Celebrating 70 years of primary care in the NHS
NAPC is delighted to be joining the NHS in celebrating 70 years since it was created.
The NHS was formed on 5 July 1948 – and for the first time, hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella organisation to provide services that were free for all at the point of delivery. Primary care looked very different before 1948 and on the day the NHS was formed.
It has taken seventy years and many milestones to develop into the services we recognise today.
1948 – 2018
1950The Collings report – the first major report on quality in general practice – found poor standards of care, bad working conditions and isolation from other professionals. Many GPs worked under considerable pressure, with limited support. This report was followed by further studies; leading ultimately to the foundation of the College of General Practitioners in 1952.
1950sIn the 1950s some GPs started to employ receptionists. The first nurses started to be employed by GP practices in the late ‘50s.
1952Prescription charges were introduced and charges for dental treatment were put in place. Charges for prescriptions cost one shilling – around 5p and ordinary dental treatment was £1.
1956The General Dental Council was established in order to protect the general public and regulate dentistry in England including dental hygienists, dental therapists, dental nurses as well as technicians.
1958In 1958 one of the key features of primary care as we recognise it now was born with the routine vaccination of children under 15 against disease. The first programme vaccinated against polio and diphtheria and was a huge success, reducing cases of both illnesses dramatically. In the 50s the middle of the night knocks on the door became a thing of the past as GP partners took it in turns to be available out of hours – more people had telephones so the GP would often called ahead to the next patient using the home phone of the current one.
1960sIt wasn’t until the 1960s and 1970s that primary care started to develop down the lines that are familiar today. Populations and practices grow so that fewer doctors were working alone. New buildings replaced the surgeries in the doctor’s front room. More staff were employed. Appointment systems were introduced. Patients were more affluent and more mobile so fewer home visits were needed.
1960A new contract improved pay and conditions for GPs, set a maximum list size of 2,000 patients and provided resources for professional education, improvement of premises and hiring of support staff. The following years saw improvements in terms of recruitment and facilities and an increasing trend for group practice to become the norm.
1988The prevention agenda took another leap forward in 1988 when the NHS sought to reduce the number of breast cancer deaths in women over the age of 50 by offering free mammograms. Early intervention and improved drug therapies significantly reduced the number of women dying from the disease.
1990The new GP contract provided incentives for more health promotion and to provide better care for patients. It led to major increases in the skills and size of primary health care teams. During the 1990s more and more GP practices embraced the technology which allowed them to establish electronic records and management systems.
1998NHS Direct was launched in 1998. It handled more than half a million calls each month before its replacement by 111 and was one of the largest single e-health services in the world. It was part of a trend towards providing alternatives to traditional GP services which included walk-in centres.
2000NHS walk-in centres were introduced to offer walk-in access to a range of NHS services. They were run by nurses and operated without appointments.
2009The NHS Constitution was published in 2009 and outlined what staff, patients and the public can expect from the National Health Service for the first time.
2009Health checks for adults in England between the ages of 40 and 74 were introduced, helping GPs to establish a better picture of the state of their patients’ health. They were then able to more effectively support patients and reduce their risk of developing heart disease, stroke, type 2 diabetes and kidney disease.
2015NHS England Chief Executive Simon Stevens launched the primary care home programme in the autumn of 2015, with rapid test sites selected in December 2015.
We are gathering memories from a range of people who have worked in primary care over the last seven decades to celebrate the great achievements of the NHS. Please send your anecdotes or reflections on how primary care has changed to firstname.lastname@example.org.
“My father set up as a GP in Airedale, Castleford in about 1923 and a house was built for him by the local colliery where he was employed as its doctor… His first home visits were made on a Douglas motor bike. Back then, some people couldn’t afford to visit the dentist or the vet so my father would even extract teeth and put dogs down too.”