Two years ago it became clear that my life was going to be a continual juggling act between my family and my career as a GP.

Before the birth of my son, I underestimated how much of a logistical nightmare it was going to be, especially after a Caesarean.

After ten months, I returned to work and now do five sessions - or two and a half days - in a practice in Maidenhead. I usually start at 8.30am and finish about 5.15pm - but partnership hours can be much longer than this, which can be a problem when I'm due to pick Joe up from his childminder.

Obviously, anyone with a family and a job has to deal with similar problems, but there are particular issues in the medical profession, which is only just emerging from the dark days of 90-hour weeks for junior doctors. Moreover, it is currently going through a process of "feminisation".

Women account for only a quarter of consultants, but half of first year junior doctors, and three in five new medical students. By 2012, most doctors will be female.

But the fact that male doctors will soon be in a minority in itself does not give the whole picture. The demand for a work-life balance from men is far higher than it ever was before.

That most female junior doctors will hope to work less than full-time at some point in the future is probably not surprising. That four in ten of their male colleagues feel the same way is perhaps more significant.

Both men and women want better work-life balance, and social norms are shifting so that men are increasingly taking on a proactive role in childcare.

Not every doctor is going to put their career before their family, so the strategic importance to the NHS of providing both flexible working and better childcare is obvious. But from a doctor's point of view, it has been a case of one step forward, two steps back.

The European Working Time Directive was introduced for junior doctors for the first time in 2004, limiting their hours to 58 a week. While this has meant an end to the days of 90-hour weeks, it has also given rise to a new system of shift working, which means working at high intensity for up to 13 hours at a stretch, often starting and finishing at very family-unfriendly times.

There have been mixed fortunes, too, for doctors who need to work less than full time.

Junior doctors have begun to benefit from a new flexible training contract, which has allowed more of them to complete their training while working less than full time. However, the Flexible Careers Scheme, which allows fully trained doctors to work flexibly is currently at risk.

Under the scheme, doctors can work up to 50% of full time, and hours can be calculated to enable more work to be carried out at one time and less at others. Without this option, I simply would not have come back to work after my son's birth.

Unfortunately, the government has devolved responsibility for the programme to local bodies, and withdrawn funding after 2005/06. It looks like the scheme's days may be numbered, taking us back to a situation where it is impossible to have both a family and an NHS career.

On childcare too, there is a gap between the government's commitment to improving doctors' working lives and practical realities.

Recent government investment in the NHS childcare strategy, coupled with assurances from ministers that they understand the importance of childcare are encouraging. Unfortunately, the strategy is failing to address the fact that both patients and families need services round the clock.

Where nursery care is available - and it often is not - it is only open in the daytime, and services out of hours are patchy. Schools' working days and holidays rarely match up with junior doctors' working patterns, while very few trusts offer pre or after-school facilities or holiday clubs.

Childcare services in the NHS are woefully lacking. At my primary care trust, all flexible workers are supposed to have NHS childcare facilitators, but I have never had any help from the NHS with childcare.

Other countries have proved that the needs of patients and the needs of families are not irreconcilable.

That should be the ultimate goal for the NHS. But there is much that could be done in the short term.

There should be more nursery places available for NHS staff, more 24-hour childcare, and opportunities to work flexibly for all doctors who need to.

· Dr Beth McCarron-Nash chairs the BMA Junior Members Forum which this weekend hosts a conference on work-life balance, 21st Century Doctors ... A Life or Medicine?