Dr Stephen Lawrence's surgery sits in the heart of the new residential quarter of St Mary's Island with its pristine family homes overlooking Chatham marina. It is not just the purpose-designed building that makes the surgery feel like a modern GP's practice. Dr Lawrence, 44, talks of it as a "business", and has employed a chartered accountant as practice manager.

But that does not mean he is entirely comfortable with the direction the government is taking the NHS. "I think practices will need to be more creative and competitive in the way they offer their services and I think some will go to the wall because the government is trying to create a market economy in health. But I don't think you can apply the same market rules."