Sir David Nicholson told the National Association of Primary Care conference in Birmingham last month that he hoped peer pressure in consortia would drive up standards.
At least half of the £20 billion efficiency savings required by the NHS over the next four years will have to come through GPs driving 'really big clinical change', he said.
Sir David predicted that the DoH's official response to the White Paper consultation would contain 'very few surprises' as there had been broad support for most of the proposals from many organisations.
'The general thrust of the White Paper I can see being taken forward,' he said.
The NHS chief executive predicted that the number of management posts in the NHS would fall from 100,000 to between 50,000 and 60,000 as a result of the NHS reforms.
But he warned that consortia must re-employ many current PCT staff. It could cost up to £1.5 billion to go out to other sectors and organisations to hire management support, he said.
Sir David insisted the reforms must not re-create existing structures. 'If we end up with a re-badged set of organisations that would be a scandalous waste of time and skill.'
He urged GPs to think about how to reduce demand and improve the efficiency of service straight away. 'If you spend the next 18 months discussing the governance and accountability of consortia, we will lose the plot - we will forget what we're here for.'