Until last week, Gordon Brown had been surprisingly - even painfully - quiet on where he thought the NHS should be headed. But last Monday he finally showed some leg, in the form of his first major health pronunciamento since moving into Number 10.

Not to be outdone, Conservative leader David Cameron proffered an ankle of his own, offering his take on health reform in a thoughtful speech on 2 January.

Reading the two speeches side by side, five things strike you.

First, their diagnoses of the forces now shaping healthcare are almost identical (and in my view accurate). Unsurprisingly they include: new scientific discovery; the increase in distributed patient knowledge; the impact of poor lifestyle on chronic disease and the changing role of the health professional.

Second, there is more agreement than disagreement on policy instruments. For example, Mr Cameron says "the best way to enhance the power of patients is through the mechanism of choice" and "it should be a basic rule of social policy that you don't pay for what you don't want more of - money should attend success, not failure" (amen to that).

Or as Mr Brown puts it, the government must "encourage plurality of provision, creating a genuine level playing field between competing local providers and allow money to follow the patient".

Third and relatedly, it is now clear that - at least on paper - there is continuity with the health policy trajectory of the past eight years. Very little in either speech is inconsistent with John Reid's white paper of 2004 (Choosing Health) or Patricia Hewitt's of 2006 (Our Health, Our Care, Our Say), both of which emphasised the coming importance of prevention and out-of-hospital care for long-term conditions.

Gordon Brown conceptualises it this way: 1997-2000 was about setting minimum quality standards, followed by a second phase of "widened diversity of supply to create new incentives for better local performance and more choice for patients - a success story in achieving the shortest ever waiting times for patients and improving the management of NHS resources through foundation hospitals and the use of the private sector".

Now we are on to the third phase, in which "strengthening the power of our commissioners" is complemented by more focus on prevention. This all feels pretty consistent with policy direction since the NHS Plan of 2000.

But fourth, despite this, the competition to be the "party of the NHS" is hotting up. In this, its 60th year, it is clear that both main parties are determined to claim the mantle of "NHS saviour". "It's an institution which embodies something which is great about Britain. That something is equity, the founding value of the NHS."

The fact that you can't be certain which of the party leaders said this simply makes the point.

Fifth, notwithstanding the rhetoric, there are fundamentally different criteria by which to judge a government versus an opposition. Whereas in opposition "a politician's word is his deed", in government actions speak louder than words. And it appears that the first real test case of Mr Brown's commitment to reform is likely to turn on primary care (as predicted in this column last June). This is because the prime minister rightly insisted in his speech that primary care needs to become "more open and convenient, with new providers and more weekend and evening access". And GPs are resisting.

Why should that be? A year ago, my colleagues at UnitedHealth Europe won a procurement by Derby City primary care trust to run urban GP services. Needless to say, defenders of the status quo asserted that care would decline and that this was the end of list-based general practice. Blah blah blah.

So one year on, it's instructive to look at what the PCT itself says has actually happened since UHE took on this largely deprived, minority ethnic population.

Here are the facts. The number of GPs has doubled. List-based continuity of care has improved. The range of services has expanded. The quality and outcomes framework score jumped from poor to reasonable in the first six months, with even better results since then. Surgery opening hours have been extended to 8pm every weekday. And - the ultimate validation - patients have voted with their feet in favour of United's new GP services: the list size is up 33 per cent.

So let's get this straight. The evidence says that UnitedHealth's new primary care services in Derby are: a) improving clinical quality, b) reducing health inequalities, c) enhancing access for deprived communities and d) highly popular with patients.

If this is a "threat" to old-style corner shop general practice, then clearly we need more of it.

Yet last week, in an attempt to deflect attention from its current contractual standoff with the government, the British Medical Association wrote to its GP members blaming PCTs for reduced access to GPs (yes, you read that right) and claiming that traditional GPs were "threatened" by the fact that "the government is encouraging commercial companies to set up and provide GP services".

This echoes criticism that BMA local activists levelled against Tower Hamlets PCT just before Christmas as it ran procurements for primary care. The chair of the local medical committee accused the PCT - shock, horror - of "only being concerned with the bidder able to offer the best value for money".

Well sorry, isn't that exactly what local patients and taxpayers want their PCTs to be concerned with?

Thanks to their New Year speeches, we now know that both Brown and Cameron think so - and they're right. And if value for money is genuinely the test, you ain't seen nothing yet.

Let us know what you think. E-mail hsj.feedback@emap.com