Embedded Files
Chris Locke | 17 October 2023
◇ Modern History | British History | Activism
Frontispiece of The Old Doctor, (print screen shot by the author).
In 2023 a succession of disputes between National Health Service (NHS) employees and the Conservative Government culminated in simultaneous strikes by junior and senior hospital doctors, an action unprecedented in the history of the NHS and the medical profession. Yet exactly a hundred years before this the medical profession in Britain was locked in a similarly intractable battle with the government.
The medical protagonists on that occasion were general practitioners (GPs) who were contracted by the government to provide medical care to working people under its national insurance scheme. The dispute began when a Conservative administration, bent on reducing public expenditure, sought to implement cuts in the insurance ‘panel’ doctors’ pay. These cuts, the GPs’ leaders argued, would fatally undermine their ability to provide an acceptable service to their patients.
The dispute was resolved after a government climbdown resulted in an arbitrated settlement in 1924. This followed a ballot organised by the British Medical Association (BMA) which saw 94.6 per cent of panel GPs pledge to resign en masse from government contracts. [1] As the BMA’s medical secretary Alfred Cox pointed out, this was never a strike in the true sense of the word as the GPs were independent contractors, but it was regularly described as such by the popular press.[2] It also set a precedent for periodic resignation ballots by GPs in the succeeding century.
This blog focuses on the part played in the profession’s campaign by two very different GP activists whose paths crossed briefly during the course of the dispute. It demonstrates how doctors with differing political opinions and social status were united by a determination to frustrate government action they deemed unfair to them and injurious to the public.
Dr J. A. MacDonald, the first of these individuals, was one of the most respected professional leaders of his generation. A Methodist lay preacher who played Rugby Football for Ireland, he ran a successful practice in Taunton in the early 1900s and became an active member of the BMA, rising to occupy its highest office as chairman of council. [3] This coincided with the critical moment when in 1911 the Liberal Chancellor of the Exchequer, David Lloyd George, introduced his National Insurance bill, offering millions of workers a range of welfare benefits including the provision of medical care and medicines by GPs. The history of the subsequent dispute between the profession and the government over the terms offered to GPs, the so-called ‘doctors’ revolt’, is well documented.Though it proved to be a disguised victory for the doctors, their apparent defeat led to acrimonious recriminations amid allegations of obduracy and ineptitude by BMA leaders.
MacDonald was humbled by the experience and accepted defeat with good grace. He was prominent among those urging the Association to establish positive working relations with government in the interests of the large numbers of GPs serving on the insurance panels and their patients. He became the chairman of the BMA's newly formed Insurance Acts Committee (IAC) which set out to secure improvements in the scheme, forged good working relationships with government officials during the First World War, and supported the establishment of a Ministry of Health in 1919. When he led the BMA delegations which met Lloyd George, the dour Ulsterman evidently found it hard to stomach the rhetorical flourishes of his mercurial adversary, informing his colleagues of his difficulty in suppressing the urge to throttle him! [4] Yet Lloyd George remembered their encounters more affectionately. In a dinner organised by veterans of the conflict in 1928 he asked a BMA council member ‘How is old MacDonald? He was against us, but I liked him!’[5]
MacDonald was succeeded as chairman of the IAC by Dr Henry Brackenbury, an experienced politician who pursued the GPs’ grievances with reasoned arguments and gentlemanly persuasion, but who, when the dispute entered a critical phase in 1923, led the profession with a quiet yet steely determination. Brackenbury stressed repeatedly that panel GPs wanted to expand and improve insurance panel practice and feared that a cut in pay would result in a poorer quality of service. [6]
MacDonald remained involved as a member of the IAC and was drafted onto a propaganda subcommittee established to try and win public, press and party-political support for the doctors’ campaign. Another GP drafted in to serve on that subcommittee was a BMA division secretary and single-handed GP from Walsall named Frank G Layton.[7] Layton was a published author who had just completed a novel called The Old Doctor based on his experiences as a GP serving the needs of foundry workers and their families in the ‘unsanitary back streets’ of an industrial town in the West Midlands.[8]
Believing it would engage the sympathies of the public and politicians with its vivid description of the conditions in which overworked and underappreciated panel doctors worked, the subcommittee provided £100 to purchase copies of the novel to send to prominent public figures. [9] Layton was a firm advocate of national health insurance, believing, in the words of the eponymous protagonist of ‘The Old Doctor’ that it had ‘put the lid on the foul old cheap club system’ which preceded it. [10] He was dismayed when the man Lloyd George had entrusted to implement the scheme, the highly capable Sir Robert Morant, died unexpectedly in 1921, dedicating his novel to his memory. Layton wrote a succession of now forgotten novels and plays on similar themes, earning plaudits from the Birmingham Mail and the Glasgow Herald for their realistic characterisation.
