Dr John Robertson told his son, Robbie, never to become a GP, but he ignored him. In turn, Dr Robbie Robertson warned his daughter, Fiona, the job was tough and stressful, yet she, too, followed him into practice. Now she has two children of her own, what advice will she give them when they are ready to consider a career?

Cradle
She might be a GP, but Fiona Robertson cannot predict the health problems her children, Robert, three and Emily, two, will face in their lifetime. At birth, our medical records are virtually blank, the illnesses which lurk in our future unforeseen.

However, since the sequencing of the human genome in 2000, giving scientists the biochemical recipe for life, the possibility of testing every individual to see which conditions and cancers they are most likely to develop has grown.

Jim McGuire, business development manager for Scottish Health Innovations, which helps commercialise discoveries by NHS Scotland staff, believes within a generation a DNA sample may be taken from newborn babies in the labour ward and put on a chip. This could then be screened for genetic quirks that increase the individual's predisposition to a range of illnesses.

He says: "As soon as you are born they will take a heel prick and that will give you your whole genetic profile, and it will be there as soon as you want to access it. It will need to be carefully controlled if we go down that route, but it will still happen at some point."

Already, women can undergo genetic testing for copies of the BRCA 1 and BRCA 2 genes, which hugely increase the risk of breast cancer, with those who are carriers sometimes opting for a double mastectomy. This involves single genes and, even so, the gene analysis takes the molecular genetics service in Yorkhill, Glasgow, about eight weeks.

Other conditions, such as cardiomyopathy, a heart condition that can go undetected and cause sudden death, are understood to involve 10 to 20 genes, making screening too time-consuming. Methods are accelerating though, with the Yorkhill team themselves working on a fast-track system involving testing two family members.

Su Stenhouse, head of the service, believes it may be sensible for every child to have their gene sequenced so doctors can look for specific variations if, for example, one of their relatives suddenly falls ill with an inherited disorder. However, she cautions that discovering that you may get something nasty has repercussions. With conditions such as cardiomyopathy, patients can alter their behaviour to minimise the risks, but not everyone wants to know they have an incurable defect.

Ms Stenhouse says: "The decision to have the test has got to be the individual's decision, probably in consultation with a genetic counsellor who can point out some of the down sides."

It is not an issue for Fiona Robertson's children now, but it might be when they become parents. Mrs Robertson, who was born in Glasgow and now lives in Edinburgh, says: "In some ways, knowing you are prone to something is extremely beneficial. If you knew you were prone to lung cancer, that would be a big motivator not to smoke. I think it might be quite a good thing."

Growing Up
Mrs Robertson suffers from asthma, so she knew to watch for the condition in her children. She has already taken Robert to hospital wheezy and breathless and he has now been diagnosed with the problem.

"The medication he gets as a child is different from the medication I got as a child," she says. "I was admitted to hospital when I was small and kept in overnight. That hasn't happened to Robert and I think that is maybe an indication that the management of asthma is a bit better now."

However, when Professor Brian Lipworth, head of the asthma and allergy research group at Ninewells Hospital in Dundee, describes the future of asthma treatment, existing medication looks crude.

He describes the current approach as one-size-fits-all. "What happens at the moment is you end up putting patients on two, three or four drugs, and you are never really quite sure which one they should be on," he says. "It is a bit of a lottery."

Professor Lipworth predicts the next big advance will involve prescribing patients treatments to control asthma symptoms that match their personal genetic profile. This, he says, should maximise the benefits and minimise any side-effects.

In five to 10 years, he envisages asthmatics using a mouthwash at their GP surgery, which collects cells that are sent away for genetic analysis. The patient can then be given the ideal drug for their body. Such mouthwash kits are already on sale in the US.

But even if this does not come on-stream soon, Robert Robertson might find he is given small doses of substances which trigger his allergy to desensitise him. With a third of asthmatics allergic to the house dust mite, Professor Lipworth is pretty sure a dust mite pill which sits under the tongue will become a major line of therapy.

"There is no question that in 20 years' time, although it will not be trivial, asthma will be easier to manage," he says.

Actually modifying a child's genes so they do not develop asthma at all, however, is a scientific leap he cannot imagine in his lifetime.

Teenage years
From this September, girls aged 12 to 13 will be given the new vaccine that protects against cervical cancer and it seems likely Mrs Robertson's two-year-old, Emily, will have the shots when she comes of age.

"I think it is a great thing," Mrs Robertson says. "It is the second most common cancer in women under the age of 44 and so if there is some way to prevent that, then it is positive."

Levels of cervical cancer have dropped significantly in the last 15 years, although it still claims around 100 lives in Scotland every year. Could Emily see the day when it is eradicated completely?

Dr Lesley Walker, director of information for Cancer Research UK, says she can imagine it disappearing, but it is not a simple trajectory.

