By Nick Triggle
Health reporter, BBC News
GP services are changing. Saturday and evening opening is set to be rolled out from this month and the spectre of super-surgeries is looming large on the horizon.
Are we seeing the beginning of the end for the traditional family doctor?
Dr Cornel Fleming says morale is very low
Dr Cornel Fleming's practice in a corner of north London is a throw back to the old days.
The Australian-born GP has been running the surgery since 1985 - mostly on his own, although more recently with another doctor.
He proudly boasts he knows all his patients by name and ailment. He treats them out of hours and if you need an appointment, well, you just turn up.
"Being a GP is about knowing your patients," says Dr Fleming. "The government has all these new ideas, polyclinics, extended hours, but it is all rubbish.
"What patients want is a doctor who knows them. That is how you provide the best care.
"For example, I'll get calls in the evening from patients. I know their history and I can tell them straight away whether they should be worried about their symptoms."
Dr Fleming believes the government's reforms are being driven by two things - money and a desire to get one over on GPs.
In the coming months, ministers are expected to push forward with their plans to create scores of polyclinics - super-surgeries housing GPs alongside other services such as nurses, social care and minor hospital treatment.
It comes after their battle with the British Medical Association trade union over extending hours.
Last month, GPs agreed to the plan, which will see the average practice open for three hours longer each week, but gave the government an overwhelming vote of no confidence in the process.
Dr Fleming says: "The idea of having these super-surgeries is crazy. How are people going to travel to them?
"The government says they want to see a range of services, but I run asthma and diabetes clinics and if someone has skin problems there is a GP down the road who specialises in dermatology.
"The skills are there in general practice already."
As for longer opening, Dr Fleming describes it as "laughable".
"We used to have a Saturday surgery but the only people who came were people wanting sick notes for a Monday.
"If people are sick they will come during the week."
Paperwork on Saturdays
Dr Fleming says he already works on a Saturday doing paperwork.
"Being forced into working Saturday will just stretch the resources further.
"I will have to get the reception staff in and I don't know when I will do all the admin side. Really, GPs have had enough."
So does this mean the future of small practices is bleak?
"In truth, I am not sure. I hope there will always be a place for them but morale in the profession is really low. I talk to other GPs and they all say they can't wait to get out of it.
"We are not against progress but we don't want change for the sake of it and that is what this government seems to doing. It we are not careful, general practice will be wrecked."