Jump to ContentJump to Main Navigation
The political economy of health careWhere the NHS came from and where it could lead$
Users without a subscription are not able to see the full content.

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

Show Summary Details
Page of

PRINTED FROM POLICY PRESS SCHOLARSHIP ONLINE (www.policypress.universitypressscholarship.com). (c) Copyright Policy Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in PPSO for personal use.date: 18 September 2021

Generalists and specialists

Generalists and specialists

(p.84) (p.85) Four Generalists and specialists
The political economy of health care

Julian Tudor Hart

Policy Press

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

Policy Press Scholarship Online requires a subscription or purchase to access the full text of books within the service. Public users can however freely search the site and view the abstracts and keywords for each book and chapter.

Please, subscribe or login to access full text content.

If you think you should have access to this title, please contact your librarian.

To troubleshoot, please check our FAQs, and if you can't find the answer there, please contact us.