Generalists and specialists

Julian Tudor Hart

in The political economy of health care

Published by Policy Press

Published in print September 2010 | ISBN: 9781847427830
Published online March 2012 | e-ISBN: 9781447303930 | DOI:
Generalists and specialists

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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

Chapter.  11466 words. 

Subjects: Public Health and Epidemiology

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