The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

6
Organizing A Practice

'I ALWAYS felt I was like someone trying to get on a bus that was going, and . . . you never quite get both feet on the platform at the back. You were just chasing yourself all the time.'1 This chapter discusses whether limited time horizons and acceptance of traditional constraints characterized doctors' management of general practice, or whether there were more strategic, and entrepreneurial considerations that shaped the development and survival of practices through economically rational choices about staffing, accommodation, and technology. Much of the scattered evidence on this subject would suggest the dominance of a short-term approach in which the sheer burden of everyday work and patients' expectations militated against a longer-term vision. Several important underlying factors were also responsible for an inbuilt conservatism that tended to preserve the status quo. Throughout the period medical education -- which might have been expected to give a wider perspective -- was geared to the production of hospital clinicians, rather than general practitioners, so that training was focused on the scientific, rather than the organizational, features of professional life. Practicalities were learned during a series of locums and assistant's posts after qualification; this gave a limited 'apprenticeship' and a necessarily restricted focus. After setting up in medical practice the GP frequently worked single-handedly and, to a considerable extent, in professional isolation. Yet despite conservative influences perpetuating inherited methods of working, some doctors were able to respond to changing professional opportunities by achieving stronger practice organization, exploiting new technologies, or adopting more efficient time management. Within a century the single-handed, 'horse and buggy' doctor of Victorian times was being transformed into a purposive professional, frequently working in partnership and running a mixed practice of privately and publicly funded health care.

____________________
1
CMAC, GP29/2/27, John Evans, MA (Cantab.), MRCS Eng, LRCP ( London, 1946), MRCP ( London, 1953).

-126-

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The Evolution of British General Practice 1850-1948
Table of contents

Table of contents

  • Title Page iii
  • Acknowledgements vii
  • Contents ix
  • List of Plates, Maps, and Figures xi
  • List of Tables xiii
  • Abbreviations xiv
  • 1 - Constructing General Practice 1
  • PART I - Careers 21
  • 3 - Recruitment, Education, and Training 40
  • 4 - Reinventing Roles 66
  • PART II - In Practice 91
  • The Medical Market 93
  • 6 - Organizing A Practice 126
  • 7 - Women Practitioners 154
  • 8 - Medical Investigation and Treatment 187
  • 9 - Patients 224
  • PART III - A Wider World 257
  • 10 - Public Duties and Private Lives 259
  • 11 - Generalists, Specialists, and Others 287
  • 12 - National Health Insurance 306
  • 13 - The National Health Service 325
  • Select Bibliography 343
  • Index of Medical Names 365
  • General Index 369
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