‘Bright-while-you-wait’? Waiting rooms and the National Health Service, c. 1948–58
in Posters, protests, and prescriptions

This chapter explores the intensifying political, public, and professional concern with general practice waiting rooms in the first decade of the NHS. It argues that the years after 1948 saw the beginnings of a distinctively ‘NHS’ general practice waiting room emerge in British primary care: a space shaped by the ways in which inter-war professional values and premises were reworked in relation to post-war political promises and the peculiar new dynamics created between state, patient, and general practitioner (GP) under the new health service. However, though GPs’ waiting rooms came in for substantial criticism, material change was neither swift nor immediately radical. GPs retained considerable autonomy over their surgeries and practices. Despite coming under considerable political scrutiny, waiting rooms were only gradually remade while doctors reconsidered how patients’ suspended time in the waiting room could be put to new use. The reflections prompted during this period created the parameters for more incremental change as professional identities and the financial structures of general practice changed over subsequent decades.

In early August 1954, the News Chronicle reported on the ‘Brighten-Up’ campaign led by Birmingham’s Local Medical Committee of forty general practitioners (GPs). Working in pairs, these practitioners planned to visit the city’s 400 general practice surgeries, inspecting premises, talking to GPs, and making recommendations for improvements. If successful, the report suggested, ‘no more will there be dingy rooms for the patients to wait in. Gone will be the old, inadequate furniture, and the chilly draughts from badly fitting doors and windows.’ In their place ‘will be well-decorated, warm and spacious rooms with plenty of seating’.1

The campaign reflected a growing concern with general practice premises in the early years of the National Health Service (NHS), with waiting-room accommodation attracting particular attention. Over the late 1940s and early 1950s, GPs’ surgeries provided a subject for newspaper correspondence and reports, social surveys, investigation by medical professionals, and even parliamentary queries. Despite voluntary efforts undertaken by GPs, such as those in Birmingham, public and political pressure eventually forced ministerial intervention. By October 1954, inspections were mandated nationally.

This chapter explores this intensifying concern with GPs’ waiting rooms in the first decade of the NHS. In its first two sections, it connects the politicisation of waiting rooms with the collectivisation of funding for healthcare. It argues that complaints first emerged with National Health Insurance in 1913, but that the creation of the NHS established new dynamics between state, profession, patient, and public which brought waiting rooms more firmly into political contention. From here, the chapter considers how professional responses to the new institutional arrangements, and political and cultural promises, of the NHS were slowly built into the very fabric of its buildings. The third section discusses how class-based presumptions about decorum, and anxieties about status, mediated some GPs’ relationships to spaces of waiting. By contrast, the final section focuses on more optimistic responses to the NHS, placing the reconstruction of waiting rooms in relation to the ‘renaissance’ of general practice that began in the 1950s. Here the very space of the waiting room – and its suspension of time – allowed GPs to subject patients to various representational practices and managerial projects.

In examining the discursive importance and material forms of the waiting room, this chapter aims to develop a nascent interest in the spatiality of the NHS.2 Previous work, for instance, has considered the narrative construction of ‘locality’ in service politics and professional relations, mapped the ways in which discrimination affected the geographical distribution of GPs, and examined how changing internal spaces of medicine have influenced medical perception.3 Ongoing research by Ed DeVane and Andrew Seaton, moreover, has situated new spaces of NHS hospitals and health centres within broader political histories of the welfare state, while innovative scholarship by Victoria Bates has begun to consider the space of NHS hospitals in multi-sensory perspective.4 Placing post-1948 developments in historical and international perspective, Bates has traced shifting designs, atmospheres, and soundscapes of NHS hospitals in relation to technological, social, and cultural change.5

This chapter combines this scholarship’s representational, cultural, and structural approaches to consider how the material and operational cultures of the early NHS were shaped by inter-war precedents. It suggests that the NHS inherited outlooks as well as buildings from previous systems, but that doctors’ beliefs and spaces were challenged and remade through interaction with the values, politics, and social dynamics of the new service. In view of this, I propose that the 1940s and 1950s witnessed the beginnings of a distinct NHS waiting room: one dominated by professionals, and whose foundations were a composite of memories of the past, anxieties about the present, and promises of the future.

The majority of GPs neither moved premises nor renovated their waiting rooms in the first decade of the service. In this sense, there is a disconnect between the scale of discussion about waiting rooms and the amount of change experienced during this period. Similarly, assessing the breadth of GPs’ frustration with the NHS is complicated by the greater visibility of critics over those satisfied with new working conditions. Nonetheless, complaints provide an insight into the development of new norms by highlighting when expectations were disappointed, and the intensity of discussion within official reports, medical writings, and the lay press speaks to the depth of GPs’ resentment at, or shared belief in, the changes wrought by the NHS.6 Crucially, the ‘ideals’ for premises elaborated in letters, articles, and reports exerted a lasting cultural influence, structuring practitioners’ and patients’ ongoing engagement with the health service.7 In many respects, therefore, this chapter articulates the emergence of a general practice being unevenly reshaped by the NHS, both physically and temporally. In so doing, moreover, it considers culturally inflected values, symbols, narratives, emotions, and psychologies alongside professional interests and tactics in order to explore new directions for analysing the political history of the service.8

Politicising the inter-war waiting room

The problematisation of the GP’s waiting room in Britain was closely connected to the extension of collectivised funding for healthcare, with the first sustained reflection on the condition and purpose of waiting rooms emerging after the commencement of National Health Insurance (NHI) in 1913. Under NHI, employees earning under an income threshold were enrolled into a mandatory scheme. They paid a fixed contribution, along with employers and the state, for flat-rate benefits.9 Members were given a free choice of registered GPs, and these ‘panel’ doctors were paid by capitation (for the numbers of patients on their lists).10

