Re-expressing the division of British medicine under the NHS: The importance of locality in general practitioners' oral histories

This paper, based on original oral history research in a single locality, re-examines the impact of the structural division of British medicine, especially between community and hospital-based medicine, on rank-and-file general practice. Interviews were carried out with 29 retired and practising National Health Service (NHS) general practitioners (GPs) in Paisley, Scotland. In contrast to the historiography and literature of academic general practice, most retired and working family doctors who were interviewed rejected the significance of the division, and instead placed emphasis on the positive relationships between primary and secondary care in their locality. Particular stress was placed by these interviewees on the significance of local medical relationships in crossing the divide between primary and secondary medical practice. An analysis of the oral testimonies, informed by the work of Bakhtin [(1984). Problems of Dostoevsky's poetics. Minnesota: University of Minnesota Press] and Schrager [(1983). What is social in oral history? International Journal of Oral History, 4(2), 76-98] identified multiple discourses within single accounts. These discourses contained 'dialects' that suggested a commonality of beliefs, especially when social and clinical networks were detailed, but they also contained 'traces' of oppositional narratives. These 'traces' of alternative perspectives suggest both the power of imagined solidarity and the exclusion of a minority of practitioners. Thus imagined solidarities, based on the making of local identities, combined with imagined oppositional positions, in which those who were constructed as not belonging were given voice. We argue that, to understand alliances between community and hospital medicine it is necessary to appreciate the position of the excluded. Those family doctors who were identified in the oral histories as outsiders tended to serve the more deprived populations. The role of private medicine was especially significant in the process of exclusion, especially the pattern of general practice referrals of patients from the NHS to secondary private care.