POLITICS MICHAEL WHITE

Sensible Cabinet ministers always contrive to make sure the boss gets the credit for announcing a worthy change in departmental policy. So it was no surprise that Tony Blair's name, rather than Frank Dobson's, rang out from last week's headlines about the medical equivalent of Tesco - one-stop shops to take the strain off GPs. Plus more NHS Direct call lines, an idea Stephen Dorrell says Labour nicked from him.

The effect of the PM's speech - to a conference of primary care group leaders in Birmingham (another snub to our marginalised national assembly) - was to guarantee a news blackout for the Commons second reading of the Health Bill, which had such a lively run through the Lords. Asking the media to run two stories about PCG reforms on the same day isn't on, Balkan war or no. So what did they miss from the Debate of the Four Health Secretaries?

Yes, not only Mr Dobson (1997-), but also Ken Clarke (1988-90), Virginia Bottomley (1992-95) and Mr Dorrell (1995-97), not to mention ex-junior minister John 'Three Parties' Horam, who protested that his local doctors in suburban Bromley had long ago opted for the PCG model rather than GP fundholding. But they had been told by Whitehall to start again using the right model.

Typical of the bill's centralising tendencies, said opposition MPs as Labour backbenchers loyally, and in most cases sincerely, trumpeted the replacement of competition with co-operation in primary care. For every Conservative who warned that asking 100 doctors to agree on commissioning policy would prove a bureaucratic nightmare, there were two Labour MPs extolling the creative potential for holistic delivery of community healthcare.

Howard Stoate, MP for Dartford and still a part-time GP, was conspicuously enthusiastic on that point. Former trust finance director Julia Drown (Swindon South) was especially scornful of Tory claims that fundholding had been a voluntary movement, while PCGs were the NHS equivalent of Stalin's collective farms. GPs had been told they would get extra money if they became fundholders, she recalled.

How did the fabulous foursome fare? It was not Dobbo's day. Ken Clarke was not far wrong when he called it a 'standard opposition-based rant', stronger on attack than explanation. Ditto Ann Widdecombe, MP-and-novelist, with whom Mr Clarke claimed to agree when plainly he doesn't.

Naturally, Clarke defended his own reforms and accused Labour of 'centralising ambitions', a serious mistake that would stifle innovation at patients' expense.

Stephen Dorrell agreed, but also pressed (to no avail) on the precise circumstances in which the emerging primary care trusts will be able to employ GPs in direct competition with traditional, independently-contracted GPs. He fears compulsion replacing (his own) reform, which allows direct and local GP employment.

As for Virginia, she detected a climate of 'despair, frustration and, in some cases, fear' in the NHS (sounds like 1992-95), but chose to see growth of primary care as evolutionary, not revolutionary, bless her.

She was also worried about our old friend, cash, as were shrewd Labour MPs like Cannock's Tony Wright, who fears that South Staffordshire HA's£7.5m deficit will be sliced off the local PCGs' budget in year one.

One other theme to watch and one brownie point. MPs on both sides are concerned that doctors should not dominate PCGs and trusts at the expense of other medical trades and professions, especially nurses.

And the brownie point? To junior Tory spokesman Philip Hammond (Runnymede and Weybridge), whose fierce speech included a memorable prediction: the bill is centralism by stealth, he said. 'A mechanism to ration care and shift responsibility for that rationing away from the government and on to the shoulders of the medical profession.' That and a looming end to medical self-regulation. And independent contractor status for GPs. And 'the pincer movement' of cash-limited prescribing budgets from NICE, enforced by CHI.

Steady on, Phil. But he kept going. Alongside the end of the traditional role of the GP 'will be lost any proxy for the informed consumer in our healthcare system'.

Woe is us.