GPs and the politics of health insurance in Britain 1900-1939

General practitioners (GPs), as family doctors, have been part of the social fabric of Britain for well over a century. In the late nineteenth century, their newly assertive professional identity and desire for the rewards of a comfortable middle-class living brought them into conflict with organisations offering sickness insurance to the working classes. Out of this conflict came a need to create representative bodies capable of defending the GPs’ professional privileges and ‘articles of faith’, which included the maintenance of independent contractor status and the patient’s free choice of doctor. 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’, though punctuated by occasionally heated disputes. Through a series of research questions, this thesis asks how GPs came to support and be involved in the administration of National Health Insurance (NHI) and how their relationship with government took shape in the interwar period. It argues that the development of the GPs’ political consciousness was influenced by an overarching desire for professional self-determination and realisation of the ‘professional social ideal’. It explains why the relationship between GPs and the state was characterised by alternating periods of harmonious cooperation and mutual distrust and antagonism. It further explains why the professional representative institutions created under NHI became so enmeshed with the culture of British General Practice that they have survived to the present with remarkably little alteration. Particular focus is placed on the role of Local Medical and Panel Committees, hitherto largely ignored by historians, both as instruments of the state’s administrative authority, and as the focus of political lobbying and resistance. The thesis contends that National Health Insurance was a qualified success for GPs and their patients. However, GPs’ support for its replacement by a more comprehensive National Health Service was conditioned by a continuing desire to protect their sectional interests and freedoms from what many of them perceived to be the widening influence of a centralist and controlling state.