The British National Health Service (NHS) Act finally became law in 1947. Scotland in general, and Glasgow in particular, had led the way to its final introduction by Aneurin Bevan, Minister for Health in the post-war Labour Government.
Many and long were the previous reports and debates. One of the most effective was that of Edward Cathcart (1877 – 1954) in 1936. He was then Professor of Physiology at the University of Glasgow. His report strongly supported the vital role of the General Practitioner in a new, unified health service.
‘The general practitioner, acting normally as family doctor, is an indispensable instrument of national health policy. Without his assistance, as health adviser and as a principal liaison between the homes of the people and the statutory medical services, these services cannot, in modern conditions, function to the full extent as part of a comprehensive policy for promoting and safeguarding the health of the people.’
Cathcart Report, 1936
In 1941 William Beveridge (1879 – 1963), a British economist and social reformer, made a very strong case for a complete re-organisation of the welfare state arguing that the post-war government must fight the five giant evils: Want, Disease, Ignorance, Squalor and Idleness.
the post-war government must fight the five giant evils Want, Disease, Ignorance, Squalor and Idleness
On 5th July 1948, the Government took over. Everything was to be funded out of Government funds, paid for by general taxation. Initially everything was available at no cost to the individual.
Anecdotes abounded. Patients expected to receive everything – from simple cotton wool to complicated surgery, for no extra payment. In Glasgow, the ‘poor law’ hospitals such as the Southern General and Stobhill were reinstated as General Teaching Hospitals.
Until 1972, undergraduate medical students in Glasgow remained largely unaware of the world of General Practice. It was not taught in the medical school. Those who were interested could spend one week in practice, courtesy of a remarkable General Practitioner, Dr William Fulton (1917 – 1998).
He was active in the British Medical Association and a founding member of the Royal College of General Practitioners in 1952.
His singlehanded crusade continued until 1972, when Hamish Barber (1933 – 2007) was appointed as Senior Lecturer in Primary Medical Care, funded by a private donation from the General Accident Insurance Company.
Unlike any other course in the curriculum, he was challenged to prove the effectiveness of teaching in general practice. By 1974, he had provided evidence that students who had been through a general practice module out-scored a control group who had not.
Thereafter, as the first holder of the Norie Miller Chair of General Practice, he met the challenge head on. His Textbook of General Practice Medicine was published and within two years the University of Glasgow established a separate University Department in General Practice. Originally based at the then new Woodside Hhealth Centre, the course gradually expanded to contribute to every year of the undergraduate curriculum.
A key development in 1990 was the introduction of a four-week final year attachment in general practice, led by Dr Jill Morrison who subsequently became the first, and only, General Practitioner and woman to become Head of the Undergraduate Medical School.
Professor Barber, whose research also included clinical trials of common conditions in general practice settings, retired in 1993, to be replaced by Professor Graham Watt (1994 – 2016). Watt had trained in epidemiology with Dr Julian Tudor Hart, a pioneer of research in high blood pressure in general practice in Wales.
Watt continued this interest in Glasgow, adding a family component to the Paisley-Renfrew (MIDSPAN) population studies of cardiovascular diseases and cancer.
He also researched the associations of social deprivation with poor health, updating Tudor Hart’s classic paper on the Inverse Care Law (the availability of good medical care tends to vary inversely with the need for it in the population served) to show that in the 21st century the inequality had worsened.
He also highlighted the challenges faced by general practitioners in Scotland, and especially in Glasgow, who served the most deprived communities, graphically describing their situation as struggling to swim in the deep end of a swimming pool.
In the 1990s, Graham Watt was heavily involved in setting up the ‘new curriculum’ at Glasgow University, which started classes in 1996.
Experiences gained in a General Practice setting were involved in every year of the course and were subject to both formative and summative assessment. The Vocational Studies course was a Glasgow innovation which recruited tutors from amongst the General Practitioners in the West of Scotland to deliver weekly sessions to groups of 8 students, working through a wide agenda of professional skills and values.
This expansion in general practice teaching, including the cost of academic and administrator staff, was funded externally via Scottish Government funding for the Added Costs of Teaching in General Practice (GPACT). Clinical and communication skills tutors were used in small group exercises, progressing through all five years of undergraduate teaching.
The new Wolfson Medical School Building, opened in 2003 by The Princess Royal, is equipped with the appropriate numbers of rooms for small group teaching in vocational studies, communication skills and clinical practice. By 2010, it was estimated that around 16% of teaching time was contributed by General Practitioners.
Watt also revised the Graduation Declaration taken by graduating medical students at Glasgow University. Other than translation from Latin to English, the declaration had been virtually unchanged for 300 years. The revision required wide consultation and went through many versions. The first three sentences from the original declaration were retained while three new sentences were added to reflect modern medical philosophy and practice.
During Watt’s tenure as the second holder of the Norie Miller chair, the department of general practice produced a dozen professors, now working in primary care research and medical education in Glasgow, elsewhere in the UK and abroad. An elected Fellow of the UK Academy of Medical Sciences and the Royal Society of Edinburgh, Watt was awarded a CBE in 2017.
Professor Frances Mair was appointed to the Norie Miller Chair in the Spring of 2017.
For more information read
- Academic General Practice in the UK Medical Schools, 1948 – 2000. A short history. (2011). Ed John Howie and Michael Whitefield. Edinburgh University Press. Chapter 4, The University of Glasgow, D Hannay and G Watt.
- University of Glasgow, College of Medicine, Veterinary Medicine and Life Sciences. 40 years of academic General Practice at the University of Glasgow, 1974-2014.
Professor Graham Watt and Dr Marjorie Allison
Images unless otherwise noted provided by Professor Watt