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The political economy of health careWhere the NHS came from and where it could lead$
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Julian Tudor Hart

Print publication date: 2010

Print ISBN-13: 9781847427830

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847427830.001.0001

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Generalists and specialists

Generalists and specialists

Chapter:
(p.84) (p.85) Four Generalists and specialists
Source:
The political economy of health care
Author(s):

Julian Tudor Hart

Publisher:
Policy Press
DOI:10.1332/policypress/9781847427830.003.0004

Since the early nineteenth century, medical specialisation has been driven by two forces: by science, through analysis of physiological and pathological processes, with consequent division and subdivision of these into apparently separate parts; and by a more general culture which tends to compartmentalise civic responsibility, leaving major societal decisions to the operation of the market. The main reason why from 1948 to 1979 the NHS was more cost-effective than any other socially inclusive health care system was its retention of community generalists as gatekeepers to specialist care, and as familiar and trusted guardians and interpreters of patients' life stories. In the presently dominant culture of NHS management in England, developed from business experience and following an industrial model, this is not recognised. This leads to demoralisation of staff and confusion of patients.

Keywords:   medical specialisation, civic responsibility, health care system, community generalists, England, NHS

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