One primary care group in four will go live today without a chief executive in post, an HSJ survey has revealed.
A telephone survey of every English health authority found that 112 posts were still unfilled in the 77 HAs that responded - in some cases after the posts had been advertised a second time.
The Department of Health said this week that appointments were 'a local decision for PCGs, assisted by their HAs', and that 'the primary objective is to secure the best candidates for the post'.
A spokesperson added: 'We do not see the late appointment of some PCG chief executives as a pressing problem.
'Nor, more importantly, is it recognised as creating serious difficulties in the field.'
The figures show that out of 351 PCGs covered by the survey, only 239 had managed to find a chief executive.
There are 481 PCGs in total, suggesting that at least a quarter, and possibly a third, of posts are unfilled. Some HAs are now considering major pay hikes to attract candidates.
Salford and Trafford HA chief executive Dr Ian Greatorex is proposing salaries of up to£50,000 a year to fill four posts. They remain vacant after interviews for the jobs, which initially carried salaries of£35-£45,000.
At least nine HAs - from Bromley in the south east of England to Morecambe Bay in the north west - had yet to make any appointments at the time of the survey. Central Derbyshire had filled one of its seven chief executive posts.
Dr Jonathan Shapiro, senior fellow at Birmingham University's health services management centre, said he was 'not altogether surprised' that some HAs wanted to wait until the task facing PCGs became clearer before making appointments. 'But clearly they are not going to be operating properly until they do,' he warned.
And he said the high number of appointments from HAs raised questions about where the new chief executives' loyalties would lie.
Despite the scale of today's NHS shake-up, the reforms are being introduced without the celebrations that ushered in fundholding, the first trusts and the internal market eight years ago.
Alan Carpenter, chief executive of Somerset Coast PCG, said there were no local plans to mark the occasion. 'We thought it better to wait until we have actually done something that the public can see before we celebrate,' he said.
Some HAs even expressed surprise that anyone should want to know the names or backgrounds of those charged with controlling local NHS resources. Others refused to provide information, referring inquiries to PCG chairs.
The survey found that HA managers were themselves the overwhelming winners of the appointment process.
Among the 239 PCGs able to provide background information on their chief executives, 138 had appointed managers from an HA background, 37 from fundholder and practice manager posts, and 32 from trusts.
Of these 239 PCGs, 123 will be led by men and 116 by women. Just 20 out of 99 HA chief executive posts are held by women. The DoH said the PCG figure 'broadly reflects the gender split of the working population'.
A full list of all 239 PCG chief executives included in the survey can be found on the HSJ website at www.hsj.co.uk
See news focus, pages 10-11.