Former bank manager Paul Cookson has more than most riding on the success of PCGs. He is one of the handful of people from outside the NHS to be appointed as a PCG chief executive.

After 27 years in banking, he admits to making a big career gamble when he takes charge of the idyllic-sounding Eden Valley PCG.

Eden Valley in rural North Cumbria has 52 GPs and 70,000 patients. It covers one of the largest and most isolated PCG patches in the country.

'You could say that there is a lot riding on this for me. You have to see it as a massive opportunity. It has been a steep learning curve - almost vertical at the moment.'

He confesses to feeling like an outsider, but is confident that his financial expertise and managerial skills will translate well into the NHS, despite the fact that he will not be receiving full details of his level two PCG's budget until the end of its first month in operation.

'One of the best skills you pick up is to listen to what people have to say and use the old rule: 80 per cent listening and 20 per cent talking,' he says.

He agrees that PCGs are one of the biggest changes ever seen in the NHS, but he does not expect any overnight transformation. Nor does he see PCGs as an attempt by central government to screw down prescribing costs.

'Prescribing budgets we have set have been agreed by GPs. There has been no pressure put on and no sense that chief execs are here to rule the roost. It really will be a collaborative process.'

He is as optimistic that PCGs will be a success. 'If you are not positive you are not going to get anywhere, are you? You have to keep your fingers crossed.'