Where PCT managers live in a cloud cuckoo land of plush offices, and employ ever-increasing numbers of staff who hold meetings by the score without anything concrete emerging? Well, so am I. And it's high time we GPs stopped being defensive and went on the attack.

We could start by bringing the public's attention to the appalling management of many PCTs: time and money wasted, ineffectual management consultants hired and decisions made which sideline the real needs of general practice.

We should create our own balanced scorecard for PCTs and make some national comparisons, naming and shaming the worst performers. How about asking the following?

Costs: What is the management cost of the PCT per head of population served? How much goes on external management consultancy? How much is spent on building purchase or rental (for management only)?

Staff: How many people does the PCT employ, and how much has this increased over recent years? On average how long do its staff remain in post? Does the PCT routinely discipline underperforming staff? Now score the overall quality of its managers, on a scale of one to 10.

Access: Rate the availability of your PCT's staff, especially between 4-5pm on Fridays. How often can you speak to the relevant manager directly, rather than getting a recorded message? How many times do you have to leave a message before they call back?

Attitude: Does the PCT overwhelm you with unnecessary communications? How clear are these letters and emails? How far do PCT managers understand the strains, stresses and needs of primary care? How much do they bully or ignore practices?

Delivery: How many practicable innovations has your PCT instituted? How long does it take it to implement projects? Are its local enhanced services sensible? Does it support practice-based commissioning?

The BMA should take the initiative, send a questionnaire like this to all practices nationwide and then arrange for the results to be published in the national press. It will make interesting reading.