Fortunate men or penny collectivists? General practice in Lancashire and Westmorland during the “classic” NHS

Abstract

The enduring image of general practice during the “classic” NHS, from its creation in 1948 until its first major reform in 1974, is that provided by John Berger’s poetic prose and Jean Mohr’s captivating photographs in their 1967 study A fortunate man. It paints a picture of a country doctor equipped with almost universal medical expertise singularly devoted to his patients and his rural Gloucestershire community to the exclusion of everything else. Whilst such an image of general practice as a slow, idyllic cottage industry is alluring given the modern experience of industrialised primary care, it fails to capture the pressures and constraints of working under the NHS. Pressures were different but similarly inexorable, and noticeable by their absence from Berger and Mohr. Instead, it is far more accurate to see general practitioners (GPs) as “penny collectivists” within a burgeoning socialised medical economy which favoured the extension of hospital services. Within this health economy GPs were effectively impoverishedentrepreneurs being squeezed from below by rising patient demand, expectations, and professional rivalries, and from above through a complex corporate bureaucracy. This paper captures this dynamic through the oral histories of GPs who practised in Lancashire and Westmorland combined with archival records of local primary care bureaucracy from 1948 to 1974.