History of the College
When the College of General Practitioners was founded in 1952, The Practitioner described it as ‘an outstanding event in the history of British medicine’, a claim that can best be understood in the context of the troubled state of general practice in the years immediately preceding and following the introduction of the National Health Service in 1948.
General practice, as we know it today, took shape in the nineteenth century and the early decades of the twentieth. During that period there was a progressive separation of the role of general practitioners from that of physicians and surgeons, who specialised and held hospital appointments from which general practitioners were largely excluded In this division the GP became the personal doctor working in the community while consultant physicians and surgeons controlled the hospitals with their scientific and technical facilities. Patients who needed these services were referred to consultants by their general practitioners.
A second significant development was the introduction of the National Insurance Act of 1911. Under this act all eligible working males were placed on the ‘panel’ (or list) of a named general practitioner who received an annual ‘capitation’ fee to provide for their general medical care. General practitioners thus became responsible for the provision of primary health care within a national system funded by the state. The ‘panel’ was extended to everyone in 1948, on the introduction of the NHS. General practitioners were then required to provide primary and personal medical care for every patient registered with them. In addition they became the gateway through which patients normally gained access to specialist hospital care, sickness benefit, and other health and social care services.
General practice had no adequate physical, administrative, or financial resources for this task. The workload was prodigious. Oral histories from that time [now at the National Sound Archive] record heroic efforts to cope, and often reflect approval for the concept of a fair and free medical service. But idealism was not enough. Inevitably, in the face of an impossible task, morale and standards fell. It became evident that general practice, vital to the functioning of the new Health Service, was failing
In 1950 The Lancet published a report, made by a visiting Australian doctor on his personal survey of British general practice (Lancet.1950.1.555-585). He had come prepared to admire and to learn, but was appalled by what he found. In his report, which was given prominence by the Lancet, he painted a dramatic picture of exhausted and demoralised doctors, hurried work and low standards. His report made it impossible for the medical establishment to ignore the impending crisis.
The Foundation of the College of General Practitioners
"I had far rather start with a big idea in a small way than a small idea in a big way"
John Hunt to Fraser Rose 3 Dec 1951
It was against this background that the idea of a college for general practitioners began to be expressed. There was a shared belief that what was needed was an academic body to support good standards of practice, education and research, such as already existed in other medical colleges. So in 1951 a small group of doctors met to consider the formation of a ‘Steering Committee’ to plan such a college. Its first meeting in February 1952 and consisted of seven general practitioners and five consultants who were known to be sympathetic to the idea of a college; very much a minority view amongst the medical establishment at that time. The Steering Committee only met eight times. The minutes of those meetings are available in the archives of the College and are an eloquent testimony to its remarkable work.
At the Committee’s eighth and final meeting in November 1952, less than nine months after its first meeting, a College of General Practitioners was legally constituted and a Foundation Council formed, having responsibility for drafting a constitution to be presented to the first AGM planned for November 1953. The report of the Steering Committee was published as a supplement in The Practitioner.
The Foundation Council
The announcement of the formation of the College of General Practitioners was well received by the medical press. Personal support was expressed by the Secretary of the BMA, Angus Macrae, and by the Society of Apothecaries whose Court was to offer the new College hospitality for the meetings of its Foundation Council, describing itself as a natural home for general practice. But the most valued support came from the many individual practitioners who wrote to express their approval and their gratitude both for the creation and for the ideals of the new College.
The task facing the Foundation Council, when it was formed in November 1952, was to create a viable organisation for the College to be presented at the first AGM, to be held in November 1953. In December, a finance and general purposes committee was formed and the Foundation Council was enlarged to a total of twenty three members with G.F. Abercrombie as chairman and John Hunt as secretary. In January 1953 undergraduate and post graduate committees were formed, together with a research committee. These committees immediately started work to prepare reports and recommendations for presentation at the first AGM
In January 1953 ‘Foundation Membership’ was offered to established GPs who satisfied defined criteria. Within six weeks 1655 doctors had joined and Membership continued to rise. If there was a downside to this encouraging response, it was that it created a division between those general practitioners who joined and those who, for whatever reason, did not.
An important objective for the Foundation Council was to establish a strong regional organisation for the College. The determination to do this was strengthened by the awareness that efforts to form a college of general practice in the nineteenth century had collapsed because of the absence of any such organisation which could represent the views and interests of GPs throughout Britain.
