In a Q&A webchat, Andrew Lansley (pictured) said in every health system there is a need for the people who are responsible for the care of patients to also be ‘responsible for the resources that go with that’.

But he said this is not the case with PCTs, who currently manage commissioning but are not directly responsible for managing care in general practice. ‘PCTs generally have failed to achieve the overall outcomes and quality through commissioning that we need,' he said.

Mr Lansley cited the recent Care Quality Commission report on commissioning out-of-hours services to highlight that ‘too often the PCT did not understand the service they were commissioning, did not monitor the quality of the service being provided and did not challenge the out of hours service provider when things weren't right.’

Meanwhile Mr Lansley said he was serious about ‘putting patients first and clinicians in the driving seat’. But he said local authorities must have a strategic role and be involved in ‘big changes’.

Editor's blog: White Paper will end the division between primary and secondary care

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