The prime minister was kept on his mettle when he appeared - on a giant screen - to reassure a GPs' conference. Kaye McIntosh was there

Just for a change, everyone was playing 'Let's be friends' at the GP 2000 conference last week.

GPs praised nurses, nurses returned the compliment, the prime minister was supportive and even health secretary Alan Milburn had toned down his customary bravado.

Family doctors seized the opportunity to tell Mr Blair a few home truths about the extra work they were taking on with primary care groups and how the generic drugs crisis was leaving PCGs cash-strapped. But there were no howls of outrage.

Mr Blair looked sincere, was extremely well-briefed and said he would only give them the money if they would modernise.

Mr Milburn made a plea for togetherness. He repeated the line about modernisation, but both ministers were obviously keen to win doctors over rather than repeat last year's attacks on them as 'forces of conservatism'.

The very fact that Mr Blair felt it necessary to turn up (virtually, via a 'live video link' from Downing Street) was a sign of Labour's twitchy nerves on the subject of the health service.

He promised that GPs were 'central to the delivery of our vision for the health service', driving change and coordinating the different 'levels of care' from basic community and social services through to the acute hospital sector and rehabilitation.

The health secretary later amplified this, saying GPs would be at the centre of a 'single system shaped around the needs of the patient'.

Mr Blair pledged to increase the number of doctors, even though 'that is in part a resources issue' (as well as an issue about the changing role of nurses). 'We are happy to work in partnership with you to solve these problems, ' he said.

Glasgow GP Dr Mary Church caught Mr Blair out. He hadn't realised he was still on screen even when not talking.

Obviously expecting cut-aways, he grabbed a cup of coffee, which provoked laughs and a jovial exchange with the conference presenter, newsreader Martyn Lewis.

After that one was sorted out, Dr Church went on the attack. Since Labour had come to power, GPs had taken on a 'whole range of activities' from running local healthcare cooperatives (PCGs in England) to clinical governance and extended opening hours.

Doctors were 'demoralised' by all the new initiatives and 70-hour weeks: 'When are we expected to sleep?'

The PM looked concerned: 'We will not expect people to do without the proper resources. . . I know we are expecting a lot of change, but that change is necessary if we are to develop. '

If the NHS didn't change, it wouldn't survive, he argued: 'We will honour our part of the bargain. If we don't put through these changes people will get demoralised with the health service. '

The NHS Direct helpline and the generic drugs crisis sparked the most heated criticism.

Dr Helen Groom, PCG chair in Central and East Gateshead, asked: 'Why are you so determined to roll out expensive new schemes such as NHS Direct when they are unproven?' Doctors based their decisions on evidence, she added.

Mr Blair insisted that the cost of NHS Direct was marginal in the overall health budget and that it was a 'good innovation'. Ninety-seven per cent of people who used it found it valuable, and there was nothing wrong with setting up new ways for people to get advice.

Challenged on destroying the traditional 'gatekeeper' role of GPs, he said the nurse-staffed helpline was 'complementary' to general practice and 'not a threat'. Mr Milburn later quoted the British Medical Association's own book on the future of general practice - which sparked the conference - back at them. The dispute over NHS Direct was 'a phoney war'. The evaluation of the service by Sheffield University due 'within weeks' showed that satisfaction ratings were high.

Another thorny issue as the first year of PCGs comes to an end was prescribing budgets. The sharp rise in the cost of unbranded drugs has put PCGs into heavy deficit on their new, unified budgets. Dr Sunil Angris, whose Staffordshire practice is a 'beacon site' for diabetes, said GPs were being asked to prescribe 'ever-more powerful and expensive drugs' by a government producing guidance on conditions such as coronary heart disease. 'But your decision to put drugs budgets in PCGs means we cannot do that without rationing other services, ' he said, to loud applause.

Mr Blair pointed out he had provided an extra£90m specifically for the generic overspend. He accepted that this was 'a real problem, but told delegates they would have to wait for the second comprehensive spending review this summer to get a full answer.

Mr Blair ended on a plea. 'We are putting more into the heath service.

People feel passionately about it and we will work with GPs. . . if we are doing things wrong we will look at how to put them right'. There would be more staff and more money. 'Our obligation is clear, ' he added.

The health secretary did attempt to defend the government, pointing out that many GPs seemed keen on the reforms. 'We aimed to set up 36 primary care group walk-in centres; more than 100 applied. ' There were 450 applications for 189 personal medical service pilots and people were begging for a third wave, said Mr Milburn.

But Dr Joe Neary from Wisbech, a member of a first-wave primary care trust, Fenland, said 'any enthusiasm is strangled at birth' by a system which left his patients waiting two years for an eye clinic appointment.

NHS Confederation policy director Nigel Edwards - who played to the gallery during his own speech - told HSJ : 'In one way conferences like this don't help, in that it suggests the 'forces of conservatism' are out there. 'Mr Blair had been given the impression that GPs were more negative than they really were, he said.

Others suggested it would be managers, not doctors, who were now in the government's sights for failing to push modernisation through fast enough. A public row with mangers could be next on the cards. And that is less likely to backfire and end in twitchy prime ministerial appearances at NHS conferences.

Talk back: BMA's vision of the GP of the future The BMA commissioned a journalist to interview more than 100 managers, doctors and academics on the future of GP practice. The book, Shaping Tomorrow , says GPs will become:

care providers;

communicators and interpreters of health information obtained from other sources, such as the Internet;

advocates for patients;

decision makers, managers and leaders in their communities.

GP leaders said family doctors are:

doctors who care for people who are ill or believe themselves to be ill;

doctors who offer a continuing relationship with patients.

Shaping Tomorrow: issues facing general practice in the new millennium.