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Doctors, Public Service and Profit: General Practitioners and the National Health Service

Published online by Cambridge University Press:  12 February 2009

Charles Webster
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Extract

GENERAL medical practitioners are a dominant element within the medical workforce. They are the largest specialism, currently accounting for about two-thirds of the senior medical personnel employed by the National Health Service (NHS). They exert a strong political influence by virtue of their importance in the British Medical Association (BMA) and its complicated representative and negotiating machinery.

Type
Research Article
Information
Transactions of the Royal Historical Society , Volume 40 , December 1990 , pp. 197 - 216
Copyright
Copyright © Royal Historical Society 1990

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References

1 In 1939 there were about 18,000 general practitioners giving service under National Health Insurance, compared with 6,000 consultants and specialists, Hill, A. Bradford, ‘The Doctor's pay and day’, Journal of the Royal Statistical Society, civ (1951), 1–34Google Scholar. The numbers had not changed appreciably in 1949. In 1988 there were about 26,000 general practitioners registered with the NHS, and 13,500 consultants employed by health authorities.

2 Address of I. Macleod to the Fifth Annual Conference of the Executive Councils Association, October 1952, 2. Address of R.H. Turton to the Ninth Annual Conference of the Executive Councils Association, October 1956, 6.

3 Spens to Sir E. Fass, 15 February 1946, Public Record Office, MH 77/176.

4 Note by official on meeting with Insurance Acts Committee, 13 November 1946, PRO, MH 77/177.

5 Eckstein, H., The English Health Service, its Origins, Structure and Achievements (Cambridge, Mass., 1958)Google Scholar; idem, Pressure Group Politics, the Case of the British Medical Association (1960); Honigsbaum, F., The Division in British Medicine: A History of the Separation of General Practice from Hospital Care, 1911–1968 (1979)Google Scholar; idem, Health, Happiness, and Security, The Creation of the National Health Service (1989); Pater, J., The Making of the National Health Service (1981)Google Scholar; Stevens, R., Medical Practice in Modern England. The Impact of Specialization and Stale Medicine (New Haven, 1966)Google Scholar; Webster, C., Problems of Health Care: the National Health Service before 1957 (1988)Google Scholar.

6 Titmuss, R. M., Essays on ‘The Welfare State’ (2nd edn., 1963), 160Google Scholar: ‘private practice was much less remunerative in the 1930s than most people were aware then or imagine today’.

7 Digby, A. and Bosanquet, N., ‘Doctors and patients in an era of national health insurance and private practice, 1913–1938’, Ec.H.R., 2nd ser., xli (1988), 74–94CrossRefGoogle Scholar.

8 Political and Economic Planning, Report on the British Health Services (1937), 149–54Google Scholar.

9 Dr G. L. Pierce, Abercynon, Glamorgan, 13 July 1945, PRO, MH 177/173.

10 The fees included: 3 gn for obstetric service under the Midwives Acts 1902–36, 2 gn for exumination and certification of persons of unsound mind or those judged mental defective, and £1 5s for examinations conducted for superannuation purposes.

11 Sources for the £1,000 idea, see Digby and Bosanquet, 77, also T. Lister, Spens Committee, 11 January 1946, PRO, MH 77/173.

12 Calculated from Spens Report (see n. 30 below), Table 4, p. 22, and Hill, Table 13, p. 22. Titmuss, , Essays, 159Google Scholar, is sceptical about Hill's findings.

13 PRO, MH 77/172.

14 NHS 9, 1943, PRO, MH 77/26.

15 Pierce to Spens Committee, PRO, MH 77/173.

16 Webster, 5–9.

17 Webster, 34–9; Harris, J., William Beveridge: A Biography (Oxford, 1977), 378–418Google Scholar.

18 Webster, 44–50; Honigsbaum, , Health, Happiness, 33–51Google Scholar. Lewis, J., What Price Community Medicine? The Philosophy, Practice and Politics of Public Health Since 1919 (Brighton, 1986)Google Scholar.