Despite enhancing many GPs’ incomes, as well as their clinical and organisational autonomy, insurance work generated new challenges in relation to the standards of premises.11 Into the 1920s, NHI contracts charged the GP with providing ‘proper and sufficient surgery and waiting room accommodation for his patients, having regard to the circumstances of his practice’.12 Moreover, insurance and local medical committees were given the joint capacity to investigate accommodation standards following complaints.13

For some GPs, proposed standards conflicted with professional aspirations to autonomy.14 These doctors saw themselves as genteel professionals, practising without outside interference, despite rarely realising this ideal in their previous working lives.15 For others, anxieties over new regulations were far more material. Though dependants – generally married women and children – were excluded from the scheme, NHI expanded access to primary care.16 Domiciliary treatment remained central to general practice – especially in well-to-do and rural areas – but GPs extended their surgery work.17 This placed considerable pressure on premises that were ill-equipped to accommodate waiting patients. During the 1920s and 1930s, most practices were housed within a GP’s home, or in a converted shop or small ‘lock-up’ surgery in industrial practice. In domestic settings, dining rooms might be converted into waiting rooms, but generally waiting areas were inadequate, with patients occasionally forced to wait outside.18 To save space, some GPs simply consulted patients in front of waiting peers.19 Facing rising patient demand and novel regulations, doctors grew to resent the arrangements of NHI practice. They regularly asked advice about available expenses and resisted what they saw as unreasonable demands for waiting-room accommodation.20

Doctors were not alone in bemoaning the conditions of inter-war practice. Patients, lay members of insurance committees, and medical and civic societies – such as the Order of Druids Friendly Society – all raised concerns about GPs’ waiting rooms.21 They often criticised the size of accommodation as ‘wholly inadequate’ to cope with queues of patients, and some even suggested that overcrowded waiting rooms ‘ought to be dealt with by Government authority, just like any other insanitary premises’.22 Many other complaints targeted the division of private and insurance patients into separate waiting rooms.23 As an affront to patients, even critical doctors suggested that segregation ‘would prejudice the insurance service in the eyes of the public’.24

Despite complaints, central government took little action beyond the vague regulations included in NHI contracts. The Ministry of Health had been created only in 1919, and service reform dominated political discussion and local activities.25 Practice standards thus rarely attracted official attention and, as explored below, GPs were divided over issues like separate waiting rooms. As will be discussed later, inter-war debates about waiting rooms were thus not limited to issues of costs and professional autonomy. They extended into discussions of class and patient behaviour, with legacies for how practitioners related to the later NHS. Moreover, inter-war GPs also discussed how they used waiting rooms to shape patients’ expectations about entitlements, manage how patients behaved in a collective system, and foster favourable working conditions. It was with the creation of the NHS, however, that such subjects gained critical mass and the waiting room moved to the national stage.

The NHS and the political problem of the waiting room

By transforming the financing and functions of British general practice, the very creation of the NHS helped to further politicise the GP waiting room and to construct it as an object of sustained professional interest. The arrangements for general practice under the NHS might be viewed as an extension of those established under NHI.26 GPs were remunerated via capitation fees and, following political resistance to salaried state employment, they remained independent practitioners contracting into public service.27 However, the NHS expanded access to collectively funded healthcare to the whole population, abolishing employment-related eligibility criteria. Care thus became framed as a right of citizenship, and the state was made responsible for everyone previously excluded from formal provision.28 This increase in demand, altered rights discourse, and expanded state liability contributed to the politicisation of the waiting room.

As in the inter-war period, patients’ increasing exposure to waiting rooms was a primary driver of novel spatial concerns. The new health system was not created on a blank canvas; few GPs moved or renovated premises on the ‘Appointed Day’. Instead, the NHS inherited practices and practitioners, many of whom previously held mixed lists. Indeed, even if GPs had been inclined to improve their premises, alterations were difficult because of initial financial disincentives, post-war shortages, and the regulation of planning and building materials for reconstruction.29 Many waiting rooms thus retained the same deficiencies that inter-war observers had noticed. Especially in industrial settings, they could be ‘cold, dimly lit, uncomfortable, far too small to accommodate the number of patients that attended surgeries and […] generally ill-kept’.30 Moreover, as discussed below, GPs felt that their premises were under greater pressure than before, complaining that the removal of financial barriers to access meant that patients would now attend significantly more readily.

Reflecting healthcare’s elevated status in political life, newspapers carried letters alongside editorials discussing the condition of GPs’ waiting rooms into the 1950s.31 Similarly, Members of Parliament raised questions about premises standards for parliamentary discussion.32 Some of these queries concerned the cost of the service, with enquirers stressing that the ‘conditions of surgeries and waiting rooms’ were now ‘a very important matter’ given the sums involved.33 Others more directly raised issues of overcrowding in industrial practice.34

Surviving archival records suggest, though, that public and political consternation with waiting rooms was not the only source of pressure for government action. The Ministry of Health was also drawn into debate about premises as a result of international critique and reviews conducted by domestic statutory bodies, think-tanks, and professional bodies. As Roberta Bivins makes clear, the NHS attracted considerable international attention from its earliest days.35 Healthcare reform was a common post-war development, but the NHS was almost unique in its funding and operation.36 One international study – produced by J. S. Collings, an Australian-trained GP, and funded by the Nuffield Trust – was particularly influential in shaping discussions of British general practice. After visits to fifty-five English practices, Collings argued that standards were being adversely affected by professional isolation, overwork, ill-defined (yet circumscribed) roles, and a lack of modern facilities.37 He declared that ‘working conditions (surgeries and equipment, organisation and staffing)’ in some practices ‘are bad enough to require condemnation in the public interest’, and that industrial practice was ‘at best a very unsatisfactory medical service and at worst a positive source of public danger’.38

