'If they fail, the NHS is doomed'

Claire Newbon meets a doctor who is being driven to despair by the pressures of general practice

Outside the consulting rooms of Dr Gillian Braunold's north London general practice, a queue of patients gradually accumulates in a narrow corridor which serves as a waiting-room. Mothers pushing large prams and elderly patients have no choice but to navigate their way around the tight staircases of the three-storey Victorian building.

For the past five years Dr Braunold has been demanding that her inner-city practice be housed in a new medical centre, and is adamant that patient lists will not be closed. Rising patient numbers are also putting the group's health and safety standards at risk. New Labour has promised the modernisation of 3,000 GP premises by 2004, but Dr Braunold believes there is a limit to what can be achieved with the listed building that currently houses the practice.

"If the Government fails to turn around recruitment and retain people, then the NHS is doomed. Only if the working environment is right and remuneration is in place will people choose to come back – this is Labour's last chance to get it right."

Since she joined the practice 21 years ago, patient numbers have doubled. With an estimated 50-60 visiting the group's clinicians at any given time, she worries that she or her partners will ultimately lose the "essence of practice" under continual pressure to meet government targets. She says her work has become a daily "trial" under Labour and that the Government must act quickly if it wants doctors to return to general practice.

"What we need are workable contracts and realistic targets, not unreal expectations for people who are already vulnerable" Dr Braunold says.

Many of her patients are people who do not speak English well, or at all. "While the average appointment time here is nine minutes, I would estimate that about one in 10 of our patients will require a translator. Appointments generally take up to 25 minutes but the patients – usually refugees or asylum seekers – do not have anywhere else to go. There's always going to be a limit to what GPs can do in one session. It's not surprising that more doctors want to work part-time or leave such an overstretched system."

As a London representative on the General Practitioners Committee, Dr Braunold examines GP performance and says there has been no evidence to show the 48-hour access pledge made by Labour will benefit the system. She believes the Government's repeated "Golden Hello" pledge last week – a financial incentive of up to £10,000 to entice back former doctors – is no more than "lip-service" and suggests London weighting or further financial redistribution might alleviate the crisis.

"At present, 90 per cent of all NHS contact is through primary care, which receives only a 10th of all funding. With the arrival of Primary Care Trusts (PCTs) we thought we were going to open the tap – just a small trickle in our direction could have made such a difference."