Managers are too preoccupied with technical detail rather than the benefits that reform delivers to patients, said Mr Nicholson, and urged trust managers to 'move the discussion on'.

Managers are too preoccupied with technical detail rather than the benefits that reform delivers to patients, said Mr Nicholson, and urged trust managers to 'move the discussion on'.

He said: 'In management circles the discussion predominately is about technical aspects and how they work. Actually the real issue is what the benefits are.

'If you talk to managers about practice-based commissioning, they will talk about indicative budgets, about budget-setting, about governance. What PbC is supposed to be is a mechanism for engaging GPs and primary care clinicians and transforming services.

'That's where I need to focus the attentions of the management community, which I don't think is there at the moment.

'I suspect that is the case across most aspects of reforms; we are focusing on the technical aspects rather than the real patient benefits and how we transform the service.'

Looking internationally, he said: 'What governments are doing is either accelerating that [transformation] or slowing it down but actually it is still happening almost irrespective of what government you have. We are not going to veer off on some other track and people need to start planning on that.'

'For example, we have known for four or five years that payment by results was going to be implemented almost exactly in the way that it has been? but not everyone has planned as if that were the case. There is this assumption that things will change and if you wait long enough it will all go away.'

'Irrespective of whether it is Tony Blair or Gordon Brown, the general direction is pretty clear for healthcare systems in the developed world.'