Subsequent British reviews sought to refute Collings. In another Nuffield-funded survey, Dr Stephen Taylor declared in 1954 that Collings ‘over-reacted to [his] shock’, ‘converting particular truths into rather less accurate general statements’.39 An earlier survey organised by the British Medical Association (BMA) and conducted by Dr Stephen Hadfield classified only 10 per cent of practices as ‘unsuitable’, though it admitted that a further 24 per cent had ‘something essential […] lacking or below standard’.40

While not responding publicly, Ministry of Health officials were startled by Collings’s damning evidence.41 They may have also been stung by the potential damage to NHS’s international reputation; the service relied on (post-)colonial labour to function as planned, and would have collapsed without such labour in the areas most heavily condemned.42 Collings, moreover, found support from other British practitioners, and the long-gestating review of the Central Health Service Council (CHSC) into general practice noted the ‘shoc[k]’ of ‘independent observers’ when confronted with premises standards, ‘particularly [in] industrial practice’.43 Referring to these reports, civil servants pushed for concerted professional action over premises from 1953, with waiting rooms a particular concern.44 Facing parliamentary and public pressure, the Minister for Health eventually rejected the BMA’s efforts to exhort practitioners into improvements, and instead pressed for a nationwide inspection of premises.45 The BMA secured professional control of assessment through Local Medical Committees.46 Nonetheless, the Ministry was satisfied with forcing a more interventionist response from the BMA, having been compelled by mounting critique of surgery accommodation and its own expanded stake in healthcare provision.

Professional anxieties and the symbolism of the waiting room

The creation of the NHS intensified political debates about GPs’ waiting rooms by expanding access to healthcare, reframing access as a right of citizenship, and constituting the state as the major stakeholder in health politics. The resulting pressure on surgeries and increased political visibility of healthcare forced government to respond to complaints and professional critiques. In many respects, this dynamic was indicative of the working culture of the early NHS: professionals dominated day-to-day organisation of care, with the central state cajoling the profession but rarely intervening directly. Patients were rarely consulted about the service, but could act indirectly through letters, complaints, political representatives, and, later, collective organisations.47 These working cultures came to be designed into the very fabric of the NHS, not least in its waiting rooms. However, the NHS also raised the symbolic importance of the waiting room for GPs in other ways after 1948, forging it into an emblem of professional anxieties about class and status inherited from the inter-war period. Efforts to address these concerns were also manifested materially in spaces of waiting.

The connection between the waiting room and questions of status can be seen in the justifications for practice improvements offered in the 1950s. Dedicating a section of their report on general practice to ‘accommodation and equipment’, the CHSC suggested in 1954 that it was ‘inevitable that general practitioners are, to some extent, judged by the appearance which they keep up’. Moreover, it added, the standard of accommodation also spoke to a central cultural promise of the health service: ‘apart from the question of status and the quality of the Service, it is also a matter of equity that practitioners should provide a reasonable standard of accommodation and equipment’.48 As well as needing a consulting room and an examination room, surgery premises were not considered adequate without a separate waiting room. The BMA consistently stressed that the diversity of local conditions precluded laying down rigid standards covering all premises – a sentiment with which the Ministry agreed.49 Nonetheless, the CHSC’s outlines were generally influential, recommending that – aside from exceptional circumstances – the waiting room should be sufficient to seat all waiting patients in reasonable comfort.50 To this end, some local Executive Councils recommended providing ten seats per 1,000 listed patients.51 In practice, however, provision followed the available space and practitioners’ own estimations of adequacy, ranging from twenty-five seats for 13,000 registered patients (one per 520 patients) to eighty-eight seats for 9,600 patients (one per 109).52

For many GPs, the waiting room held symbolic importance beyond questions of quality. For instance, discussions of patients’ behaviour in waiting rooms were consistently inflected with class anxieties and expectations. Practitioners accused patients of stealing reading materials, and one survey respondent from a working-class practice lamented having to ‘bolt his waiting room chairs together to prevent their being taken’.53 Such theft was allegedly indicative of patients’ general disregard for their surroundings. Reports were sent to central departments about patients who would ‘tear out pages of periodicals in the waiting room, grind sticky sweets into the carpet, take cushions, and even carve their initials on the furniture’.54 Shock at this violation of middle-class propriety was underlined by appeals to the Ministry of Health to make ‘it quite clear to the general public that a doctor’s waiting-room is not a place of public entertainment, but rather a place where people are expected to behave with a certain amount of respect and decorum’.55 As explored further below, the descriptor of the ‘doctor’s waiting room’ was telling: the waiting room straddled the boundaries of public and private space, being a place in which citizens gathered, but situated either in the doctor’s private property or in specially built premises where the privacy of paternalistic relationships was considered paramount.

