THERE is one certainly about 2010: there will be an election. One of the problems with our electoral system is that it is adversarial. To quote W S Gilbert from 1893: "One party will assuredly undo all that the other party has done."

Although the three party leaders have agreed to a television debate, it is likely to be three monologues. Under our electoral system no leader can say: "That's a great idea. I am happy to discuss this and, if we win, we can work together."

The election campaign has already started if we listen to politicians or read the letters page in the Herald Express. New Labour has either saved the NHS and introduced the greatest changes since Nye Bevan or been a total disaster, spending a fortune to provide a bureaucratic nightmare, wealthy GPs, poor nurses and dirty hospitals.

The truth lies between the two extremes. I am not a politician but I have worked in the NHS for more than 30 years. Perhaps I can give an objective view of the New Labour handling of the NHS without being accused of electioneering.

Over the last 12 years the NHS has been revolutionised. Some of the changes were due to improvements in medicine and would have happened regardless of Government. But the Government has made a difference. Of course there are areas where they could have done better but I would mark their achievements as A-.

In the 1990s some of the waiting lists were over a year and decisions on spending were purely local and based on little evidence.

The National Institute of Clinical Excellence, or NICE, was one of the most successful ideas of this Government and is now being copied around the world. Any system of health must have rationing. No country can afford everything. But where do we draw the line? NICE is independent of government. They bring together experts who look at all the evidence behind both new and established treatments and produce readable reports. These discuss whether the treatments are both effective and cost effective. They also outline how the GP should examine a patient and what should be recorded.

Not everyone agrees with every report, especially pharmaceutical companies who are told that their latest expensive drug is not cost effective. But at last we have guidelines and these have revolutionised my day-to-day work.

Hospitals have changed dramatically. No longer do we have a general physician, a general surgeon or orthopaedic surgeon. We have specialist heart physicians who deal with heart valve problems and others dealing with rhythm abnormalities. One orthopaedic surgeon will only operate on knees with another specialising in feet.

Newly-qualified doctors now have to decide their speciality early and follow a specific training programme. This means much better care for patients but a less interesting job for doctors. It also means that a specialist in one area will have very little knowledge in another area. This 'division of labour' has come late to medicine and follows the ideas of economics from Plato, through Adam Smith and Karl Marx to Emile Durkheim in 1893.

So how can General Practice survive in a world of specialists? We are now the specialists in personal family medicine. As hospital consultants know more and more about less and less it is vital for a patient to have a personal doctor to take an overall view.

But general practice has changed. The computer on the desk has become a vital tool. In a world of specialists a GP cannot be expected to know everything. Patients may be able to check their diseases on the internet but the GP can help interpret their findings. We work with patients to check specialist websites and look up rare diseases. The internet has become a vital tool for keeping GPs up to date.

Under the old system GPs were paid according to the number of patients. Under the new contract GPs earn points for providing good long-term care; for example, ensuring that blood pressure, cholesterol and sugar levels are controlled in diabetics. Money earned can be reinvested in employing more nurses to achieve these targets. The New England Journal of Medicine has recently praised this innovative system.

Another great innovation has been the 'two week wait' for suspected cancer. A GP now has clear guidelines when to suspect a cancer. If worried, the doctor fills in a form which is faxed to the hospital. The patient will be seen within two weeks. At the hospital there are now specialist departments. If, for example, the GP refers a woman with a breast lump there is a specialised breast clinic. All the equipment is available with staff trained to deal with this one problem.

The national computer system has been seen as a disaster, wasting billions of pounds on a failed IT system. It was over ambitions and poorly managed but has some positive outcomes. The Choose and Book system for booking appointment has problems but so did Disney World when it opened. I can now book an outpatient appointment from my surgery, print it out and give it to the patient. They have the choice of hospital, time and date. When it works it is superb.

The price of the changes, and the reason for my A- and not A+, is the massive increase in bureaucracy. The changes have been 'micromanaged' with armies of managers dotting every i and crossing every t.

Whoever wins the election the last 12 years have dramatically changed the NHS for the better. I suspect that the opposition parties quietly agree and will not throw out too many of the changes if they win the election.