"It will bring together responsibility for clinical decisions and for the financial consequences of these decisions." (4.4)
"GP consortia will align clinical decisions in general practice with the financial consequences of those decisions." (5.12)
This is basically saying that GPs will have to wear two hats: doctor and accountant. Many will continue to proscribe what is needed and the consequence may well be that their practice goes into debt (however, they will have to bear in mind (5.14) which says that the government will not bail out GPs who go into debt). But some - too many - will ration care because this is exactly what Lansley wants.
One thing that patients must realise - Conservative governments regard them as a drain on the taxpayer.
nhsmanagers.net have commissioned Prof Chris Newdick to write about the consequences of these sections: available here. He points out that GPs have a duty to provide care according to need - he calls this "a special Hippocratic right in primary care". He says that the current 2004 version of the GPs regulations require GPs to prescribe the medicines which "are needed for the treatment of any patient" and this is "needs-based, not resource-based" and so in direct contradiction to sections (4.4) and (5.12) of the white paper. This will not please GPs.
Further he points out another issue that I have touched upon. Prof Newdick points out that "the NHS Constitution requires PCTs to have systems which explain how and why the NHS cannot afford some expensive treatments". This will be the responsibility of GP commissioners, and ultimately the people who employ them, the GPs. Prof Newdick says:
"This is unfamiliar territory for many GPs, with legal and ethical problems. Will Nye Bevan’s needs-based, Terms of Service duty to prescribe have to go?"
and the answer is undoubtedly Yes.
Lansley thinks that patients are drains on the economy and he cares not one iota for them (otherwise, why would he legislate away any responsibility that the Secretary of State for Health has for health provision?) If you are a patient then in the next few years you will pray for a miracle cure because you'll not longer be able to rely on Lansley to provide treatment for you.