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
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.
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.