As I recall
BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7150.40 (Published 04 July 1998) Cite this as: BMJ 1998;317:40
- David Morrell, former professor of general practice.
- 14 Higher Green, Epsom, Surrey, KT17 3BA
At the end of half a century of general practice in the NHS it is interesting to reflect on the enormous changes that have occurred in this branch of medicine. My qualifications for doing so are that I entered medical school in 1947, graduated in 1952, entered general practice in 1957, and retired in 1993. I was active in the College of General Practitioners from its earliest years and in academic general practice from its inception. I have worked with most of the leaders in general practice over this time. From this very personal perspective I attempt to review the evolution of general practice in the NHS.
Summary points
The NHS introduced free access to primary care services to the entire population, and in operating the new service general practitioners and their patients were confused about their roles
Research in the first two decades of the NHS clarified the diagnostic methods appropriate in managing illness in primary care, and the training and organisation needed to fulfil this role
After the family doctor charter in 1966, research and training in general practice and the reorganisation of primary care flourished
The changes introduced in 1990, compounded by cultural changes in the population and the profession, now challenge the role of the general practitioner as a provider of personal and continuing primary medical care
The early years
I have no personal experience of general practice before or immediately after the introduction of the NHS. To get a feel for the benefits and difficulties that the NHS brought to the lives of general practitioners it is necessary to turn to anecdotes from doctors living through that time, leading articles and letters in medical journals, and a limited number of biographies.
The one great financial benefit that the service conferred on many general practitioners was to relieve them from the …
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