Many clinical commissioning group leaders will need to see their GP in the next few weeks. The pressure they are now under, just days away from assuming their new powers, is immense.

Even for the 43 CCGs the NHS Commissioning Board has authorised without conditions among the 211 groups, there are difficulties.

The first is simply: time. With two days probably being the minimum a GP commissioner can wisely spend in their surgery each week, they will be faced with leading their commissioning organisations in no more than three. In practice of course – whatever their intentions – the boundaries between the two will be blurred and the risks of doing neither job well are considerable.

Tough cost limits mean management support will be sparse, while there is the added complexity of having to depend on a commissioning support unit for much analysis and guidance, so considerable time will have to be invested in that critical relationship. A GP commissioner making a medical error simply through overwork is a real danger.

Then there is the web of relationships commissioners must develop. In our networked world, there is something appealing about the diffuse accountability for CCGs, who will be scrutinised by the commissioning board, the local health and wellbeing board and the local medical committee.

The relationship between local medical committees and CCGs is going to be confusing. They are both membership organisations of GPs. LMCs are clear that they are the formal representatives of the doctors, but it is all too easy to imagine an LMC opposing a CCG plan which could dump extra work on GPs, and the CCG arguing that it has the support of its GP members.

Perhaps the biggest unknown is the relationship between CCGs and the commissioning board. Despite the mantra of assumed autonomy for CCGs, the board has yet to provide convincing evidence that it sees this as its goal. It is becoming increasingly clear that Sir David Nicholson will be stepping down as chief executive in the coming months. Perhaps that will be the moment when a more empowering, less controlling culture will begin to develop.

With so much pressure to move services from hospitals to the community, there are serious dangers of conflicts of interest as commissioning groups invest in services that financially benefit local doctors. Research by the BMJ revealed that more than a third of GPs sitting on CCG boards have a financial interest in private health companies, ranging from local diagnostic and minor surgery businesses to major private health providers. The Royal College of GPs is just one of several organisations who are worried about this.

The problem is exacerbated by poor understanding among GPs about how conflicts of interest in the public sector need to be managed. NHS and local government managers have been horrified that many GPs don't appreciate the need for open, transparent governance.

This is likely to get messy. "GP lines own pocket" makes a great local newspaper story, even if the only intention was to do the right thing for patients. And the formal niceties of people leaving the room while decisions are taken will make little difference to perceptions. If a local trust is fighting a CCG decision to cancel a contract for hospital business and move it to a company part owned by a CCG board member, it is not difficult to see where that argument might go.

Perhaps the best hope for the wellbeing of GP commissioners is for a few CCGs to demonstrate what can be achieved. At this early stage there are a handful who appear to be enjoying the benefit of taking over from a good primary care trust. Their preparations and thinking are already well advanced and they are ambitious for success.

No doubt early achievements will be trumpeted by the government as evidence that the new structure works. But it has to work for almost everyone to be a success. With 10 days to go, the reformed NHS is awash with risk.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers. The Guardian is hosting an event on CCGs – First 100 Days – on Monday 8 April from 5.30pm. Contact joanna.letts@theguardian.com for more information.