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At the heart of general practice since 1960

01. Sir David Nicholson (up 1)

The next 12 months will be crucial in deciding whether the restructured NHS is a success, so it’s lucky the man on whom the whole thing rests has broad shoulders.

The next 12 months will be crucial in deciding whether the restructured NHS is a success, so it's lucky the man on whom the whole thing rests has broad shoulders.

Sir David has been chief executive of the NHS since 2006 and is a respected hand on the tiller of the health service, and will head up the organisation that all GP practices in the country will contract with.

As chief executive of the NHS Commissioning Board, he will be in charge of implementing the radical redesign of the NHS, which will see PCTs and SHAs abolished and CCGs take their place.

It's a huge challenge, but he is also tasked with making £20bn worth of efficiency savings under the eponymous ‘Nicholson challenge' – which will now extend beyond the original 2015 – and he recently warned the NHS needed substantial ‘service change' to succeed.

As our panel said, he was ‘make or break' – and as the most influential non-GP his interpretation of the Government's legislation will be crucial.

One panel member said: ‘His interpretation of central policy into local implementation will have significant impact, even if it wasn't what the policy makers envisaged.'

In his keynote speech to the NHS Confederation in June, he called on politicians as well as doctors to show leadership and make the case for change to the public, and was candid about the possible need for hospital closures.

But he also seems to be a man who listens. Faced with a Pulse investigation showing the majority of CCGs had yet to recruit a consultant to their board, he said he was ‘very open' to relaxing the legal stipulation that they must come from outside the area.

Having said all that, the board has had its share of controversy – with new guidance on commissioning primary care suggesting that GP local enhanced services should only be commissioned without using any qualified provider if they are of ‘limited value' or where GPs are the ‘only capable providers'.

So far he has avoided any overt criticism of GPs – unlike the chair of the board Professor Malcolm Grant – but he will be the man ultimately responsible for performance managing practices.

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