The class-based nature of GPs’ judgements about patient behaviour was manifested more overtly in discussions of dirt and cleanliness. As histories of manners, interior design, and public health have emphasised, concerns with cleanliness have long been connected with class-bound ideas of respectability and colonial framings of civilisation.56 Indeed, though no explicit references to marginalised migrant communities were made here, British cultural politics had a rich tradition of framing ‘white’ others in Britain’s working class as ‘racialised outsiders’.57 The sense that GPs equated pristine waiting rooms with respectability, and that they perceived poorer patients as undermining their standards, was noted in Hadfield’s 1953 survey. Defending inadequate waiting rooms in industrial locations, Hadfield remarked that ‘in some poorly housed districts it seems to be difficult to maintain the standard of the premises above that of the neighbourhood’. ‘Any feature of comfort or cleanliness’, Hadfield declared, ‘is soon defaced’, and ‘some general practitioners are evidently discouraged when they see lines round the walls where greasy heads have rested or marks of nailed boots on the floor’.58

These prejudices were built into the culture of the early NHS, being incorporated along with the GPs who had worked within earlier mixed economies of healthcare. In the inter-war period, for instance, GPs accused insured, working-class patients of being uncivil vectors of filth and of posing a risk to the health of their businesses by offending the sensibilities of private patients. ‘It is rather disconcerting’, noted one GP,

to ask the trained manservant, the skilled lady’s maid, or the daintily dressed milliner to be seated next to the estimable charlady who has done her ‘bit of shopping’ first and nurses a parcel of fragrant kippers on her knees, or to the cowman who has fallen down in the farmyard and brought ‘straight to the surgery’, or to a labourer injured with a muck-fork who ‘did not stop even to wash himself’.59

In response, many inter-war GPs established separate waiting rooms for insured and private patients, and often shortened the waiting times for those who paid.60 Though occasionally blaming patients for this separation, GPs clearly aligned themselves with the values of ‘private patients, who […] dislike sharing a waiting room with panel patients’.61 Though insurance payments gave them every right to occupy the waiting room, panel patients were thus sometimes considered ‘dirt’ and ‘matter out of place’ by inter-war GPs.62 To some extent, the creation of separate waiting rooms enabled GPs to ‘tidy’ their practices through reclassification: the insured were not excluded, but belonged as a second order of patient.63 This rearrangement reflected panel patients’ connections with capital, which created the conditions for ill-health and stratified classes, but which the liberal state sought to soften (rather than dismantle) through insurance.64

The NHS, however, remade the principles of healthcare and actively sought to integrate a divided society. Indeed, British society and politics were awash with questions of place and belonging in the early post-war years, from how to address the growing presence of women in traditionally male spaces of work and leisure to how best to rehouse working-class communities.65 Of course, inclusion was not a unanimous response. Prominent politicians, professional bodies, and local communities often responded to post-imperial questions of nationhood and citizenship with exclusion or systems for regulation.66 As a key pillar of post-war welfare, however, the NHS was built on a vision of social justice and equity.

The waiting room was thus symbolically and materially central to these ends. Some GPs seemingly retained separate waiting rooms for paying and state-funded patients after 1948.67 However, the practice quickly became uneconomical.68 Finding their values challenged by the new system, other GPs turned to interior decoration for solutions. Class division may have been unacceptable, but GPs could design out the marks their patients left behind. Published discussions of practice design, for example, focused on the durability of flooring materials while also noting the benefits of skirting boards and the use of ‘waiting room bumper rails [behind chairs] to protect the walls’.69 Concerns about patients’ dirt also manifested themselves in sentiments about paint, with one article suggesting that ‘greasy heads present a problem, but it is possible to ensure that the finish where this contact may take place is really washable’.70 As will be noted in the next section, NHS waiting-room design was influenced by diverse overlapping concerns, and in healthcare it was not always possible to divorce thinking about cleanliness from concerns about infection.71 However, such statements make clear that GPs’ anxieties about dirt and poor patient comportment were symbolically important, even being designed into the materiality of waiting rooms.

In fact, GPs’ discussions of ‘full’ waiting rooms directly connected their feelings about patients being ‘out of place’ with their frustrations about the post-war settlement. GPs critical of the NHS argued that the post-war promise of universal care, and the subsequent removal of direct fees, had ‘overlooked the resilience […] of human nature’.72 The result was ‘people who come with the most trivial conditions, simply because it is free’.73

The NHS might have secured equitable access to healthcare for citizens, but – these GPs argued – it also produced harmful unintended consequences. Waiting rooms were ‘so congested with trivial cases’, one correspondent claimed, ‘that it was difficult to find time to attend adequately to the others’.74 Other GPs added that the presence of so many patients would lead to rushed care.75 Perhaps worse, as waits for consultations became longer, some patients were even deterred from attending, with undesirable results for doctors.76 One GP complained to the press about being ‘roused from my sleep by a furious ringing of the night bell’ by one of their ‘NHS “units”’ to consult on a ‘trivial complaint’. The patient had allegedly ‘called during the afternoon surgery on Saturday, but had left on finding so many other patients waiting to see me’.77

According to these GPs, then, the NHS’s creation of unnecessarily full waiting rooms adversely affected practitioners as well as patients. Whereas patients suffered delayed consultations and rushed care, practitioners were swamped with cases that wasted their time and talents.78 There were practitioners who saw such alleged trivia differently. Following the psychoanalysts Michael Balint and Enid Balint, some GPs began to see biomedically ‘trivial’ visits in light of a patient’s psychosocial needs.79 The consultation became an offer of time and mutual investment, an opportunity to use the doctor–patient relationship to address the social and psychological issues driving presentation.80 Such approaches, though, developed slowly, and many GPs in the 1950s saw their engagement with trivia as indicative of second-class status.81 The NHS had thus condemned them to professional mediocrity. To make matters worse, it compounded this standing by creating demanding rather than deferential patients: patients who simply ‘ente[r] the consulting-room’ ‘to tell us what is wrong and what he wants for it!’, or who might leave a note ‘on my waiting room table’ saying ‘“Doctor, I want …” – no “please” or “thank you”’.82

In such situations, the full waiting room provided an important signifier of both a decline in deference and social standing and a shift in GPs’ working conditions and professional status. However, where some practitioners despaired or emigrated, others mobilised to develop general practice into a respected discipline in its own right.

