Once again 30 per cent of our patients state that they have to wait more than 48 hours for appointments, even though we offer open access surgeries. Half say they can't get through on the phone even though we now have a dedicated phone room with so many lines that when the phone rings there's a risk that someone will be crushed in the stampede to answer it. Our staff are so happy to speak to a patient that the nervous ones hang up in fright.

This being so, we are delighted that 48-hour access is going, until we hear that it's still embedded in the QOF, so if we don't do it we won't get paid.

Likewise the early morning surgeries, to which I crawl vampirishly on Thursdays, are going, but we can't afford to give up the payment for doing them.

The staff now enjoy the brief respite of an hour rotated into a silent phone room waiting for a call while all the patients eschew the phone for turning up at the front desk and shouting instead and don't want to give that up. The public think that our targets have been hurled into the Pit of Recession, but behind the scenes everything seems the same.

Decisively, we vow to work in the way that seems the most clinically sound, and set about Making Changes. We alter the walk-in surgery back to being for urgent cases again. We discuss the potential date for stopping extended hours. We put a meditation mat in the telephone room. Then we sit back and wait for everything to - well, simply calm down a bit.

Nothing changes. Just as many people come to the on-the-day surgery - but now they say its urgent. The phones still don't ring. I still spend Thursday morning looking like the Undead. People still judge us on what they expect, rather than what actually is, and behave accordingly. The government sings a welcome song, but there's a familiar tune playing in the background so the words don't fit. Plus ca change, plus c'est la meme chose.

• Click here to read the latest in Mary Selby’s Road to Revalidation