Department of History
Thesis title: GPs and the Politics of Health Insurance in Britain, c.1900 to 1939
- Julia Moses (Primary)
- Adrian Bingham (Secondary)
General practitioners (GPs) , as family doctors, have been part of the social fabric of Britain for over a hundred years.
In the late nineteenth century, their search for a distinct professional identity and desire for the rewards of a comfortable middle-class living brought them into contact, and ultimately conflict, with organisations offering sickness insurance to the working classes.
Out of this conflict came a need to create representative bodies capable of asserting and defending the GPs’ professional privileges while simultaneously policing intra-professional interactions.
The National Insurance Act 1911 heralded the beginning of a new relationship between GPs and the state which began inauspiciously in an atmosphere of recrimination and suspicion, but eventually became one of mutual dependence, founded on bargained corporatism, punctuated by occasionally heated industrial disputes.
This relationship helped establish a pattern for delivery of general medical services to the public which has survived into the present century and proved to be one of the most enduring and valued features of the British National Health Service.
My thesis begins with the development of the GPs’ professional identity and culture in the late nineteenth century, which was conditioned by marginality, economic insecurity and a desire for collective upward social mobility.
It charts the progress of professionalisation and development of a collective ideology in which the maintenance of private practice, the patient’s free choice of doctor and professional control over standards of competence and behaviour became articles of faith for a multitude of professional representative organisations.
My thesis then charts the development of political consciousness among British GPs and the role played by local and national representative bodies in their struggle for self-determination in the early twentieth century.
The proliferation of representative groups reflected the GPs’ continuing insecurities and the absence of clearly developed and agreed strategy for professional self-realisation. The profession came together momentarily, however, in a unified show of resistance to what it feared would be disastrous consequences of National Health Insurance in 1911.
Their ‘defeat’ was actually a disguised victory which won them a significant share in the administration of the new service and an unexpected measure of self-government.
This study involves an in-depth analysis of the representative structures established following the passing of the National Insurance Act 1911 which, it argues, mediated between GPs, their professional leaders and the local administrative apparatus of National Health Insurance.
It suggests that the GPs’ Local Medical and Panel Committees which have hitherto been largely ignored by historians are worthy of study, in being both conservative instruments of the state’s administrative apparatus, and the focus of political lobbying and resistance to government authority.
It contends that National Health Insurance was a qualified success and that the GPs’ support for a comprehensive national health service was ultimately conditioned by a continuing desire to protect their sectional interests and freedoms.
The source material for this research includes previously unresearched documentation concerning medical guilds and associations, Local Medical and Panel Committees, ‘Public Medical Services’ and relations between the British Medical Association, rival organisations, the Ministry of Health, the approved societies and the press.
- BA (Hons) University of Oxford 1980
- LLM Cardiff University 2010
- PhD History, University of Sheffield, 2016 - present
- Publications and conferences
Conference and seminar papers:
- University of Sheffield History Dept Colloquium May 2018: ‘The Political Doctor is now born: GPs and the Politics of State-funded Healthcare in Britain 1900-1939.’
- University of Leicester May 2019: ‘GPs and their search for identity and self-determination in nineteenth and early twentieth century Britain.’
- Goethe University, Frankfurt October 2019, Guest lecture: ‘Health Insurance, the State and Professional Self-determination: General Medical Practitioners in Britain 1900-1939.’
- University of Sheffield, Northern Network for Medical Humanities Conference, January 2020: ‘From the margins to the mainstream: political resistance and the professional culture of GPs in nineteenth and early twentieth century Britain.’
University of Sheffield ‘History Matters’ blogpost, May 2020: ‘Dawson’s big idea: the enduring appeal of the Primary Healthcare Centre in Britain.’