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UNCORRECTED TRANSCRIPT OF ORAL EVIDENCE
To be published as HC 796-v
HOUSE OF COMMONS
Q514 Chair: There is one set of issues we have not touched on, which is the "Who commissions the commissioners?" question, which Andrew touched on, which is the relationship between the consortium and its own primary care members, GP members. When Sir David was here, and I refer back to that session, he indicated he felt it was necessary to have an engagement by the Commissioning Board at subnational level in order to be able to be an effective commissioner of primary care. If we develop that argument-and clearly primary care, by its nature, is a local service-there is a history, isn’t there, in the Health Service of the problems caused by having separate commissioning networks for primary care and secondary care? That is how we got to where we did with FHSAs being merged into health authorities. Do you think the danger exists of that being recreated, in other words of a primary care net that is separate from the commissioning structure for secondary care? Is it not desirable, in fact, to have the primary commissioning decisions for primary care being made alongside the decisions for secondary care, in other words, in the consortia?
Mr Lansley: I am sure Barbara will want to add a little, but let me say why I don’t think that is likely to be a serious problem. First, although we are intending that the NHS Commissioning Board-in fact, it is set in the legislation-will be responsible for the contracting process with individual GP practices, of course we are looking, increasingly, at the same time, that the NHS Commissioning Board will be expecting the commissioning consortia themselves to engage with the GP practices in how they deliver the quality and outcomes that they are looking for. To that extent, performance monitoring and management can be devolved from the NHS Commissioning Board. Indeed, in so far as the NHS Commissioning Board is making decisions about the way in which it contracts-the process, for example, that Barbara was describing about determining whether there is a gap in commissioning primary medical services, or numbers of practices-that is something that would not be determined by the NHS Commissioning Board in isolation. It would be done literally as a consequence of a discussion about primary medical services in the Health and Wellbeing Board in a particular local authority, so seeing how the Joint Strategic Needs Assessment will govern that. This parallels, in that sense, the way in which the NHS Commissioning Board will respond to the Strategic Needs Assessment on things like pharmaceutical services or dentistry.
Can I take this opportunity to let you know something which, from my point of view, has been erroneously suggested. I know how it happened. There has been an assumption, which was made by some but not by us, that 80% of the commissioning budget of the NHS would be in the hands of GP led commissioning consortia. Therefore, people said, if there is £100 billion in the NHS budget, that is £80 billion. It does not work like that. The total resources for the NHS are £100 billion and rising. The commissioning budget, at the moment-if you were to say it is the primary care trust budget-is £89 billion in 2011/12. Part of that is public health, and we have yet to determine how much, but part of that will become part of the responsibilities of Public Health England and the local authorities, so the comparable figure would be less than that. Of that total, about £10 billion is for commissioning specialised services-the sort of thing Bruce was talking about-the national and regional specialised services, prison health and high security psychiatric services and so on. The primary medical services, which you are just asking about, represent about £8 billion. Other family health services activity, dentistry, pharmacy and ophthalmic services, are something over £3 billion. When you put all those together, the amount of resources that would be in the responsibilities of GP led commissioning consortia-their commissioning budget to look after their patients-is of the order of £60 billion rather than £80 billion.