Doctors and the State
Since no national health service scheme can be worked except through the medical profession it is important that the Government in laying its new plans should have the backing of the profession. But it will not be forgotten that the doctors at the outset strenuously opposed the first National Health Insurance measure. We should therefore keep an open mind in approaching a report just issued by a representative committee of the British Medical Asso- cation, just as we should when we approach the White Paper that is to be published by the Government. The B.M.A. committee is strongly opposed to the conversion of the medical profession into a salaried branch of central or local Government service, or the invasion by the State of the doctor-patient relationship ; and it would equally object to the splitting of the medical profession into two groups—official doctors and non-official doctors. The public will probably agree to the extent that it desires the right to choose its own doctors, and to retain the essence of the doctor-patient relationship. But are this choice and this relationship inconsistent with the payment of doctors by the State for services rendered? In regard to the splitting of the profession, it is already. split, in that sense, by the existence of Medical Officers of Health who are salaried servants of the local authorities. The middle classes are not likely to be satisfied by any service calling itself a national service which leaves them still uninsured against illness requiring the attention of the general practitioner or the occasional major illness requiring complicated treatment such as today is financially disastrous to them. General practitioners are hard-working men who for the most part well earn their fees. If there is any fear that fees will tend to be reduced under a State scheme it is inevitable that there will be opposition ; and undoubtedly there is such a fear. A satisfactory scheme must be fair to the doctors and not endanger their proper remuneration. On the other hand they must not be in the position of a guild with power to dictate terms to the community.
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