In 1946, the New Statesman published this article on health minister Aneurin Bevan’s statement that the purchase and sale of private medical practices ought to be stopped. Such a practice is “an anomaly and a scandal”, wrote the unsigned writer, “because [for doctors] it makes the possession of capital rather than skill the master-key to medical success”. But some members of the medical profession disagreed with Bevan’s ideas; a set of seven principles put together by the “Negotiating Committee”, would, the writer said, be a “gratuitous challenge to Mr Bevan” – though it would unlikely be endorsed by younger, more progressive doctors. Beyond the problem of the sale of practices lay a core crisis of the NHS that Bevan had uncovered: “The average general practitioner today is a harassed man,” on call 24 hours a day and “economically dependent on fees determined by the mere number of his patients”. Bevan had many more decisions to make with regards to the establishment of the NHS.
Mr Aneurin Bevan stated recently that it would be incompatible with the provision of an efficient National Health Service that the future exchange of medical practices and the creation of new practices within that Service should be left entirely unregulated. In less parliamentary language this meant that the purchase and sale of practices is to be stopped. With this intention few people (it might have been thought), even in the ranks of the medical profession, would be inclined to quarrel. Traffic in practices drawing most of their income from public funds under a National Health scheme would be on all counts indefensible. But, apart from that consideration, the sale of practices is in any case an anomaly and a scandal. It is an anomaly because it has no basis in legal property right; any doctor may “squat” where he pleases, instead of buying a practice – if he can afford to wait, and prefers to expend his capital in waiting instead of buying a clientele ready-made. It is a scandal because it makes the possession of capital rather than skill the master-key to medical success.
- In the public interest, the medical profession must not have imposed on it any form of service which lends itself, directly or indirectly, to the profession as a whole becoming full-time salaried servants of the State or the Local Authorities.
- The profession should remain free to exercise the art and science of medicine according to its traditions, standards and knowledge, the individual doctor retaining full responsibility for the care of the patient, and freedom of judgment, action, speech, and publication, without interference, in his professional work.
- The citizen should be free to change his or her family doctor, to select the hospital at which he or she should be treated, and to decide whether to have recourse to public medical service or to obtain private medical attention.
- Doctors should be free to choose the form and place of work they desire without governmental or other direction.
- Every registered medical practitioner should be entitled as of right to participate in public medical service.
- Hospital services should be planned over “natural” hospital areas, centred on the universities.
- Doctors should be adequately represented on all administrative bodies associated with the proposed National Health Services.
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