Talking at a King’s Fund event on Tuesday, Robert Creighton, chief executive of the newly merged NHS Ealing, NHS Hillingdon and NHS Hounslow, warned that the reorganisations could become ‘a bloody awful train crash’.

He said PCT managers were spending their time ‘looking inwards’ and focusing on changes to their organisation structure under the DoH's plans set out in the White Paper.

Mr Creighton said: ‘There are all the makings of a very severe collapse in the system.

‘I spent 13 hours yesterday in interviews [for a new top management team]. I am spending six hours today and another eight hours tomorrow [on interviews]. In all that time I am not spending a moment thinking about patient care or money or anything else.’

He warned that that during this time it was very difficult to keep a focus on generating innovative ideas to drive forward change and urged GPs, PCTs and patients to work together.

He said: ‘We can only do this if we work together. There are all sorts of good examples of patients, GPs and PCT staff working really well together, but we are at risk of blowing it, seriously.’