Primary care: core values Contracting for general practice: another turn of the wheel of history

Series editor: Mike Pringle

British general practitioners often assert their pride at being “independent contractors,” without remembering the origin of the term. Dr Ransome, pictured on his rounds as visiting physician to the local cottage hospital (box), was one of my predecessors in practice, and his extract from Kelly's 1908 directory of trade and professional people reminds us how most of our medical forebears earned their living.1 Others of my 19th century medical ancestors are entered in such directories as Surgeon to Waveney Valley Branch of Great Eastern Railway (Dr Adams, 18752), Surgeon to the Dispensary for the Poor (Dr Garneys, 18283), and Surgeon to the Rational Sick and Burial Association (Dr Johnstone, 18904).

This collection of contracts included occupational and public health services, treatment and certification of subscribers to friendly societies, care of inpatients at cottage hospitals, and a very basic service to the indigent poor (whether inside workhouses or on “outdoor relief,” as the forerunner of social security payment was called).

Although these arrangements initially seem to be relics of a bygone age, the modern general practitioner immunises children and adults, sees patients at the surgery or in the home, visits residential homes, and has hospital practitioner contracts at a community hospital or in a district hospital specialist department—he or she has a spectrum of work that bears a remarkable resemblance to that of Dr Ransome and his Victorian colleagues.

As well as these contracts, these doctors would have undertaken private consulting practice. John Scott, a well to do local diarist, records that he consulted Dr Garneys about his feeble sister Charlotte3 and, on behalf of concerned local worthies, about the 1849 outbreak of cholera in the town5. On New Year's Eve 1828 Dr Garneys was even called on to …