History & Chronology
History of the College
By Ian Tait
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
relation to the history of general practice in Britain and its
troubled state in the years immediately 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’ 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.
With the introduction of the
National Health Service in 1948, this ‘panel’ system was
extended to cover the entire population. 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 many of the other provisions
made available under the NHS.
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. He report made it impossible for the medical
establishment to ignore a crisis that was overwhelming general
practice.
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 by some of
its concerned and influential leaders.
They shared a 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. Such a college, it was
argued, could provide leadership for those many doctors anxious to
work for better standards in general practice, and would also make
it possible to attract into practice young doctors of the highest
quality.
In 1951 a small group of doctors met
to consider the formation of a ‘Steering Committee’ to plan such a
college. It included Drs. Fraser Rose (Preston), Geoffrey Barber
(Dunmow), Talbot Rogers, and John Hunt. The latter’s practice in
London put him in personal touch with many influential figures in
the medical world.
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Under his guidance the Steering Committee took shape to be
chaired by Sir Henry Willink, Master of Magdalene College,
Cambridge, and previously Minister of Health 1943- 45. Willink was
later to describe his role as Chairman of that Steering Committee
as ‘one of the very best projects with which I have ever been
involved in my life’.
The Steering Committee held its first meeting in February
1952. It had 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 it’s 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. They remain moving personal testimonies of those heroic
times.
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. Fifty years on this division is
still a matter of concern.
Regional Faculties
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
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George
Abercrombie
Chairman
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John Hunt
Honorary Secretary
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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.
Under its founding editor, RMS McConaghey the College's Research
Newsletter, first 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 with a listing in the Index Medicus.
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.
Vocational Training
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.
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. This was a great
challenge to the College. The Vocational Training Working Party
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.
The Chairman of the Vocational Working Party, John Horder,
also chaired the small group that 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.
The fulfillment 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.
Undergraduate Education
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 in the creation of
many new chairs and departments has been influential but not
direct.
The College as an
Institution
Following the foundation of the College, the medical
establishment, despite early misgivings, recognised that the new
College was going to be of benefit both to general practice
and to British medicine. The College’s partnership with the BMA,
not always easy, matured and strengthened and its contributions
became important to the Government and to the work of many
institutions concerned with health care both at home and
abroad.
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.
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. In its evident determination to
be rigorous in its pursuit of good standards in general practice
the College is proving true to the spirit of its founders.
The Future
As the College completes its first half century general
practice 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. 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.
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