Even the dogs on the street know the fundamental cause of the NHS “winter crisis” – as much of the media is currently not calling it (because the horror of Paris drove healthcare stories from the front pages, and thus halted its intention to declare one).

It is that A & E departments are often now used as doctors’ surgeries – with patients who might a decade ago have waited to see their GP pitching up at hospital instead, and demanding to be treated.  Add a cold late January and February and, bingo! You have an NHS “winter crisis”.

Three main solutions have been floated.

The first is to charge patients who turn up to the A & E, but haven’t had an accident and aren’t enduring an emergency.  In many cases, this would be fair enough.  However, it would be politically impossible, at least for a Conservative-led Government. The papers would fill up with horror stories of desperate patients who had unjustly been asked to pay.  Labour would chorus that “the Tories don’t care about the NHS”.  The tales would top the media agenda.  The polls would turn red. The inevitable U-turn would follow.

The second is to make it easier for patients to get an appointment with GPs.  This is exactly what Jeremy Hunt is striving to do.  He wants every patient to have their own doctor – “just as it used to be”.  First his scheme was introduced for patients aged 75 and older.  Now it is to be rolled out for others.  In crude terms, the Health Secretary hopes to get people out of A & E and into surgeries – at least, those who should be going to the latter in the first place.

The third is to abolish the A & E four hour waiting time target – originally introduced by the last Labour Government.  The logic of the argument is pithily put by Camilla Cavendish in today’s Sunday Times (£).  Since comers must be treated, admitted or discharged within four hours, it is impossible for medical staff to treat people simply on the basis of clinical need.  Were the target scrapped, they would be able to do so. Word would then get around: if you go to A & E and don’t need to, you’ll wait…and wait…and wait.

The flow of patients would then shift from A & E to surgeries.  Problem solved.

Needless to say, it isn’t quite that simple.  Some people would turn up at A & E, be refused quick treatment, demand their “rights” – and turn violent.  Labour would still claim that “the Tories don’t care about the NHS” because “desperate patients are being left to wait”.

Voters could also riposte that, with its walk in centres and minor injuries centres, confusion is scarcely their fault.  And shifting the queue from hospitals to surgeries would simply intensify GPs’ problems.  But the nub of the matter is that more patients would go where they should.