Frank Field wasn't the only politician casting around for new ideas to help the NHS this week. Though less exotic than Mr Field's suggestion that patients be sent to India or China for treatment, Dr Liam Fox is halfway through some basic rethinking, too.

The Conservative health spokesman shared his thoughts with Tory peers in a private session the other evening, shortly after William Hague assured the Royal College of Nursing Congress that the Opposition was 'unshakeably committed' to a comprehensive NHS that treated patients on the basis of their clinical needs and was free at the point of delivery.

Bear that pledge in mind as we follow Dr Fox's train of thought as he addressed Tory peers. First, that spending£3bn a year on settling medical negligence claims is a global trend ('I don't see it going as far here as it goes in the US'), and that politicians have a duty to speak out against it - 'damages reduce the size of the pot available to provide healthcare'.

Second, that he sympathises with much of what health secretary Alan Milburn is trying to do (ditch the waiting-list obsession, for instance), but believes he is mistaken in trying to micro-manage the NHS. His proper job is threefold: to protect overall funding levels, to provide a framework for public health, and to be the guarantor of quality care, regardless of where patients are treated.

It is an illustration of the current Foxite view that ministers are guilty of a classic Whitehall error in trying to impose a one-size-fits-all vision of primary care in primary care groups to cover inner cities (where they may well work, he concedes), as well as rural areas. But he promises not to stage yet another reorganisation. If doctors want to join primary care trusts, they can. But he cites Southend, where 58 per cent of GPs voted no, and were overruled - in breach of what he says was health minister John Denham's specific promise there would be no compulsion.

Does such talk presage a return to fundholding?

No, not a generalised one, not a 'tidy map', he explains. 'I think fundholding would not have worked if applied universally.' Dr Fox says what is crucial is quality care, a modernised skill-mix. (Can singlehanded GP generalists cope with the sheer bulk of specialist information now available? No, he says. ) At this point, we reach a couple of his specific innovations.

He would increase the period of pre-registration for doctors from one to two years, and thus ensure that - his estimate - 2,000 extra bodies would be available for stints in both GP practices and hospital accident and emergency departments. Dr Fox reaches back to his own brief experience as a GP in Harlesden, one of London's poorer suburbs, so different in reality from training. 'Access to care there is a barrier to health outcomes.'

Yes indeed, and the Fox remedy is to create something called 'pension-enhanced zones'. Come again?

Yes, neighbourhoods in which GPs who have retired early, and may have found their pensions not quite enough to sustain a golf habit, can be lured back to work part-time. In return for deploying their expertise in areas that need it most they would get not only their pay but additional pension rights. Daft? Not quite. He cites the old Foreign Office practice of extra pay in hardship posts. Teaching has them, too.

The Fox review is sceptical of NHS Direct (overused by a small number of patients? ) and walk-in centres (fragmenting medical care? ), and dismisses charges. The idea of a£5 charge to visit GPs to filter the system is illogical, he says.

As for Mr Hague's 'patient's guarantee' that people will be treated within a specified time in the public or private sector, Dr Fox has been analysing surgical activity, comparing models of how doctors think they will treat conditions over a specified period with how they actually treat them.

It reveals that many treatments are handled like a motorway lane closure. No wonder there are delays, Dr Fox says. He wants to encourage corporate insurance to cover limited treatments - say, sports injury - not cardiac conditions or the comprehensive 'shadow NHS' insurance which many people currently buy at great expense.

Governments and insurance firms will hate it, he concedes. It all sounds as flaky as Frank Field's solutions to me. More work needed, chaps.