A structure of regional Faculties was proposed which would assume local responsibility for advancing the aims of the College. Each Faculty would have a Provost in a presidential role, an executive Chairman, and an elected Faculty Board. The Board was to nominate at least one member to represent the Faculty on the College Council. Sub- committees would be created to cover local education and research. The Faculties were to be financially independent, with an ability to raise funds for their own purposes, as well as receiving some limited funding from the College.
The first AGM of the College was held in the great hall of BMA house in November 1953. The Foundation Council retired and was elected as the first College Council, with William Pickles as President, George Abercrombie as Chairman and John Hunt as Honorary Secretary.
The College in Action
In its first years the College’s activities were dominated by the need to consolidate the organisation, find appropriate accommodation and establish effective working relationships with other bodies. The work of the College’s committees became productive and a number of important reports and publications made it evident that it was becoming an influential think- tank for the academic life of general practice. The College became incorporated in 1962. Formal recognition of its status came in 1972, a year in which the College was granted its Royal Charter and HRH Duke of Edinburgh became its President and Patron. HRH Prince of Wales was also the President of the College in 1992
The first Research Newsletter, issued in February 1953, developed in the next decade into the Journal of the College of General Practitioners. This was the first scientific publication to be dedicated to research in general practice and it quickly earned an international reputation. The College has been active in support of research in general practice throughout its life, whether undertaken by individuals or in co-operative studies which have offered new and important research opportunities through the involvement of many practices.
A field in which the work of the College was to prove uniquely effective was in the development of postgraduate training for general practice. Influential reports on this subject were published by the College in the 1960s. In 1964 the Vocational Training Working Party was formed and became the focus for a positive explosion of ideas and initiatives. Many of them originated at Faculty level, thus confirming the vision of the Foundation Council that the Faculties should become vital sources of creative energy in the life of the College. A small group from this party wrote and published ‘The Future General Practitioner’, an ambitious attempt to define the role of the GP together with the knowledge, skills and attitudes needed in general practice. The book became immensely influential in the design of vocational training schemes both in Britain and abroad.
In 1966 the College submitted evidence to the Royal Commission on Medical Education. This was to prove of decisive influence in shaping the recommendations of the Commission when they were published in 1968 (Todd Report). The Report made a powerful case for the recognition of general practice as a separate discipline within medicine, requiring its own form of postgraduate training organised by general practitioners. The fulfilment of the College’s work came in 1976 when parliament approved legislation making vocational training a requirement for any doctor seeking to become a principal in general practice and set up new national organisations to administer the act.
The College’s interest in undergraduate education dates from its foundation but its early hopes of influencing the medical schools were frustrated for many years. In 1963 Richard Scott was appointed to a new chair of general practice in Edinburgh; a world first. But it was not until 1972 that the first chair in England was created for Pat Byrne in Manchester. Since that time the College’s role has been influential but not direct.
Examinations and Standards
An important achievement has been the creation of an effective examination for Membership, which is also used to recognise the successful completion of vocational training. For the last twenty years increasing attention has been paid to the complex and sensitive issue of how best to define and maintain good standards of practice. As early as 1983 the College launched its ‘Quality Initiative’ which encouraged doctors to define the services they felt their practices should be providing and to monitor their ability to do so.
In 1985 the ‘What Sort of Doctor’ report was published, which recorded the result of four years of work to develop systems to assess the quality of care by matching individual performance against defined and agreed criteria of competence. In the same year the College published 'Quality in General Practice' as a major policy document. In line with its policy that assessment of quality in general practice is not only possible but necessary, the College is now promoting the idea of assessment as the preferred route to Fellowship as well as Membership.
As the College celebrates 60 year supporting general practice, the sector is no longer the ‘cottage industry’ it was in 1952. At that time it was not uncommon to hear doubts expressed about its very survival. Today it is clear that it is the Health Service that cannot survive without general practice. GPs are at the centre of the plans to reform the NHS, and are poised to take on responsibility for planning and commissioning local health services. In an environment where increased competition is being encouraged, they have to be business minded and keep an eye on the purse strings, embrace greater patient choice and new developments in technology.
New challenges lie ahead, but the College’s aim for its Members and Fellows, and indeed for all general practitioners, remains unaltered: to support the general practitioner as the personal doctor at the heart of our Health Service, to ensure good standards of practice, and to contribute to the academic life of medicine.
Essay written by Ian Tait, May 2002
Edited and Updated by the Archivist, March 2012