Oo-err. This could be the end of a beautiful friendship. Because, according to a BMA survey, two thirds of us GPs are worried that the NHS reforms will damage the doctor-patient relationship. Hardly surprising, as we're going to be providers and – more pertinently, given the potential for aggro – commissioners of care.

Then again, what's new? After all, the concept of GPs being devoted and determined advocates for patients went out years ago, along with Gladstone bags, elbow patches and long afternoons on the golf course. For ages, we've also had to be advocates for the DWP when refusing spurious sick notes, of the prescribing budget when saying no to unnecessary antibiotics, of rational radiology when declining inappropriate demand for scans, and so on. So we're used to conflict.

But there's a key difference. Up until now, we've been able to shift the blame and hide behind excuses. ‘It's not me,' we'd explain, with an expression designed to convey vocational worthiness crushed by heartless bureaucracy. ‘It's the NICE guidance/latest political initiative/PCT directive/local referral protocol...'

Not any longer. As the more informed, articulate and assertive punters will point out, we're in charge. So whatever I'm refusing – which will be quite a lot – will be down to me. Doctor-patient relationship? More like war.