Renaissance of general practice and the opportunity of the waiting room

As noted above, a slew of major investigations into the work and conditions of GPs followed the NHS’s formation. Considered alongside the creation of the College of General Practitioners in 1950, these reports were indicative of a period of sustained professional reflection on the purpose of general practice.83 To some extent, this introspection resulted from long-term changes in British medicine. GPs had complained about encroachment from specialists since before the inter-war period, while the contrast between laboratory- and hospital-based training and the realities of community practice was growing starker.84 Under such circumstances, the need to define a role for general practice might be expected. However, the creation of the NHS brought this existential crisis to a head: a significant proportion of GPs quickly came to resent their initial conditions of service and felt isolated from the prestigious hospital medicine they now guarded rather than practised.85

In the face of depressed morale and low prestige, articulating a role within a new hospital-orientated system became something of a professional necessity. Nonetheless, as Julian Simpson has noted, the so-called ‘renaissance’ of general practice that began slowly in the 1950s should not be seen as a top-down process.86 Individual GPs had their own motivations for innovation and were significant agents in reshaping the field. Much of this work in industrial and inner-city areas was undertaken by doctors who were marginalised from the NHS through racism and othering, but who aspired to improve professional standing and working conditions.87

Reconsidering premises formed a key part of professional strategies for renewal. As a space within which patients were suspended in time, waiting rooms offered GPs a way to cultivate distinct professional identities, and to build the presumed needs of patients into the fabric of the NHS. These considerations came to the forefront in plans for new premises, and particularly for group practices and health centres.88 New buildings forced GPs to think about how best to design their practices, as well as about how to accommodate the growing staff occupying the practice and the new forms of work this made possible. However, by the early 1950s even single-handed GPs began to reassess the spatial and temporal organisation of care, with improvements facilitated by new financial settlements and lighter regulations for planning and building materials.

The idea that general practice was a personal, holistic, even intimate form of medicine pervaded discussions of waiting rooms. The BMA suggested that for larger practices the use of a large common ‘waiting hall was to be avoided’, and stressed the desirability of each doctor either having their own waiting room or sharing a room with one other doctor at most.89 GPs broadly heeded this advice, though larger centres often included a waiting hall to initially hold patients before distribution to separate waiting rooms.90 Although the rationale for such recommendations was rarely given, one report noted ‘fears […] that health centre practice would be too remote and impersonal and would interfere with the doctor–patient relationship’. The authors, however, believed that ‘the provision of a separate waiting room for each doctor’s suite has helped to preserve’ this relationship by ensuring a direct line from patient to GP.91

The reference to ‘impersonal’ common waiting areas, and a desire for GPs to ‘own’ a waiting room in shared premises, indicated the extent to which GPs did not want to ‘lose sight of the advantages of the doctor’s private house’ or ‘imitate the hospital out-patient department’.92 Indeed, the BMA warned of health centres doing ‘more harm than good if they acquire an institutional atmosphere’, as ‘in hospital outpatient departments it has been difficult to avoid the impersonal handling of patients, and in the public health clinics, too, the atmosphere has been anything but one of privacy’.93 GPs may simply have been acknowledging the increasing unpopularity of outpatient departments. Alternatively, they may have been recalling earlier suggestions that outpatients could have an ‘unhealthy mental atmosphere’, or contemporary concerns about the ‘sinister influence’ of ‘chatter’ in institutional spaces like the ‘antenatal waiting-room’.94 However, such statements also acknowledged how the waiting room provided GPs with an opportunity to professionally differentiate themselves from hospital clinicians through their premises. When doctors constructed the ‘self’ of general practice, one grounded in personal relationships and knowledge of patients, the impersonal hospital provided a powerful Other against which to work.95

Privacy formed a logical companion to the personal. ‘At all costs’, the BMA suggested, ‘the patient must continue to feel he is making a private visit to the doctor who is a friend of his own choice.’96 Indeed, so pivotal was privacy to creating a trusting doctor–patient relationship that publications stressed the importance of placing waiting rooms at a remove from consultation rooms. ‘There are few things more embarrassing for prospective patients’, Taylor noted, ‘than to hear, as they sit in the waiting-room, doctor and patient discussing an intimate ailment in loud voices.’ ‘The right solution’, he went on, ‘is for the consulting room to open off a passage or lobby which opens off the waiting room’, to create ‘an air lock which acts as a sound lock’. Failing that, inferior make-do alternatives existed, such as adding fibre-board or curtaining to the consulting-room door.97

Once again, the creation of the NHS probably contributed to an interest in privacy. Inter-war complaints about doctors consulting in front of waiting patients highlighted patients’ desire for privacy when discussing medical matters.98 Yet contemporaneous letters to the British Medical Journal also suggested that some GPs had rather different views of their patients’ expectations before 1948. One correspondent, for instance, suggested that among panel patients ‘symptoms and diseases – especially in medical terms […] are bandied about with the greatest gusto’. Even for private patients, ‘nothing pleases them better than the semi-public discussion of their own and other people’s illnesses’.99 Thus while shielding consultations from waiting patients was a pre-NHS ideal, presumptions about panel patients in particular probably compounded the architectural and financial challenges of soundproofing to prevent this in practice. With the creation of the NHS, however, state and profession came to take such conditions more seriously, and privacy became vital for GPs looking to revive general practice around personal relationships. Indeed, new technologies and housing designs had facilitated a transformation of privacy in working-class communities more broadly.100

