Fears are growing that important decisions are being delayed or shelved during the health reform's transition period.
David Stout, Deputy Chief Executive of the NHS Confederation, told MiP he fears the creation of multiple new organisations under the health reform will create a 'traffic jam' meaning important decisions may "take months, years or even decades" to be decided.
Backing Stout's prediction, Professor Chris Ham, Chief Executive of the King's Fund, told MiP that in creating a "bureaucratic and complex system", there is a real risk delays in decision-making will occur.
"[Health Secretary] Andrew Lansley had such a clear view of his proposed health reform back in 2010 but the design has now been muddied, risking the creation of a slow-moving NHS at the very time it needs to be quickening," said Professor Ham.
"The government needs to be clearer as to where individual responsibilities lie under the reforms, but this could be difficult to say in an unnecessarily detailed and complex structure."
He warned there is a real risk London GPs in particular will see a wealth of "unfinished business" become lost in the "sea of change" as "nobody will be held accountable".
The former Chief Executive of the Outer North West London PCT cluster, Robert Creighton, told MiP there is evidence to show the 'traffic jam' is already firmly in place.
"Without question, and I can say with almost certainty, decisions are being delayed and/or passed over as staff are distracted by having to adapt to the structural changes," Creighton told MiP.
"I get the sense that some decisions are being put on hold until the system has bedded down."
Mary Barnes, Director of Avon, Somerset and Wiltshire Cancer Services Network, said PCTs are too preoccupied with balancing the books and ensuring they stay out of the red to focus on development work during this transitional year.
"PCTs are not as interested in development ideas as they once were and they often cringe when they hear the word," she said.
"We sympathise with their position but innovation has to be balanced with cost saving measures.
"Their priority at the moment is to balance the books."
However, those at the frontline hold a different view.
Berkshire GP Dr Malik said the collaborative working nature of the practice and Berkshire East PCT has meant the drive for improving quality has not been lost in during transition.
"There has never been a 'them and us' culture between the practice and PCT and thankfully this has not changed during this challenging time," he told MiP.
"In working together, we now feel confident to make the structural changes required to ensure the reforms are successful."