Management caps in GP consortia

[W]e want to give GPs control of commissioning, creating a direct relationship between the management of care and the management of resources.

That was Andrew Lansley the NHS Confederation conference in June.

Sounds like he wants to give control to GPs over commissioning, doesn't it? Stop the top-down nature of health policy and delivery and all that.

You'd be quite wrong, of course, because you've obviously underestimated the power and reach of the "non-top down, top down approach", subject of many a post here (start here and work you're way back).

In this case, the Department of Health's commissioning czar - arguably a position that personifies the non-top down, top down approach - has said:

The consortia will get their budget and there will be a limit on how much can be spent on management. It will reflect the cost of management but also the desire to reduce them.

That is, GPs can have control over commissioning and spend the money how they want, unless they spend it on things that Andrew Lansley doesn't want them to spend it on.

Management caps are relatively benign because it's easy to bash a middle manager. But what happens when GPs start closing things down or paying for drugs that Lansley doesn't like?