19 Maude, 23 June 1943, PRO, MH 80/26.

20 Honigsbaum, , Health, Happiness, 51–94Google Scholar.

21 Titmuss, R. M., Problems of Social Policy (1950), 517Google Scholar; idem, Essays, 75–87.

22 See sources cited in n. 5 above.

23 Maude, 23 June 1943, PRO, MH 80/26.

24 The chief veterans were: H. G. Dain (born 1870), E.A. Gregg (born 1881), and S. Wand (born 1899). They were advised from the sidelines by such figures as Alfred Cox (1866–1954), who was Medical Secretary of the BMA from 1912 to 1932.

25 BMA, evidence to Spens Committee, 28 11 1945, PRO, MH 77/173. See also Gilbert, B. B., The Evolution of National Insurance in Great Britain (1966), 408–9Google Scholar.

26 BMA, memorandum to Spens Committee, 1945, PRO, MH 77/172.

27 More detailed consideration of inter-war controversies surrounding the NHI capitation fee is contained in Eder, N. R., National Health Insurance and the Medical Profession in Britain, 1913–39 (New York, 1982)Google Scholar; Gilbert, National Insurance; idem, British Social Policy,1914–1939 (1970). 267–76.

28 British Medical Journal, 1944, i, Supplement, 6–7.

29 Maude to Charles Hill (the newly appointed Secretary of BMA), 17 May and 10 July 1944, PRO, MH 77/172.

30 Ministry of Health and Department of Health for Scotland, Report of the Inter-Departmental Committee on the Remuneration of General Practitioners, Cmd. 6810 (1946), Spens Report.

31 BMA, memorandum to Spens Committee, 1945, PRO, MH 77/172.

32 Hill, 1–18. This and other evidence is considered by Titmuss, , Essays, 206–7Google Scholar.

33 Hill, 24–6.

34 BMA evidence to Spens Committee, 28 November 1945, PRO, MH 77/173.

35 Meeting of Spens Committee, 11 January 1946, PRO, MH 77/173.

36 Eckstein, , Pressure Group Politics, 127Google Scholar.

37 Douglas to Hill, 22 July 1946, PRO, MH 77/177. Sir James Douglas succeeded Maude as Permanent Secretary in the autumn of 1945.

38 Spens Report, para. 13.

39 Douglas to Hill, 22 July 1946, PRO, MH 77/177.

40 PRO, MH 77/177.

41 The BMA regarded a capitation fee of 20s as the basis for an average net salary of £2,000; evidence to Spens Committee, 28 November 1945, PRO, MH 77/173.

42 Sir B. Gilbert to B. F. St.J. Trend, 28 November 1947, and note by Cripps, 29 November 1947, Treasury, SS 5/150/01 A.

43 For further detail, see Ministry of Health, Handbook for General Medical Practitioners (1955), 36–53Google Scholar.

44 Eckstein, , Pressure Group Politics, 127Google Scholar.

45 Department of Health (DH), 94256/5/2, 94256/6/75.

46 General Medical Services Committee, Statement of Case, Danckwerts Adjudication, 1952, Treasury, SS5/150/OIC.

47 Eckstein, , Pressure Group Politics, 126–50Google Scholar, an excellent condensation, but faulty on many points of detail, including dates.

48 Meeting between GMSC representatives and Ministers, lasting 6 hours, 9 May 1951, Treasury SS5/150/O1B.

49 DH, 94157/I/I.

50 Report of the Committee on General Practice within the National Health Service (1954), Cohen Report.

51 The essential sections of the Danckwerts adjudication are given in Ross, J. S., The National Health Service in Great Britain (1952), 387Google Scholar and Report of the Ministry of Health 1952 (1953). 37–8.

52 Distribution of Remuneration among General Practitioners (1952).

53 Titmuss, , Essays, 208–9Google Scholar.

54 R. Ross, ‘The Family Doctor in Factory Town’, CHSC (GP)(53)E87, DH 94I57/4/4.

55 Collings, J. S., ‘General Practice in England Today, A Reconnaissance’, The Lancet, 1950, i, 555–85, 558, 568CrossRefGoogle Scholar.

56 Peterson, O. L., A Study of the National Health Service of Great Britain, Typescript, Rockefeller Foundation, New York, 11 1951, 54Google Scholar.

57 A National Health Service, Cmd. 6502 (1944), 83–4;Royal Commission on the National Health Service Report, Cmnd. 7615 (1979), Table E9.

58 Report of the Ministry of Health, 1952, 37.