I think I started this column way back in 1996. Since that time in England we have had eight Secretaries of State for Health. Since I started as a GP we have had a total of sixteen. Throughout the decade and a half that I have been writing this column - during which I have found myself knee deep and bloodied in the politics of the NHS - I have steadfastly ignored every single development that has come along when choosing what I should write about. Whether it has been fundholding, total purchasing, practice based commissioning, the role of the health authority, FHSA, PCG, PCT or whatever that year's great new idea has been, I have ignored the lot.Partly that's because you can read quite enough about medico-political shenanigans elsewhere, but mainly it's because what has gone on in my consulting room has been resolutely unaffected by what has gone on in Whitehall.My patients kept on coming with their dis-ease and disease. They were worried, and frightened, and puzzled. In the privacy of the consulting room, in that extraordinary intimate exchange between doctor and patient, they shared their hopes and fears.