Mid-morning at the surgery of a big inner-city practice. In reception, there's a computer terminal, but the shelves are full of wallets stuffed with patients' notes. Receptionist to elderly woman: "Who are you here to see?" Patient: "I don't know. They told me a new name on the phone."

This isn't an Alan Bennett play; it's a surgery in Highbury, north London, but there is drama behind the scenes. For here, as in all NHS practices, GPs are studying a new survey by the British Medical Association (BMA) on their changing role.

Will the growth of walk-in clinics and consultations by telephone (NHS Direct) undermine the traditional doctor-patient relationship, the report wonders. Do patients value that relationship anyway, or would they rather be seen quickly by any available medic rather than wait for an appointment with their own GP?

At this Highbury surgery, the care of 11,300 patients is in the hands of five partners - plus two registrar GPs, newly qualified, spending one year here - three nurses, six staff in reception, and a practice manager. There's also a counsellor and a health visitor who come for several sessions a week to the surgery, which occupies the lower floors of a Victorian villa.

For a branch of the NHS supposedly in transition, this all looks very familiar. Waiting to be seen is a 27-year-old woman, a patient here since she was a baby, who says that nothing can ever replace face-to-face contact with her GP. She has a computer at home but would never use the net for health information, "because you'd be paying for it".

Also waiting is a financial consultant with her young son. She hasn't heard of NHS Direct - it isn't available in London yet - but she reckons it would be useful if there was a crisis with the children in the dead of night. She, too, thinks the family doctor system is working pretty well - apart from occasional niggles about waiting times for appointments, and with the caveat that she prefers, as far as possible, to see the same GP.

Much of this is music to the ears of Dr Nick Brand, a partner for five years. He knows that the tide of change is always lapping round general practice, but he chose general practice because he likes taking care of families, generation by generation.

Primary care, the gateway of the NHS, remains fulfilling in spite of increasing bureaucratic demands, and patients' rising expectations, says Brand. The workload is changing, and pressures increasing, however. "Depression is our bread and butter. It's 30% of what we see."

Patients classified as "the worried well" are a growing proportion that eat up consultation time, says another staff member. They want advice and reassurance, and see themselves as informed consumers. Quite often, it's the practice nurses who deal with them.

Brand, however, seems rather glad that NHS Direct isn't yet available in the London area. He's a believer in the 10 minute face-to-face consultation. There's one chore, though, he would happily give up: the letters that tenants seeking better council housing ask him to write to support their applications. Council officials don't take a blind bit of notice, he's been told. But patients still insist, and he still obliges.

As for more flexible opening hours, the GPs aren't keen to change. Brand points out that, for several years, the practice had late nights: a walk-in surgery that in effect meant that the queue wasn't cleared till around 10pm. But patients didn't like sitting around for so long; and as more women GPs became partners - three out of five now - they were unhappy with unsocial hours, so the scheme was dropped.

There's more interest in starting early morning and late evening surgeries from the practice nurse manager, Geri Hearne. "Patients just want us to be here 24 hours a day," she says. Late opening could be made possible by closing for longer in the middle of the day, between 1 and 4pm, she says - though afternoon clinics would have to be rescheduled.

Patients in general are likely to see more nurses working alongside GPs. One medical academic in the BMA survey forecast a dissolving of the boundary between doctors and nurses: a decade hence, they could all be "clinicians".

That's a bold prediction. Hearne says it's true that surgeries are benefiting from "a flood of nurses" who are quitting hospitals for the friendlier hours, greater autonomy and absence of a pecking order that makes work in general practice much more pleasant.

In some surgeries, the BMA survey found, some nurses can deal with 30% of patients. But strict limitations remain: nurses can't prescribe drugs; and, while NHS Direct is a new avenue for them, it is run entirely by highly-qualified sisters who have to follow strict protocols of questions in dealing with phone callers and, says Hearne, aren't allowed to use their initiative.

But how about technological change? Brand smiles at the mention of "paperless practices" where all patients records are stored electronically.

This practice has had a computer for 10 years - but it's of limited use: booking appointments, repeat prescription, and partners' emails. A new system is being installed, and within a year the partners will be making notes on-screen as they see patients. More efficient but not more space-saving: the law says they must still hang on to those wallets.