The news that CCGs are failing to engage their member practices reveals the full scale of the challenge to reverse the culture of apathy and suspicion that poisoned the relationship between PCTs and GPs.
These new beasts are meant to be led from the bottom up, driven by the will of their member practices. The reality, of course, is that many GPs fear they will become carbon copies of their predecessors, strangulated by bureaucracy, and divorced from the reality on the ground.
Official reports from the NHS Commissioning Board's CCG authorisation 360° stakeholder surveys show many practices reporting a lack of involvement and understanding of their CCGs' plans.
Achieving 100% engagement with GPs would, of course, have been an uphill task, but if half do not feel involved with the vision it raises huge questions over how clinically-led the new system will really be.
With many conflicting pressures on GPs' time and workload, perhaps it was inevitable that CCGs struggle to involve them - the message from many seems to be, ‘let us get on with the day job.'
But with GPs about to be handed the unenviable task of commissioning services with a substantial reduction in management costs, and daunting efficiency targets, CCGs failing to engage their constituent practices will find life increasingly difficult.