Mr Lansley told the RCGP's annual conference last week that funding issues would be handled by consortia to protect the doctor-patient relationship.
But he warned of an 'unprecedented squeeze' on funding, that existing PCT contracts would have to be honoured, and that failing consortia would be 'disbanded'.
Mr Lansley told the conference in Harrogate: 'It would be unacceptable for the rationing of limited resources to take place at the level of the GP and their patient. That's not what I mean by commissioning.
|Lansley Speech - The Key Points|
|In a wide-ranging speech to the RCGP conference, health secretary Andrew
Lansley responded to key concerns raised:
'Commissioning is about ensuring the services you need are available and the choices are there. Where investment or disinvestment are needed there will be collective decisions in conjunction with healthcare providers and local authorities. It is not a decision for individual GPs to make.'
GPC chairman Dr Laurence Buckman welcomed the statement: 'We've been encouraging the secretary of state to think like that.' Dr Buckman said GPs could collectively be involved in spending decisions but individually treat patients as their first priority.
RCGP chairman Professor Steve Field said it was 'great to hear a politician speak our language of patient-centredness'.
In a question-and-answer session after the speech, south London GP Dr Eugenia Lee asked the health secretary what would happen to a consortium that failed.
Mr Lansley said consortia would be guided and protected, and given access to national and local risk pooling arrangements. 'But, in the long run, if a consortium fails and cannot meet its obligations, on either quality or finance, there will be a process by which it will be disbanded and a new consortium established with new managerial responsibilities.
'But that does not change the direct relationship through the contract with the individual practices. That's still governed by the GP contract.'
Suffolk GP Dr Mary Selby asked whether he could prevent consortia being 'drowned at birth by the debts and mistakes' of PCTs, including a local polyclinic that had four years to run on its contract.
Mr Lansley said: 'The Darzi centre in every PCT is a classic example of what I am trying to avoid by working to local needs. But a contract is a contract and for the continuing life of that contract you will have a responsibility to get the best value out of that facility.
'But consortia will not be set up to fail. They will be set up to succeed and we have an obligation to ensure that consortia start with as few inherited problems as possible.'
Mr Lansley was also asked whether GPs would receive training to help them commission effectively.
He said: 'I do not want to turn you in to managers. What I want is your leadership and expert judgment, and for you to work with patients.'
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