“I'm waiting in my cold cell, when the bell begins to chime.

Reflecting on my past life and it doesn't have much time.”

For a reason I can't explain, this Iron Maiden song is playing in my head, over and over. The last time it was such a powerful mental presence was years ago. I was singing it, perched on a playground swing, watching the sun go down over my high school. It was the evening before my first ‘A level’ exam. A moment in time when the next few weeks would determine a large part of the rest of my life.

And so here we are again, ‘post-Lansley’ as it's being called, once again at the beginning of something life-determining. My senior receptionist has just informed me that our most commissioning astute partner is off this week at CCG meetings and courses. It wasn't felt necessary to get a locum in because we would all prefer the extra money, apparently. So while he's at a swanky hotel playing at being one of the ‘Dragons in the Den’ I’m stuck here seeing twice as many patients. Having taken a peep at the appointments diary it seems this could be the case for the next few months. I will have to do something about this.

What's this? Patient involvement group, tonight, here, at the practice? Practice representative, me!! I should have read the minutes of the practice meeting, is the response when I ask how this came to pass. I’m the most liked of the doctors in our practice according to the patient feedback survey, so it was thought I would be the most appropriate person to attend. Perhaps patients do appreciate my ability to raise them from their bed to the surgery. I know I appreciate not having to do a home visit.

I'm actually all for these groups as it's the ultimate way of shifting responsibility and deflecting blame. The Government likes to encourage “local decision making based on local needs”, which translated means “if you mess up then it's your fault”. It's a similar principle with the patient involvement groups who are allowed to influence which services are commissioned, because after all they are members of our local community so obviously they know best what the local needs are. This means I can wash my hands of any responsibility when things go wrong, and smiling can refer any complainant to the Patient Involvement Group, or PIG. How nice it's going to be not to be faced with: “The only reason you won't give me an implant is because you want to save money”. From now on the response will come from one of their own, who'll be able to be a little more honest, and blunt: “You're not getting an implant because since you're pregnant you no longer fulfill the criteria. Anyway, you had three appointments to have one fitted and you didn't bother to turn up. Each time we left you a voicemail, sent you a text and an e-mail, tweeted you, and even posted you a letter, to remind you about the appointments. So don't try and make excuses that you didn't know when to come”.

The song isn't my only déjà-vu. I was a fundholder in the 1990s and we did pretty well for our patients. That was until a change of Government came along with a ‘new broom’ philosophy. History does have a habit of repeating itself so who knows how long CCGs will last? Presumably just as PCGs became PCTs, it won't be too long before CCGs become CCTs. Let's just hope they don't become the Clinical Needs Trust.

My next patient hasn't turned up so I’m in the staff room making myself a nice cuppa. I can't believe it, playing on the radio is the same Iron Maiden song “Hallowed Be Thy Name”. It's hard not to smile at the lyrics, they could have been written for what primary care is going through at the moment and I guess sum up the questions many of us have:

“Can it be that there's some sort of error?

Hard to stop the surmounting terror.

Is it really the end, not some crazy dream?”