Independent Decade : Time and motion for body and soul

Health of the nation

She was the gatekeeper to the National Health Service and traditionally a bit of a dragon. Her sole aim was to keep you from your doctor unless, she decided, it really was life and death.

But the surgery receptionist of today has been transformed; her worst tendencies tempered by the "Have a Nice Day" mentality that has followed the metamorphosis of patients into consumers.

The receptionist is now a "facilitator" to the brave new world of the modern, primary healthcare-led health service, with its bright, attractive waiting rooms, and play-areas for children; where the dog-eared copies of ancient Reader's Digest's have been replaced by last week's copy of Hello, and where your medical records rarely go missing because they are held on computer.

Family doctors have changed too; jettisoning their paternalistic attitudes to deal with the new breed of patient who has been empowered by the explosion of healthcare information in the last decade and the Patient's Charter. GPs are also more powerful and self-confident, and less in thrall of consultants; they hold the purse strings and hospitals are desperate for business in the internal market created by the NHS changes.

Of course, an appointment with your GP is as difficult to come by as it was in 1986 - marginally less difficult than finding a dentist willing to treat you on the NHS - and rarely available with the GP you want when you are ill. The "drop-in" appointment system no longer exists except for emergencies, and routine night-calls are likely to follow suit.

But your GP may not be the first port of call anyway. Now there is the practice nurse or nurse practitioner, an American innovation designed to reduce doctors' working hours. She (99 per cent are women) can conduct an initial examination, monitor long- term treatments, prescribe certain drugs, order X-rays, carry out smear tests, take samples, give injections and stitch wounds.

The practice nurse has also assumed responsibility for health education and preventive care, a fundamental plank of the Government's Health of the Nation strategy which articulated a realisation that stopping people becoming sick was as important as treating them when they did. And persuading them to take responsibility for their own health would also be cheaper in the long-run.

National screening programmes - the first in the world - for breast and cervical cancer have been a pioneering venture but doubts over their real value and cost-effectiveness are still being raised. Detecting more cancers may not in itself save lives, instead it will be the specialist centres set up to deliver the screening and staffed by experts which have the greatest impact in improving every aspect of the treatment and management of a disease.

Hospitals too have undergone some cosmetic changes and are, on the whole, nicer places to be sick in than they were 10 years ago. And even if they are not, you will be spending far less time in them anyway. Pressure on beds and more effective drugs and surgical techniques have cut the average stay by as much as a week.