However, he was never as successful as his medical contemporaries Francis Brett Young and A. J. Cronin. Unlike MacDonald, Layton did not earn a fulsome obituary in the British Medical Journal, so we know little about him. Alfred Cox, the medical secretary of the BMA who served under MacDonald and Brackenbury and provided brief portraits of both in his memoirs, provides one tantalising reference to him. He described Layton as ‘a cheery and versatile fellow’ who, when they met, always addressed him irreverently as ‘Uncle Alfred’. [11]
Whether Layton’s novels did much to further the GPs’ cause is a matter for speculation. But the BMA did succeed in convincing some influential public figures that their campaign was not purely about maintaining doctors’ incomes. When the dispute ended, The Times medical correspondent opined that the doctors had been protesting against a scale of payment which ‘rendered efficient service difficult or impossible’, concluding that their action ‘was their clear duty to the public as well as themselves.’ [12] Today’s striking doctors might wish the press were as ready to support their demand for pay level restoration and recognise that years of underinvestment, and the government’s failure to accept the demonstrable link between staff pay, morale and the quality and sustainability of healthcare services, is what is fuelling the unfolding crisis in the NHS.
Postscript: When studying for my doctorate I was pleased to find tangible evidence of the connection between McDonald and Layton from an unexpected source. Having obtained a copy of The Old Doctor for a few pounds from an online bookseller, I was delighted to discover, from a signature and date on the inside cover, that the original owner of the book was none other than J. A. MacDonald himself, the signature being identical to that printed in his BMJ obituary. One could imagine MacDonald reading the novel and being struck by the similarities, and the differences, between his and Layton’s situation and experiences as a GP, and their shared hopes for a better and properly financed public medical service. This adds a degree of poignancy to the obvious similarities between their motivation and mindset and those of striking NHS doctors today.
Chris Locke is an honorary research fellow in the History department of the University of Sheffield. His book GPs, Politics and Medical Professional Protest in Britain, 1880-1948 is published this November by Routledge as part of their Studies in Modern British History series.
References
[1] BMA Archive, B/203/1/15, minutes of IAC meetings of 26 October 1923 and 7 November 1923.
[2] Alfred Cox, Among the Doctors, (Christopher Johnson, London, 1949) pp. 124-125.
[3] BMJ, 5 May 1928, MacDonald Obituary, pp.781-782.
[4] Cox, Among the Doctors, p.87.
[5] BMJ, 5 May 1928, MacDonald Obituary, tribute by Sir Ewen Maclean, p.782.
[6] BMJ, 29 October 1921, Supplement p.164.
[7] BMA archive, B/203/1/15, minutes of the IAC meeting on 26 June 1923.
[8] Frank G Layton, The Old Doctor (Cornish Brothers, Birmingham, 1923)
[9] BMA archive, B/203/1/15, minutes of the IAC meeting on 26 June 1923, min 382.
[10] Layton, The Old Doctor, pp.140-141.
[11] Cox, Among the Doctors, p.167
[12] The Times, 25 November 1924, ‘Panel Doctors’ Fees’ p.11, col 4.
Page updated
Report abuse