National managing director of commissioning development, DH (2010 ranking: 7)

Dame Barbara had to defend the commissioning reforms from the word go and was a visible advocate of the “let all flowers bloom” approach to gP commissioning. So, as ministers realised they would have to adopt more standardised flora - and leave Sir David nicholson in charge - some suspected her days could be numbered.

They look to be incorrect. Her credentials as a former gP and primary care innovator continue to count in her favour, as does her record as a commissioner and SHa boss. Board chief executive Sir David needs enough gPs on side to make the new system work - something even more vital to the government than a year ago. Dame Barbara is key to this and tough enough to face up to the British Medical association and royal College of gPs.

She has won the battle to keep the clinical commissioning group authorisation regime “developmental” rather than setting the higher “bar” some wanted and has the capability to shape the commissioning landscape.