In 1945 a Labour government was elected and new health minister Anuerin Bevan set about implementing the party’s manifesto promise for a National Health Service.
Convincing the medical profession to back the NHS was not easy. While many doctors generally supported the principles of the NHS, they also feared their loss of independence and were concerned about remuneration. Some 84% of GPs voted against the introduction of the NHS in a BMA vote held in January 1948.1
However Mr Bevan was an astute politician who first won over the royal colleges and hospital specialties to the NHS cause, with GPs eventually following suit.
On 5 July 1948, 86% of all GPs joined the NHS and over the next six months the proportion rose to 96%.2
GPs in the NHS received a capitation fee for each patient who registered with them and they had to meet the costs of running the practice out of those fees.
Given that people now had access to a doctor free of charge, unsurprisingly the early years of the NHS saw a steep rise in GP workload. The average consultation rate per person per year rose from 2.8 in 1947 to 5.6 in 1950.1
The 1950s were a difficult period for general practice. A highly critical report by Joseph Collings in 1950 concluded that ‘the overall state of general practice in England is bad and still deteriorating’.3 He believed there was no planning for general practice and few incentives for good practice.
The report provoked an angry response from the profession, with many believing it to be unfair. However, it did lead two GPs, Drs John Hunt and Fraser Rose, to the conclusion that the profession needed a college to help raise morale and improve standards. Their discussions led to the founding of the College of General Practitioners in late 1952. It received its royal charter in 1967.
During the late 1950s and early 1960s it became apparent that there were huge challenges in general practice, perhaps key of which was the way GPs were funded.
GPs had huge workloads and many tasks could have been carried out by nurses or secretaries, but there was no funding to enable this to happen. There were also concerns about training and education for GPs and a lack of research in general practice. A number of reports in the early 1960s helped to define the problems facing the profession and suggest solutions.
The Gillie report
The most important of these was the Gillie report, published in 1963 and authored by Dr Annis Gillie who had been the first female chair of the College of General Practitioners from 1959 to 1962. The report made a series of recommendations about how the profession could change including mandatory vocational training, the expansion of post-graduate education, more research in general practice and easier exchanges of staff between general practice, hospitals and public health.2
November 1963 also saw the publication of the very first issue of GP newspaper.
The first issue of GP, November 1963
The editorial of that first issue discussed the Gillie report: ‘The central problem in general practice is the increased load of work, while the present method of remuneration offers scant encouragement to good work,’ GP argued. ‘One wonders after reading this report not why the entry of new young doctors to general practice has been falling off, but that there are any applicants at all.
‘The committee’s recommendations are far reaching and fundamental… All this is stirring stuff. Let us hope it will stir the minister and his advisers.’
The report did eventually stir the government to act, but not quickly enough for many. In 1964, the profession came close to mass resignation from the NHS. Finally, in 1966, following negotiations between the government and the BMA, new terms of service – the family doctor charter – were agreed.
The charter was first proposed by the BMA in 1965, at which time GP said: 'It may prove in years to come that this charter is as important to family doctors as the Charter of the United Nations is to human freedom.' Which perhaps gives some indication of the pressures GPs were under in the early 1960s.
Family doctor charter
The charter delivered major changes in the way GPs were paid, under a system which became known as the red book. This enabled GPs to claim 70% of the cost of employing ancilliary staff and 100% of premises costs. It also paid additional fees for GPs who accepted responsibility for patients outside of ordinary hours and financial incentives were introduced for group practices of three or more doctors, for work in under-doctored areas and for undertaking continuing education.2
In addition, there was a commitment to encourage the creation of departments of general practice in all medical schools.
The charter was a turning point for the profession allowing GPs to improve their premises, employ practice nurses, receptionists and secretaries and form partnerships.
As Dr Fry explained in 1988: ‘In one leap general practice moved into a new era. It was up to GPs themselves to use the opportunities. This they did to the full. Group practice grew, many more staff were employed, better premises were built and working conditions improved.’2
- Loudon I, Horder J, Webster C. General Practice under the National Health Service, 1948-1997. Oxford: Clarendon Press, 1998.
- Fry J. General Practice and Primary Health Care 1940s-1980s. London: Nuffield Trust, 1988.
- Collings JS. General practice in England today – a reconnaissance. Lancet 1950;1:555-79.