Commissioning consortia set up now in shadow form will not be “set in stone” for the long term, the health secretary has told GPs in an apparent attempt to drive forward his reforms.

Mr Lansley has written to all GPs, primary care trust chief executives and strategic health authorities “to set out the next steps” on GP commissioning and “answer directly some of the questions that have been raised”.  

He said PCTs already had the legal freedom to devolve commissioning decisions to groups of GPs and other clinicians, and he was “actively encouraging them this interim approach”.

“If you have decided among your colleagues that you will be seeking to take on more responsibilities in shadow form – you will be able to approach your PCT(s) for the support you need to begin work now.”

But he said: “This does not pre-empt decisions on the more decisive shift to GP led commissioning that we are proposing, and it means that your initial decisions will not be set in stone for the longer term.

“Over time, you will be free to develop your commissioning arrangements, structures, sizes and governance as you learn from your experience and the experience of others.”

A separate letter has also been sent by national managing director of commissioning development Dame Barbara Hakin emphasising to chief executives that GPs have been encouraged “to approach their PCTs soon with a view to making progress under existing arrangements”.

However, while calling on PCTs to offer fledging consortia support, Mr Lansley once again launched thinly veiled criticism of the commissioning record of PCTs themselves. He has been previously criticised in HSJ by NHS chief executives for breaking an unwritten rule that ministers should not publicly criticise civil servants.

In his letter Mr Lansley said: “Many of you [GPs] will have witnessed care which has been commissioned or provided inefficiently, or care services which have not been integrated sufficiently – and this will have frustrated you, as much as it does me. That is why I believe you are best placed to make every penny count in the NHS, for the patients it serves.”

Mr Lansley claimed no decision had yet been made on the level of the management allowance that will be given to consortia to spend on commissioning support from PCTs, local authorities or external providers.

It has been widely quoted that this allowance will be somewhere between £9 and 12 per patient.  

But Mr Lansley said: “I know there has been speculation about what the management allowance might be, but the reality is that no decision has yet been taken.”

He said he intended this decision would be “informed” by current levels of expenditure by PCTs on management and administration but highlighted that this would be affected by other proposals in the white paper.

 “There are many responsibilities which are currently placed on PCTs which we propose will not be placed on consortia,” he wrote.

“The exact transfer of responsibility – and therefore the resources needed to discharge these responsibilities – is subject to the consultation process and parliamentary approval, but we will ensure information is communicated clearly to you.”