This isn't the first time GPs have been the bad guys of the NHS

Jun 21, 2012
Colin Brown

GPs' strike draws attention to a weird anomaly: they are private business owners who have public sector pension privileges

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GPs risk losing their almost saintly status in the National Health Service because of the grubby business of their 'strike' - a go-slow on non-urgent patient referrals - to preserve their pension privileges. It would not be the first time.

The current row about GPs' pensions goes right back to the creation of the NHS by Nye Bevan, the Labour health secretary, in 1948, as I discovered when I was researching the welfare state for a forthcoming book, Real Britannia.

Bevan had to win a very bitter battle with the GPs' 'trade union', the British Medical Association, to bring about the birth of the NHS on 5 July that year.

One former BMA leader accused Bevan of acting like a little Hitler.
The NHS Act, he said, was "the first step to national socialism as practiced in Germany. The medical service there was put under the dictatorship of a medical Fuhrer. The Bill will establish the minister for health in that capacity".

Coming so soon after the Second World War, this was incendiary language. Bevan initially refused even to negotiate with the GPs.

Most family doctors were private contractors, and suspected Bevan wanted them to surrender their independent status to become salaried GPs in a nationalised NHS. Their fears were well-founded.

Bevan took his inspiration from his roots in the Welsh Valleys and the Tredegar Medical Aid Society where steel workers and miners banded together to provide health care for themselves in return for a deduction of 3d in the pound from their wages. Their contributions paid for a cottage hospital and a local health centre staffed by six salaried family doctors in a corner shop that is now part of a Bevan heritage trail in the town.

Before the NHS, most other family doctors charged patients or friendly societies for their services. The NHS removed the fear for families of the cost of getting ill. But Bevan knew he had to reach a compromise with the doctors to make the NHS work.

The Welsh leftwing firebrand met leading members of the BMA in secret over the starched cotton tables of the Café Royal in London's Regent Street. Dr Roland Cockshot, a leading BMA negotiator, recalled: "We screwed our nerves – we might have been going to meet Adolf Hitler…We were quite surprised to discover he talked English."

Bevan bought off the GPs. He conceded the family doctors could keep their status as private business contractors within the NHS; they were paid according to the number of patients on their lists, rather than a fixed salary and they would be allowed to join the NHS public sector pension scheme, over which they are now fighting.

GPs have remained an anomaly in the NHS ever since, operating not quite as a private service, such as opticians and dentists, and not quite as employees of the NHS like nurses and salaried doctors. Part of the price the GPs had to pay was to give up the 'goodwill' value of their practices, which, before the 1948 NHS Act, could be sold when a GP retired to pay for his pension. But they retained their jealously-guarded status as private businesses.

Bevan also had to negotiate separately with the surgeons led, ironically, by the private surgeon to Sir Winston Churchill, Lord Moran. He allowed them to keep their lucrative private beds in NHS hospitals. Bevan boasted later of "stuffing their mouths with gold".

Clearly, the vast majority of GPs are dedicated to the NHS as a health service, free at the point of demand, paid for through taxation. The creation of the welfare state is one of the great, lasting monuments of the postwar Attlee Government.

The NHS is now so universally admired, that, despite its day-to-day faults, it has become a no-go area for those who would privatise it.

Even Margaret Thatcher thought better of privatising the NHS, while asserting her right to jump queues by paying for her own private healthcare.

But the GPs who are refusing to refer non-urgent cases for treatment today might like to reflect on the anomaly in their position – they are still operating as private businesses, but jealously defend the privileges of public sector pensions which the rest of us in the private sector can only dream about.

The fact is that had Bevan had his way, they would all be NHS employees, on NHS salaries in NHS practices. And, in my personal view, they would have a better case for protecting their NHS pensions.

  • Real Britannia: A Partial, Proud History of the Glory and the Spin by Colin Brown is due to be published by Oneworld Publications on 1 November 2012

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It will be ripe for privatisation soon. Young doctors are being offered pensions of £65000 45 years into the future in place of the £50000 available today. What that is in todays money must be at least £10000. They are being portrayed as being grubby and greedy.