The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

13
The National Health Service

THE Beveridge Report's blueprint for post-war welfare reform, of which the National Health Service was to be such a notable feature, was published in 1942, and two years later the wartime coalition government's White Paper, A National Health Service, was issued. A landslide Labour victory in the general election of 1945 then made possible a much more radical transformation of the health service. The interim Report of the Medical Planning Commission ( 1942)1 and the Goodenough Report on Medical Education ( 1944) had also articulated the aspirations of the medical profession for this new health service. The latter gave a central role to general practitioners within it:

One of the principal aims of national policy should be to secure for everyone the highest possible standard of physical and mental health . . . By becoming advisers on health both to individuals and to the community, medical practitioners will have bear much of the responsibility for ensuring this result.2

This chapter is concerned with the historical role that GPs played in shaping this new health service, and with the reception of the NHS by doctors and their patients.

A very extensive historiography on conflict or consensus in the formation of the NHS has given varied roles, alliances or animosities to socialist idealists, medical corporations, and paternalist bureaucrats.3 In concentrating on the few years preceding the NHS historians have focused their attention on the state and the medical profession at a moment of high policy, but in doing so have tended to neglect the intervening period since the preceding high point -- the national health insurance scheme of 1911, and thus have not brought the interwar years adequately into focus in order to explain the role of ideologies and interests in shaping these legislative watersheds. In a discussion of public policy Michael Freeden called this the 'on/off switch', and has also referred to the 'treeless wood', the tendency to assume that a piece

____________________
1
The commission was set up by the Royal Colleges, the BMA, and the Scottish Royal Medical Corporation.
2
Goodenough Report, 10.
3
For an incisive discussion see C. Webster, "Conflict and Consensus: Explaining the British Health Service", Twentieth Century British History, 1 ( 1990), 115-52.

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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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