lansley accuses the government of a gap between rhetoric and reality.

But the detail must reflect local differences; by looking for a national formula to measure access the DoH risks falling into the trap of adopting a one-size-fits-all policy.

For example, as the King's Fund has pointed out, some areas may benefit more from an emergency nurse practitioner rather than another GP. It will be perilously difficult to judge these nuances from Whitehall.