It is not often you read of a new controversy in the Sunday papers and stumble on what looks like the answer in Hansard before bedtime. It happened this week. Here goes.

The Sunday Telegraph reported that GPs are being paid£59 per patient, or "up to£4.50" (£1 in The Times) for every referral to a hospital they don't make, treating their customers within the primary care system instead.

Apparently it is a new epidemic across Essex, London, Oxfordshire (where a hotbed of resistance has arisen) and into the West Country.

There is an issue here, but what is it? Fast forward (strictly speaking, three days backward) to the government's Commons debate on primary care and a familiar scene: health minister Ben Bradshaw fighting off renewed criticism by Tory spokesman Andrew Lansley of what he calls the Department of Health's muddled "Martini strategy" on primary care.

American envy

During the course of the Tory attack, Mr Lansley quoted Barbara Starfield, a healthcare management and health equity specialist of great eminence at Johns Hopkins University, the top-notch medical establishment in Baltimore.

Much of the US lacks a proper primary care infrastructure like ours, so there is "envy" of it, especially the GP structure. Professor Starfield wrote: "Primary care deals with most health problems for most people most of the time. Its priorities are to be accessible as health needs arise; to focus on individuals over the long term; to offer comprehensive care for all common problems; and to co-ordinate services when care from elsewhere is needed.

"There is lots of evidence that a good relationship with a freely chosen primary care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs."

Not much to quarrel about there and Mr Lansley didn't. His complaint is that ministers are "atomising" primary care via walk-in centres, a smattering of "Darzi centres" and the denial of real GP power. In its place has emerged a centralised philosophy which stresses a patient's right to see a GP within 48 hours - any GP, not their own GP. Which misses the whole point, Professor Starfield's point about that vital "good relationship" over several years, Mr Lansley told MPs.

Rising referrals

Maybe, but it also answers The Telegraph's point, does it not? The idea behind the drive to keep GP patients out of hospital - referral numbers rose sharply this year - is that it is cheaper and better to keep them out.

So it makes sense to keep patients at home. The real question is: should GPs be paid to do this? MPs did not address incentive culture in their debate, being more preoccupied with the negative features of the Healthcare Commission's annual performance rating for English trusts. Yet the implied answer was "perhaps not".

Mr Bradshaw was taunted about the malign effects of GPs' incentivising 2004 contract. As you know, that is now being tweaked. GPs' minimum income guarantee is clearly not long for this world.

Mr Bradshaw's boss Alan Johnson went on radio and TV to praise the commission's overall findings; justly so. But he inevitably got skewered over persistent MRSA problems and the commission's startling finding that only 31 per cent of patients can see their GP within the target 48 hours compared with 80 per cent last year and 87 per cent in the DH's own findings.

Cold calls

Johnson, Bradshaw and their officials assure me the culprit is the commission's new method of data collection, including "cold calling" patients.

Clearly the system is patchy, but common sense says it has not collapsed since 2007. Talking of which, chancellor Alistair Darling's suggestion that ministers will promote capital spending projects, including the primary care building programme, is typically sensible.

It prompted media profiles of the great economist JM Keynes, who championed counter-cyclical state spending to mitigate the effects of recession. Fine, fine, but the media also exaggerates (cries of "surely not!") what ministers can do. Expect some schemes to be accelerated, but times ahead are going to be tight. Quite how tight remains to be seen.