Does HSJ’s exclusive analysis of the leadership of clinical commissioning groups signal a lack of engagement in the reforms by GPs in general or a pragmatic response to the scale of the challenges ahead?

The fact that over two thirds of GP chairs have been involved in earlier forms of clinical commissioning will be put forward as evidence that the NHS has gone through a huge upheaval for little real change. This claim will be strengthened by the finding that - despite the government urging clinicians to step up - only 40 per cent of nominated CCG accountable officers are GPs and three quarters of the most senior CCG managers are primary care trust staff.

But those who are inclined to see the glass half full will view these trends as sensible and reassuring.

Those parts of the NHS which have made most progress over the last two decades are those with the best record of clinical engagement in service design and performance review. They have built a continuity of clinical leadership which has survived the changes in the organisational vehicles constructed to host it.

Assuming the CCGs have chosen wisely (or have been allowed to), the relatively high proportion of PCT managers in lead roles is another positive sign of continuity. Corporate memory is in danger of crumbling and anything that mitigates that should be welcomed.

The success of CCGs will rely on significant contributions from clinical and managerial leaders. It will also require a supply of new blood to inject renewed energy and ideas into the design of services. Attracting that will make it ever more important that experienced leaders are taking the helm while the new generation emerges.