Health ministers set great store by what they call evidence-based policy-making. Anxious not to repeat the mistakes of their Conservative predecessors, they make much of their laudable efforts to consult and evaluate: witness, for example, the comprehensive studies of the primary care pilot schemes (see pages 12-13). Not for them the diktat from the centre and the brass-necked refusal to brook any protest from the front line about what is and isn't realistic. That was for Kenneth Clarke, a politician who - like his NHS reforms - is now consigned to history.

But all is not quite as it might seem according to the spin doctor's world picture, as our survey of health authority finance directors, conducted with the Healthcare Financial Management Association, reveals (see pages 2-3 and 12-13). This is evidence to which ministers need to pay urgent attention before implementing further their policy on primary care groups. The vast majority of finance directors agree with the broad thrust of the policy, but they have profound worries about the practicalities of getting PCGs in place by next April.

Resources and workload top the list of concerns. A quarter of finance directors estimate the cost of setting up PCGs at more than pounds200,000, although 63 HAs have been allocated less than this, and 18 have been allocated less than half that. Almost two-thirds felt PCGs would cost more to operate than existing commissioning systems. That is a damning indictment.

Equally worrying is the confession that managers may have to 'take their eye off the ball' on other issues to cope with the PCG agenda. Managers taking their eye off the ball during the last reforms brought about some of the most disgraceful abuses ever to afflict the NHS. Are alarm bells ringing yet in Richmond House?