It is an iron rule of NHS reform that development is both geographically patchy and concentrated in certain areas - look at the progress made in tackling heart disease compared with the record on sexual health, or how performance in the South West has consistently outstripped other regions.

However, HSJ’s unique analysis of 335 emerging commissioning consortia (not just the 177 pathfinders) reveals for the first time the dramatic variations in the pace of progress in taking on new responsibilities.

Slow development might be expected given the political uncertainty over the health reforms which has dominated this week and the efficiency drive which is understandably occupying most primary care trusts. What is perhaps surprising - except of course to the ever-sanguine Andrew Lansley - is that at least £7bn of spending power is to be handed over from April.

It will be interesting to see whether or not these pioneer consortia are as eager to row back on the reforms as the rest of their medical colleagues appear to be.