GPs had other ways of compensating for the loss of the personal and private space of the doctor’s home. As the first space that patients entered – and in which they passed the most time – waiting rooms also offered the chance to make renovated, shared, and purpose-built premises feel welcoming and domestic.101 Describing a new health centre in Harlow, the British Medical Journal noted that the two waiting rooms were ‘curtained and carpeted to give a homelike appearance’, with comfort and a sense of familial care secured through the provision of ‘chairs of different sizes, small for children and capacious for portly adults’.102 Recommendations for furnishings also nodded towards general practice’s unique character, with the CHSC promoting ‘domestic rather than institutional’ furniture for premises.103 Taylor likewise concluded his discussion of furniture by acknowledging the different factors shaping GPs’ decisions: ‘floor covering should combine cleanliness and durability with homeliness’.104

As recent scholarship has suggested, ideas of the domestic had important political overtones in the immediate post-war period, with the family considered the ideal unit through which totalitarian regimes could be resisted and democratic citizens made.105 Similar political importance was also attached to discourses of ‘brightness’, with brightness seen a way to convince the population of the benefits of post-war social democracy. In the late 1940s, for instance, the Deputy Prime Minister, Herbert Morrison, wrote to the Minister of Transport advocating ‘the brightening up of the railway stations’. He suggested that ‘in these austere times, even a coat of paint may have a good psychological effect’. There were, of course, electoral issues to consider. Morrison admitted to declaring ‘publicly more than once’ that such advantages should follow from nationalisation. Failing to deliver would obviously not reflect well on the Labour government. Nonetheless, he believed that such ‘little things’ could ‘mean a great deal in terms of public goodwill’, especially with ‘proper publicity’.106

Given such a context, it is unsurprising that discussions of premises promoted ‘bright’ and ‘cheerful’ waiting rooms. The NHS was a central feature of the post-war welfare state, and required public acceptance to function, particularly when facing severe criticism from some political and professional quarters.107 Yet, though austerity may have made bright, uplifting décor an attractive design choice in the 1950s, discussions about waiting rooms also indicated the psychological function of well-decorated spaces.108 As places in which patients might be suspended for hours, waiting rooms could help manage patients’ moods. Practitioners in Harlow, for instance, proudly described their waiting room as ‘cheerful’, while Taylor noted how ‘cheerful posters’ provided suitable additions to the space.109 In turn, the CHSC argued for the importance of ‘bright and pleasant, well lit, well warmed, well cleaned and well ventilated’ premises.110 The importance of brightness was underlined by an article in The Practitioner which suggested that ‘really cheerful colours are justified for the patient will probably not be feeling his best, may well be feeling cold and cheerless on arrival, and may have to spend some time before being seen’.111 The CHSC’s references to ventilation, warmth, lighting, and seating likewise underlined the practical and performative consideration of ‘comfort’ in this regard as well.112

An interest in psychological management did not stop at a patient’s mood, at easing the intolerability of waiting. The idea of the waiting room as a public space in which certain dispositions could be cultivated was also manifested in efforts to shape the health behaviours of patients. Use of the waiting room to cultivate health citizenship first emerged in inter-war NHI work, with practitioners looking to delimit reasonable expectations and a patient’s entitlements under the scheme. Posters clarified what users could expect, to save busy GPs ‘wasting’ time explaining the new system, and other signs defined unacceptable forms of bureaucracy.113 By the late 1930s, the BMA also supported GPs who were engaged in public health campaigns to increase service use, albeit primarily to underline the contribution of a mixed economy of providers to the nation’s health.114

Similar materials were sought after 1948. Some posters, flyers, and pamphlets reflected the shifting pattern of public health. For instance, the BMA lobbied the Ministry of Health to expand the range of materials about vaccination programmes available to GPs, with the aim of reshaping post-war subjects into good health citizens.115 GPs were also keen to reorientate patients to new temporal demands; one practitioner recalled how ‘the exhibition of the BMA notice on timing and urgency of calls is very valuable’ for efforts to ‘drill my patients’ into new forms of time discipline.116 Executive councils also produced posters ‘containing instructions to the public on National Health and National Insurance matters’, with the BMA equally keen to disentangle the two.117 As Taylor noted, not all GPs supported such endeavours, and not all patients engaged with this material.118 However, he hoped that ‘with doctor–patient co-operation and health education, a small response is better than none’.119

Regardless of its slow take-up, such suggestions underlined how the waiting room had become an object of concern with the collectivisation of service funding. The renewed emphasis on education, prevention, and appropriate service use after 1948, moreover, was indicative of the way GPs gradually reframed the waiting room from a source of anxiety into an opportunity. The suspension of patients in space and time required management to be acceptable, but it also offered ways to remake citizens and differentiate general practice as a form of care.

