Intended for healthcare professionals

Feature NHS at 70

“Doing better, but feeling worse”: doctors’ 70 year relationship with the NHS—an essay by Nicholas Timmins

BMJ 2018; 361 doi: (Published 28 June 2018) Cite this as: BMJ 2018;361:k2683
  1. Nicholas Timmins, senior fellow
  1. King’s Fund, London, UK
  1. n.timmins{at}

Nicholas Timmins looks at how the medical profession’s relations with the health service, and the different governments that have run it, have evolved over the NHS’s 70 year history

The 70th anniversary of the NHS also means, of course, 70 years of a relationship between the medical profession, its patients, and the NHS itself. What a long, strange trip it has been.

From the original unwritten compact—“give the doctors the money and trust them to do the right thing”—to a time when leading figures in the profession took the view that it had become, quite simply, unsustainable.

From general practice experiencing a devastating fall, to a rise, and a fall again. From the doctor being all knowing, to patients arriving armed with internet printouts and their own diagnosis, having looked their medic’s attributes up in detail. To much more shared decision making, indeed risk sharing, between clinicians and patients.

From the solo to the team. From some engagement with the management of the service, to a near total rejection of that, to today’s partway house. From a hugely male dominated world to one where seven presidents of medical royal colleges are women. A much changed world—with much, though not all of it, changed for the better.

This is the personal and partial view of a reporter who has spent 40 odd years reading the NHS’s history and watching it in operation. It is focused on what has chiefly engaged me: the money and the management.

Turbulent evolution

At the very beginning, the battle over the foundation of the service, despite its being portrayed (accurately) as one between Aneurin Bevan and the BMA was actually one between Bevan and the GPs. The presidents of the three senior royal colleges were in fact the midwives who helped Bevan deliver it.

The deal gave the …

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