It happened over the QOF. The DoH thought it would impose 'tough targets'. Our negotiators said GPs were already hitting most of them. Nonsense, replied the DoH - before staring into a financial black hole as we promptly delivered far more points than they had budgeted for.

It happened over out-of-hours. The government's offer to take it over for the derisory sum of £6,000 gave off the clear message that it thought PCTs could run outof-hours much more efficiently, especially when it declared that relinquishing out-of-hours was a one-way trip: we wouldn't be allowed to take it back again. That's how little faith it had in us. (We just grinned, and signed on the dotted line.)

Now we have a much more expensive out-of-hours service that is creaking at the knees: in some areas just three doctors are on call for 600,000 patients, and pointed questions are being asked about safety.

Then there was Choose and Book. It isn't working, GPs said repeatedly. It's a huge additional burden and it wastes our time.

Undeterred, managers have been trying to bribe, cajole and strong-arm us to get involved. Haven't they realised that if Choose and Book was as good as they say, we'd have been falling over ourselves to use it?

In fairness, some politicians and managers are excellent - but others seem impervious to reason and fact. Don't they realise we're under immense pressure? Obviously not: they are convinced they understand how to deliver healthcare much better than we do.

Indeed, some PCTs seem deliberately to ignore their GPs. This is particularly disturbing at a time when the government is introducing projects that seriously threaten the future viability of primary care - Darzi clinics, the removal of MPIG, curtailment of premises' funding, registration with the Care Quality Commission, and the so-called 'world class commissioning' drive.

How many times do doctors - the most trusted people in the country - have to say, 'it won't work' and 'we don't have the time or resources' before politicians and NHS managers actually pay attention?