Analysis And Comment Primary care

A century of general practice

BMJ 2006; 332 doi: (Published 05 January 2006) Cite this as: BMJ 2006;332:39
  1. Zosia Kmietowicz, freelance medical journalist (
  1. 1 London N16 7QJ

    The role of NHS general practitioners looks likely to expand over the next few years. The history of the specialty shows they are used to change

    The past 100 years have produced several important changes in general practice. It was during this time that general practice established itself as a separate specialty in medicine with a professional body and academic rigour. It is also a time when general practitioners have had to show considerable flexibility by adapting to the demands of a changing society as well as to politicians' ambitions for the health service.

    Start of the NHS

    Before the 20th century general practitioners worked as private traders, treating patients only if they had the means to pay. But in 1911 Lloyd George, then chancellor of the exchequer, introduced the National Insurance Act, making health insurance compulsory for working people on a low income.1 Local insurance committees administered the scheme, contracting general practitioners to provide general medical services. Doctors were paid an annual capitation fee for every insured patient who registered with them.2

    Conditions for general practitioners changed when the NHS was created in 1948 and everyone became eligible for free primary care. Although many general practitioners had been initially opposed to the idea because it might compromise their independent status, most signed up to the scheme “for the sake of their patients.”3 Many were relieved that they could now treat patients without worrying about whether they were able to pay. But the prediction by Lord Beveridge, the economist whose …

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