Something is sub-optimal in the state of the National Health Service. Indeed, it is one of the miracles of our "national religion", as Nigel Lawson called it, that the NHS is so loved despite its many flaws.
One of its most serious defects is often evident at first point of contact: trying to get to see a family doctor. If you can get through on the telephone, you are likely to be told that the next available appointment is several days or a week or two away. Although GPs are supposed to offer appointments within 48 hours, this requirement is often satisfied by keeping a block of slots available on the day for "urgent" appointments, which tend to be snapped up by patients who know the system, in the lottery of who gets through to the switchboard at 9.01am.
The last Labour government can fairly claim to have saved the NHS from decades of cumulative under-investment. Spending on the service rose by a third in real terms and hospital waiting lists were brought right down. But something went wrong with GPs' contracts. This may have been one of the practical effects of Gordon Brown's long feud with Tony Blair: Alan Milburn, the Health Secretary, kept his negotiations with the doctors away from the Treasury. Whether or not that was the reason, GPs ended up with a lot more money, but that increase failed to be reflected in the quality of service offered to patients.
The true picture is complicated. Complaints about the adequacy of late-night and weekend cover predated the new GP contract, and a recent King's Fund study could find no evidence that the increase in numbers turning up at accident and emergency departments was caused by people finding it hard to get to see their GP.
However, it can be said that GP services have failed to keep up with the demands on them, especially those of an ageing population, and that they have failed to modernise in ways that technology makes possible.
For these reasons, we welcome the plan to improve GP services that David Cameron is expected to announce tomorrow. The sum of money involved, £50m, is trivial: a mere 20th of 1 per cent of the total budget for the NHS in England. Some of the elements of the plan are familiar, such as the idea of "personalised care plans" for older patients. But the announcement is significant for two reasons.
One is that it marks a push for flexibility and more efficient ways of working. The possibility of consultations by video, such as Skype or Google Chat, catches the eye, but is only one of several ideas for making surgeries work better that should have been adopted long ago. There is much greater scope for consultations by telephone or email, for making appointments or renewing prescriptions online, and for providing out-of-hours and weekend appointments.
It is often assumed that older people are unwilling to engage with new technology and in some cases this is true. But large numbers of them have taken to computers like geeks to html, and are eager to exploit the convenience and efficiency they offer.
The other significance of tomorrow's announcement is that it identifies the Prime Minister with the drive to raise standards of primary care. For a long time, since the defenestration of Andrew Lansley, whose top-down rearrangement of acronyms in the health service diverted so much time and managerial energy, No 10 has been reluctant to put its weight behind NHS reform.
This, however, is change we can believe in. It may be a modest start, but with the full force of prime ministerial attention behind it, a more patient-friendly GP service has a chance of emerging from the confusion of health policy over the past four years.