Health secretary Andrew Lansley has acknowledged concerns over the accountability arrangements for GP budget holding but has said there is “no merit” in implementing his planned changes slowly.
HSJ understands Treasury officials have written to the Department of Health asking how the NHS budget will remain in balance if the planned policy to transfer the vast majority of its resources to GP consortia is implemented.
At £122bn a year, NHS spending makes up 18 per cent of total government spending.
As HSJ reported earlier this month, the Treasury is concerned because the planned move would happen amid an unprecedented squeeze on funding and would involve passing responsibilities to organisations that, by and large, do not yet exist (June 10, p4-5)
Although Mr Lansley has described his plan to give GP practice based commissioning consortia control of the NHS budget many times, he is yet to set out the accountability arrangements for that. At present primary care trusts have a statutory duty to ensure they breakeven. Under Mr Lansley’s plans they would likely lose their “accounting officer” status but it is uncertain who would pick it up instead.
Options being considered include transferring responsibility to either consortia chiefs or to the regional offices of the planned NHS commissioning board.
Answering questions at the NHS Confederation conference yesterday Mr Lansley acknowledged the concern.
He said: “Somebody has to be financially responsible”. He did not divulge who he had in mind, saying instead that would be announced to Parliament.
Senior sources have told HSJ the Treasury has demanded more clarity on the matter in a formal letter to the DH.
DH officials had been instructed to work to an April 2012 deadline for the start of the transfer of commissioning responsibilities to GPs. But yesterday Mr Lansley erred in confirming whether or not that timescale remained.
However he said there was no benefit in delaying.
“I have been with GPs who say they are ready to go now,” he said. “There is no merit in making these changes take a long time. There is every merit in knowing what we need to do and doing it quickly”
Asked what the Treasury were saying to him, Mr Lansley said: “What I say to them and what they understand is that we are transferring commissioning responsibilities to the GPs.”
He argued the GP’s gatekeeper role meant they were in the best position to manage the demand on NHS services as they were closest to patients.
Asked who carried the risk of over spending he said: “In the long run, I do.”
He said he would establish a system of financial control to ensure “we do not spend more money than we have” but PCTs had not demonstrated their abilities to do that any better than GPs.