Conclusion

The NHS provided a symbol of universalism, yet its cultures were not formed democratically: though GPs sought to build the presumed psychological needs of patients into the fabric of the NHS, they rarely asked patients for their input. Despite the rights of patients growing in relation to healthcare, the profession remained dismissive of ‘the laity’. Medical and employment aspects of the service remained their preserve as experts. The Birmingham Medical Committee put it plainly when ruling out patient consultation during surgery inspections: ‘we think we can find the bad spots ourselves without having to ask lay people for their opinions’.120

In many respects, the Ministry-prompted inspection of surgeries was indicative of the working culture of the early NHS. The medical profession dominated service provision, though only in complex interplay with political institutions that could prompt change and professional self-management if motivated.121 Patients often existed on the margins, but they engaged with the running of services indirectly, sometimes through elections or complaints to Members of Parliament, sometimes through letters to newspapers and public problematisation. As this chapter has suggested, in terms of the waiting rooms these dynamics were literally embedded into the spaces of the NHS.

In terms of general practice, however, the waiting room also sat at the intersection of various developments that made the space of waiting a public and professional concern. Some of these developments saw GPs negatively engage with waiting rooms. Anxieties about declining deference, for instance, manifested themselves in complaints about how NHS patients behaved in waiting rooms, just as concerns with professional status were expressed in frustration with ‘full’ waiting rooms. Overcrowding was a mark of undeserving patients attending unnecessarily for consultation, producing rushed care and a working day dominated by low-status ‘trivia’. More ‘productive’ problematisation of the waiting room was of course connected with such concerns, and with the opportunities that the new NHS offered. Financial settlements of the early 1950s and especially the 1960s provided opportunities to redevelop practices. A reduced emphasis on competition for patients fostered group practice, and complaints about status prompted the creation of new professional identities. Creating new spaces, or renovating existing ones, encouraged GPs to reflect on the space of the surgery, and they sought to put it to novel use. Waiting rooms provided the means for professional self-representation and differentiation, as well as for managing patient experiences and shaping health citizens.

Any consideration of the specific ‘NHS-ness’ of post-war waiting rooms needs to recognise the inheritance of outlooks and buildings from earlier periods. Indeed, though this chapter has focused on change, the majority of premises were left unaltered until later decades. As noted, moreover, thinking about the waiting room and its patients was closely connected to the extension of collectivised funding dating from the commencement of state insurance in 1913. Equally, some of the issues considered here were connected with longer-term trends in medicine and society. Post-war economic and political developments generated affluence, raising questions about deference and class prejudice, while professional reflections on – and anxieties about – the role of general practice were underpinned by the growth of hospitals and paramedical professions.122

Nonetheless, the post-war problematisation of the waiting room was inextricably entangled with the NHS. The NHS extended citizens’ rights to healthcare, raised expectations, and added political weight to complaints. It heightened international interest in British medicine and drew questions about the nature of general practice to a head. In terms of inspections and ‘full’ waiting rooms, the NHS represented unwelcome state intervention in the work of liberal professionals, and embodied an egalitarian ethos that some GPs found anathema to personal and professional aspirations. Finally, even positive reactions to the NHS were related to the new circumstances created for collegiality and redevelopment of premises, as well as for patient management. The NHS thus substantially (re)shaped the spaces it produced and inherited.

Questions remain about how patients responded to the remade spaces of the NHS or felt about their changing status. Ongoing research is only beginning to uncover the sources that might provide insight into these topics, and it appears that patients’ experiences (like their doctors’) were simultaneously shaped by inherited norms and post-war promises about access and belonging. Greater understanding, however, will require further work. Rather, this survey has sought to show the ways in which the social, cultural, and political dynamics of the health service were built into the very spaces of the NHS, and that even the waiting room was made to serve a purpose.

