How primary care looked before 1948
- When the NHS was established in 1948 the central principle was that the new health service would be available to all and financed entirely from taxation, so people would pay into it according to their means.
- Ambulance services were set up to cope with emergencies.
- Many doctors didn’t want to become employees of the government and hospital consultants wanted to continue to charge private patients for treatment. A survey of GPs showed that 64% were against the NHS as they wanted the freedom to treat patients privately. The BMA organised a fierce campaign of resistance against Health Minister Aneurin’s vision of a free health service.
- Bevan finally got the cooperation of doctors when he promised new hospitals and equipment which were badly needed. He also agreed to allow doctors to treat private as well as NHS patients.
- Before the NHS, general practice and hospital medicine were very separate fields which were grossly underfunded in terms of premises and back-up services. Consultants gave their time free in exchange for private beds, and because of this were more interested in private patients and the GPs who sent them private patients.
The NHS in 1948
- In 1948 GPs took on responsibility for covering the entire population and controlling access to specialist care – a major expansion in their role. Within one month, 90 per cent of the population had registered with a GP.
- For the first time people had access to medicines on prescription. People plagued with rotten teeth were able to see a dentist for the first time. Deaf people could hear with new aids. Millions received free dentures and spectacles for the first time.
- Before 1948 general practice was a cottage industry. Most GPs worked independently usually from a consulting room in their own house. There were few if any staff and the duties of answering the phone usually fell to the GP’s wife (most doctors were male at that time) or in some cases a housekeeper.
- In the early days of the NHS most GPs still worked alone or with one other partner, usually in the front room of their own home. The waiting room might be an extension built on the side of the house.
- There were no appointments. Few patients had phones or cars so they would simply turn up and wait at morning and afternoon surgeries. In emergencies they would knock on the doctor’s door at any hour of the day or night. Doctors would answer middle of the night calls in their dressing gowns! Many consultations took place at patients’ homes.
- GPs helped midwives to deliver babies at home and some even assisted in operations at local cottage hospitals.
- Setting up a practice from scratch wasn’t easy and GPs had to borrow the £2,000 – £3,000 needed from their local bank or family.
- The major change for GPs was the inclusion of the whole family in a free medical service. Before 1948, the wage earner had free access to his GP but his wife and family were not covered, although most GPs treated them for a nominal fee or no fee at all in some cases.
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.
“We were responsible for 24/7 care 365 days a year. I’ve been on call on Xmas day and got up from lunch to do a house call. Our home phones would ring in the middle of the night (when on call) and often we could be driving to a patient’s house at 2, 3 or 4am… and then be in surgery at 8am. Wives/husbands would have to answer phones at home when we were out on call. The significant change to this only occurred in 2004, albeit by the mid 1990s we started to computerise, use mobile phones (the size of bricks on 1G and 2G) and sub-contract out of hours work to agencies/co-operatives.”Dr James Kingsland, GP and President NAPC