A 100-year-old doctor remembers the first days of the health service
As the health service turns 70, Peter Stanford gets a diagnosis of where it went wrong from one of its very first doctors
Teeth and specs” – that is the phrase that comes to mind when Dr Peter Pritchard remembers July 5 1948, the first day of the new National Health Service. At the time, he was a 30-year-old assistant registrar working at Great Ormond Street Hospital in London. Now in his 100th year, the retired Oxfordshire GP is one of the very few medics still around with first-hand memories of the birth of the NHS, which is marking its 70th year.
“There was a fear that everyone would want free false teeth and spectacles,” he explains. “And it was true that there was quite a demand in those early days – so much so, in fact, that ministers took fright and added prescription charges. But we junior doctors had watched the poor come cap in hand to the teaching hospitals for treatment and not receive a good service. So we were strongly in favour of the NHS.”
Unlike his bosses, he recalls. The consultants regarded the introduction of a National Health Service by the post-war Labour Government as a threat to their livelihood. “They were very hostile. My chief [at Great Ormond Street] was Wilfred Sheldon, and I can still recall him saying to me, sourly, shortly after the NHS was launched: ‘I’ve seen my one and only private patient for July’. Private practice, you see, was how they made their money. They didn’t have a hospital salary until later, and thought the NHS would ruin their private practice.”
While the 70th anniversary of a health service free at the point of delivery will no doubt cast a golden glow over the visionary spirit of those pioneering days, Dr Pritchard’s from-the-coalface recollections in his newly published memoir present more of a warts-and-all picture.
A reticent, unshowy man – save for the souped-up mobility scooter that helps him get out and about, and which he refers to jokingly as his Harley-davidson – it quickly becomes apparent, sitting with him in what was once his surgery, attached to the side of what is still his family home in the middle of the small town of Dorchester-on-thames, that he is also meticulous. Dr Pritchard chooses his words with care, avoids hyperbole and prefers – like any good doctor – to stick to the facts in making his diagnosis of the NHS, past, present and future.
His initial medical training was at Cambridge pre-war, and then after that on the wards of St Thomas’s in London. In 1943, he joined the Royal Army Medical Corps and served with distinction in India and Burma, where he was mentioned in Dispatches.
The healthcare system he returned to in 1946 at Great Ormond Street was, he recalls, deeply unsatisfactory. “Under the old panel system, GPS got paid [by the state] a very small amount for treating employed males, the rest – their wives and children – had to pay. Many GPS were very generous and didn’t charge them but, in the cities, if you couldn’t pay, you would join the queue at the local teaching hospital to see a doctor.”
The hospital made no charge, he says, “but the Lady Almoner – the predecessors of social workers and called ‘All-moaners’ by patients – would assess whether people could pay by questioning and” – here he pauses and smiles – “intuition”.
Such honest talking meant Dr Pritchard developed a reputation as something of a maverick during his medical career. After a spell at another London teaching hospital, in 1951 he moved out to Oxfordshire with Daphne, his wife – now of 74 years – and their three children, Wendy, Rosemary and James, and into general practice. There, he broke ranks with the medical establishment by championing patient participation in NHS decision-making.
Even in the early days, he could see the seeds of problems being sown. “It was always all very bureaucratic. The politicians just didn’t have a clue, not a clue, on how to run this new NHS.” Instead, they have “made a mess of it”, he says, forever changing their minds and ignoring evidence from those on the front line about how best to improve it.
Dr Pritchard discovered this first-hand when he sat on various committees reporting on how to make the primary healthcare system responsive to changing needs, a contribution that has recently led to him being awarded a Certificate of Commendation for “outstanding contributions” by the Royal College of General Practitioners.
“I was a member of the regional health authority for eight years, and they covered the period of [then health secretary] Keith Joseph’s reorganisation in the Seventies. It was a major undertaking, and very well planned, with [management consultants] Mckinsey and Brunel University backing it, and with pilot studies in our region. But then papers would come down from the Department of Health, ignoring the
‘We used to see ourselves as a personal doctor but the NHS has dropped all that’
plans and saying what the next steps should be. Those in charge of implementing the reforms at local level would be horrified.”
That tendency of the centre to overrule those at the coalface has, he estimates, proved “disastrous” for the NHS. He quotes the changes introduced by Labour to GPS’ contracts in 2003 so that they were no longer required to do weekend or after-hours work.
“It was a piece of cake for the doctors concerned, but it was a disaster for general practice, and it still hasn’t recovered. Yes, GPS are overworked and, yes, weekend work was very stressful. That’s why I retired at 60 and went on as a locum until I was 70. But the right answer was for a consortium of practices to cover night shifts. That way, a local GP would only be on call once every two or three weeks. It could be compatible with a tolerable life.”
Instead, the contracted-out afterhours services have, he believes, broken a vital link between patients and their GP. “We used to see ourselves as a personal doctor. It was a one-to-one relationship, and generated a lot of goodwill. But the NHS now has dropped all that, and you are registered with a practice; no one doctor feels responsible for you. Yet a Finnish study has shown that having a personal doctor for each patient reduces admission rates and improves quality of care.”
We are, in Dr Pritchard’s words, heading in the wrong direction. Does it all, I wonder, come down to lack of money and tight budgets? Pritchard shakes his head sadly: “It is more about bureaucratic shortcuts.”
One of the bonuses of having been there since the beginning of the NHS is that he can evaluate what has been gained, but also what mistakes have brought us to a situation where he believes the NHS is “unsustainable in its present form”. And so, just months from his own centenary, Dr Pritchard is determined to contribute to the debate about how it can be rescued.
As I am leaving, he hands me a paper he has written, entitled: “The NHS is heading for bankruptcy – how can it be prevented?”. Jeremy Hunt, confirmed in his post yesterday as Health Secretary, would do well to get hold of a copy.