“Some have argued Liberating the NHS constitutes an unwise distraction from the quality and productivity challenge facing the NHS.

On the contrary, the reforms will support [it].” So declares the government’s response to the white paper consultation.

It continues: “some argue the Government’s reforms will fragment the NHS. The reverse is true… our plans reinforce the fact that the NHS is an integrated system.”

It also rejects myriad suggestions to slow the reforms, stating: “The Government’s intention is to undertake structural reform rapidly.”

While health secretary Andrew Lansley may play down his reforms’ radicalism, this clearly does not involve big changes to his plans.

The most significant measures appear to have been introduced in the 2011-12 operating framework. Key messages include extending the deadline for efficiency savings to March 2015, introducing competition on price in the next financial year and forcing primary care trusts into 50-odd “clusters” to aid transition.

If the bad news for PCTs arrived this year, 2011-12 looks likely to be very difficult for providers, with the Department of Health taking a hard line on cutting tariffs. For many, next year looks like a choice between a pay freeze or redundancy.

The consultation response is adamant commissioning consortia will not “recreate” PCTs. But our analysis of the 52 pathfinders suggests a close - if not exact - match in size. The response confirms a consortium’s accountable officer need not be a clinician.

Anecdotal evidence too suggests an evolutionary process on the ground. HSJ spoke to a former PCT chief executive now running a pathfinder. He was looking forward to moving his new organisation into the former PCT offices.

HSJ wishes all its subscribers a happy Christmas and, particularly for those facing an uncertain future, a good new year.