It is very rare I work less than 42 hours in any given week, though I don't religiously keep count of it all, but likewise if I need a few hours off here or there (for a dental appointment, family issue, or what-ever else) it "just happens" - my flexibility is appreciated and offered back when I need it, which I consider rather civilised. Occasionally there are crunch times when a lot of overtime is needed, which we don;t pay for overtime (I keep hinting!) time-off-in-lieu is arranged and there is usually no pressure if you simply can't do the extra due to personal commitments.
Working a fixed number of hours to the minute and watching the clock, while stable, doesn't strike me as a "human" way of running things. There was a time when there was a definite flexibility mis-balance and I "worked to rule" for a time to prove a point, but that was resolved quickly at that point. Of course I don't work for a massive company - I imagine the effort of policing more flexible conditions in order to make sure no one is taking the piss at the expense of others would be much more difficult for a multi-national.