It is as if someone is deliberately trying to make my swearing detox fail. A conspiracy theorist would see clear provocation.

......................................................................

Click here for details of 'Is SOS Lansley a fool or a knave? Manchester Care Pathway speech defines a career', the new issue of subscription-based Health Policy Intelligence.

......................................................................

The only other conceivable explanation for PM David Cameron's brilliantly evidence-free attack on GPs and the middle classes yesterday in his speech on open public services is that there is a bet going on between the Cabinet on who can make the most ludicrously ill-judged intervention on NHS reform.

There must be a fair few quid riding on this bet.

Health Secretary Andrew Lansley (saviour, liberator) set the bar stratospherically high with his dire speech to the NHS Confederation last week.

And Mr Cameron has risen to the challenge like a leaping, shiny-faced salmon.

He pulled off a stunning three-in-one, by asserting that "People with money can get friendly with their local GP at a dinner party, maybe see them out of hours if there’s an emergency".

Clearly, things are different on Planet Cameron. The PM's social circle, including the delightful News International chief executive Rebekah Brooks and his ex-director of communications Andy Coulson, would clearly never stoop to any method of cutting corners or jumping queues, would they?

More to the point, if a Prime Minister uses a situation to justify a policy, perhaps he should be clear that he's talking about something that is a) widespread and b) a real problem, as opposed to a marginal one.

I don't suspect Mr Cameron knows a lot of GPs. I know one or two. The last thing any of them would do is see me out of hours if there's an emergency, for the good and simple reason that if there's an emergency out of hours - in the meaningful sense of the word emergency - a GP would not sensibly be my first port of call.

If it's an emergency, it won't be a GP I need. This. Is. Not. Rocket. Science.

In his speech, the PM chuntered on about "the people who feel ill late at night and go to an NHS walk-in clinic run by Assura". (That would be the same Assura whose CE joked about people from lower socio-economic groups - did you spot the character from Little Britain? - last week at the NHS Confederation conference, by the way.)

When it comes to the PM's critique of "people with money" cutting corners of public service provision, he is raising irony to a new level; building the Big Ironic Society.

In La Rouchefoucauld's classic dictum, 'hypocrisy is the homage the vice pays to virtue'.

There are very real problems in primary care. They are mainly to do with distribution and variation in access and quality of services.

The real problems in primary care are as close to nothing to do with GPs seeing their mates out of hours in a fictional 'emergency' as makes no difference.

The Prime Minister is talking round objects; not for the first time.

Mr Cameron is at once making people who know GPs think he is an idiot; suggesting that GPs are where you go in the event of an emergency; and implying that GPs will wrongly prioritise their mates. I suppose that getting three things wrong at once is one definition of efficiency.

Oh, and remind me: who are the group whose engagement and involvement will be crucial to making the proposed NHS reforms work?

GPs, did I hear you say? Mmmmmm.