The vaccine protects against a virus called Human Papillomavirus (HPV), which is transmitted through sexual intercourse and which is major contributory factor in cervical cancer. Dr Walker says: "The vaccine that is being adopted in this country will protect against the two major strains, but we do not yet know what kind of cross-protection there will be against other high-risk strains. There will be two in 10 cervical cancers where the vaccine might not protect."

However, she notes there is potential for huge business in this area, adding: "I am sure we will see companies refining the vaccine."

Adulthood
Naturally, Mrs Robertson, 39, and her father say it is up to Robert and Emily to choose the careers they want to pursue. They would not steer them away from general practice, but they do worry the face of medicine might change.

Mr Robertson fears the traditional family doctor may be dying out. He notes GPs are learning more specialised skills, which could mean patients go to their surgery for investigations and screening tests, instead of being referred to hospital. But, he adds, this may also mean they do not build a relationship with one GP, who knows them well.

When he was a GP in Springburn, he used to offer evening surgeries and remembers his father deciding to close on Saturday nights only because of the number of drunks after football fixtures. Today, most GPs have given up responsibility for out-of-hours care and complain bitterly about the political drive to bring back some evening appointments.

"I think GPs have to be careful how far they go with this," says Mr Robertson. "What might happen is there will be a creeping privatisation. You could have Tesco operating surgeries."

Mrs Robertson hopes her children will have access to a named family doctor as they become parents, and could also rely on the support of a health visitor, should they need one. Pilot projects, which scrap health visitors in favour of a generic community nurse, are currently under way.

Illness
About 10 years ago Elsa Robertson, Fiona's mother, was diagnosed with breast cancer. She successfully battled the illness. But how much risk her daughter and grand-daughter have of developing the same disease is not precisely known.

As Emily grows up, the opportunity to obtain a clearer picture may become available to more girls, not just carriers of BRCA 1 and BRCA 2.

Dr Walker says: "We are not yet in a position, for example in breast cancer, to test women so that we could say, you have a greater risk, you do not, but we could well be substantially down that line within five to 10 years."

Furthermore, she foresees women taking preventative drugs to ward off the killer, just as statin medications are taken to guard against heart attacks today.

She says: "I do feel that in the next few decades we are going to have at some point some preventive medicine for the two big hormonal cancers, breast and prostate."

Mr Robertson, 68, was diagnosed with bladder cancer three years ago, and faced major surgery. As with asthma, cancer treatments are expected to improve, becoming more tailored to individual patients and better aimed at the affected cells.

Drugs which actually recruit viruses to help kill cancer cells and ways of targeting therapeutic molecules so they act only inside or around a cancer cell are being explored around the world.

"We may have treatments that negate the need for surgery," says Dr Walker, although she expects it still to be widely used as Emily and Robert grow old.

Grave
Under current projections, Robert can expect to live to 76 and Emily 81, and they will be in good company. Experts have predicted that by 2071 the UK will be home to more than 8.2 million octogenarians, compared with 2.4 million in 2001.

The burden this places on the NHS, as well as the rising costs of new treatments for conditions such as cancer, is the source of anxiety. The Robertson children might live longer than their parents and grandparents, but can the NHS survive their lifetime?

Dr Andrew Walker, health economist at Glasgow University, says the principle behind the NHS is equal access to care, when required, at the point of delivery - a promise he believes can be maintained while the service adjusts to suit the changing scenery. That does not mean the Treasury can afford everything for everyone the moment they need it. "That wasn't the case in 1948 and it will not be the case in 2068,"

he remarks.

Some researchers suggest identifying a core bundle of free services which could expected, but excluding anything from tattoo removal to fertility aid. Dr Walker says: "In the future, there will be more things that are explicitly not available on the NHS and the challenge facing the Scottish Government and UK government is whether they allow people to pay for those and effectively have a two-tier service based on income."

This concept worries Mrs Robertson and her father. He believes one of the problems with the NHS has been the introduction of managers with a "supermarket philosophy".

He says: "We are dealing with human beings - human beings with worries and concerns. I hope we never lose that."

Years of change

July 5, 1948 The NHS is born.

1958 Glasgow produces the first practical ultrasound scanners.

1960 A team at the Royal Infirmary of Edinburgh perform the UK's first successful kidney transplant, when they give a 49-year-old man a kidney from his twin brother.

1972 A fundamental discovery in Aberdeen shows how cells are programmed to "commit suicide", a key development in advancing the understanding of disease.

1974 The development of the Glasgow Coma Scale - a set of measures now used around the world to record a patient's level of consciousness.

1982 First case of Aids identified in Scotland.

1989 Keyhole surgery breakthrough when a patient's gall bladder is removed using minimally invasive techniques in Dundee.

2006 Smoking is banned in enclosed public places in Scotland.