Notes

As always, deep thanks are owed to Gareth Millward and Harriet Palfreyman for their insightful comments on successive drafts of this chapter. Lisa Baraitser’s and Laura Salisbury’s incisive feedback on early drafts greatly transformed my handling of the material, for which I am immensely grateful. I would also like to thank the rest of the Waiting Times team – especially Michael Flexer and Stephanie Davis – for their generous comments and support. The work was greatly enriched by input from Hannah J. Elizabeth, Andrew Seaton, Kristin Hay, and my ‘Open Space’ colleagues in the Wellcome Centre for Cultures and Environments of Health, and the argument sharpened by wonderful editorial comments. This work was generously funded by the Wellcome Trust Collaborative Award ‘Waiting Times’ (grant number 205400/A/16/Z).
1 ‘Bright-While-you-Wait is Doctors’ New Plan’, News Chronicle, 3 August 1954, The National Archives, London (TNA), MH 135/255, HNR 6/8.
2 On the ‘spatial turn’ see F. Williamson, ‘The Spatial Turn of Social and Cultural History: A Review of the Current Field’, European History Quarterly, vol. 44, no. 4 (2014), pp. 703–17.
4 I am grateful to Ed DeVane and Andrew Seaton for discussions about their work and access to material from their doctoral research. See also Andrew Seaton, ‘The Gospel of Wealth and the National Health: The Rockefeller Foundation and Social Medicine in Britain’s NHS, 1945–60’, Bulletin of the History of Medicine, vol. 94, no. 1 (2020), pp. 91–124; Edward DeVane, ‘Pilgrim’s Progress: The Landscape of the NHS Hospital, 1948–70’, Twentieth Century British History, 5 July 2021, https://doi.org/10.1093/tcbh/hwab016.
5 Victoria Bates, ‘“Humanizing” Healthcare Environments: Architecture, Art and Design in Modern Hospitals’, Design for Health, vol. 2, no. 1 (2018), pp. 5–19; Victoria Bates, Making Noise in the Modern Hospital (Cambridge: Cambridge University Press, forthcoming). My thanks to the author for generously allowing me pre-publication access to this wonderful material. See also J. Hughes, ‘The Matchbook on a Muffin: The Design of Hospitals in the Early NHS’, Medical History, vol. 44, no. 1 (2000), pp. 21–56.
6 Daisy Payling, ‘“The people who write to us are the people who don’t like us”: Class, Gender and Citizenship in the Survey of Sickness, 1943–52’, Journal of British History, vol. 59, no. 2 (2020), pp. 315–42.
7 On GPs and the development of premises see Geoffrey Rivett, From Cradle to Grave: Fifty Years of the NHS (London: King’s Fund, 1998), pp. 80–90, esp. 88.
8 Such work combines the New Political History’s emphasis on language and culture in constituting subjects with the sociological and political frameworks of social and policy history: D. Wahrman, ‘The New Political History: A Review Essay’, Social History, vol. 21, no. 3 (1996), pp. 343–54. Cf. Rudolf Klein, The New Politics of the NHS: From Creation to Reinvention (5th edition, Oxford: Radcliffe, 2006). For similar considerations of emotions, public health, and politics in histories of the NHS and welfare state see Stephen Brooke, ‘Space, Emotions and the Everyday: The Affective Ecology of 1980s London’, Twentieth Century British History, vol. 28 (2017), pp. 110–42; Hannah J. Elizabeth, ‘Love Carefully and without “Over-Bearing Fears”: The Persuasive Power of Authenticity in Late 1980s British AIDS Education Material for Adolescents’, Social History of Medicine, September 2020, pp. 1–26, 10.1093/shm/hkaa034.
9 Anne Digby, The Evolution of British General Practice, 1850–1948 (Oxford: Oxford University Press, 1999), p. 307; F. Honigsbaum, The Division in British Medicine: A History of the Separation of General Practice from Hospital Care, 1911–1968 (London: Kogan Page, 1979), pp. 9–10, 17–18.
10 Digby, Evolution of British General Practice, p. 310.
11 N. R. Eder, National Health Insurance and the Medical Profession in Britain, 1913–39 (London: Garland Publishing: London, 1982), pp. 29–31; Digby, Evolution of British General Practice, pp. 307–15. Though cf. responses from older GPs to insurance bureaucracy: ibid., pp. 313–14.
12 ‘Court of Inquiry into the Insurance Capitation Fee’, British Medical Journal (BMJ), Supplement, 5 January 1924, p. 6.
13 ‘Insurance Medical Service’, BMJ, Supplement, 14 November 1936, p. 260.
14 ‘Special Conference of Local Medical and Panel Committees’, BMJ, Supplement, 26 July 1919, p. 30.
15 Andrew Morrice, ‘“Strong Combination”: The Edwardian BMA and Contract Practice’, in Martin Gorsky and Sally Sheard (eds), Financing Medicine: The British Experience since 1750 (London: Routledge, 2006), pp. 165–81.
16 M. Gorsky, ‘Friendly Society Health Insurance in Nineteenth-Century England’, in Gorsky and Sheard (eds), Financing Medicine, p. 159.
17 ‘Insurance Acts Committee’, BMJ, Supplement, 23 June 1917, p. 144; Digby, Evolution of British General Practice, pp. 148–50.
18 Digby, Evolution of British General Practice, pp. 140–2.
19 ‘Special Conference’, p. 30.
20 P.P., ‘The Medical Insurance Service’, BMJ, Supplement, 3 March 1923, p. 74; ‘Decoration of Consulting Room’, BMJ, 2:3524 (21 July 1928), p. 138; ‘Insurance Acts Committee of the BMA’, BMJ, Supplement, 14 January 1939, p. 16.
21 ‘Private and Panel Patients: Druids’ Complaint of Differentiation’, Manchester Guardian, 25 May 1923, p. 13; ‘The Daily Sketch and the Panel Doctor’, BMJ, Supplement, 17 February 1923, p. 49. On how older Friendly Societies were integrated into state healthcare programmes see P. Ismay, Trust among Strangers: Friendly Societies in Modern Britain (Cambridge: Cambridge University Press, 2018), pp. 205–13.
22 Respectively: ‘Private and Panel Patients’, p. 13; ‘The Insurance Medical Service’, BMJ, Supplement, 10 February 1923, p. 35. See also H. Beadles, ‘Future Medical Policy’, BMJ, 1:2944 (2 June 1917), 748.
23 ‘The Insurance Medical Service’, p. 35; ‘Private and Panel Patients: Druids’ Complaint of Differentiation’, p. 13.
24 ‘London Panel Committee’, BMJ, Supplement, December 1927, p. 250.
25 Klein, The New Politics of the NHS, pp. 3–4; Martin Gorsky, ‘“Threshold of a New Era”: The Development of an Integrated Hospital System in Northeast Scotland, 1900–39’, Social History of Medicine, vol. 17, no. 2 (2004), pp. 247–67.
26 D. Hannay, ‘Undergraduate Medical Education’, in I. Loudon, J. Horder, and C. Webster (eds), General Practice under the National Health Service 1948–1997 (Oxford: Oxford University Press, 1998), p. 167.
27 Rivett, From Cradle to Grave, p. 80.
29 Report of the Committee on General Practice within the National Health Service (London: HMSO, 1954), p. 23. On regulations see Paul Addison, No Turning Back: The Peacetime Revolutions of Post-War Britain (Oxford: Oxford University Press, 2010), pp. 12–32.
30 TNA, MH 135/255, ‘The family doctor in factory town: a study of general practice’, undated, p. 3.
31 ‘State of Doctors Surgeries: A Rochdale Inquiry’, Manchester Guardian, 22 November 1950, p. 2; Third Doctor’s Wife, ‘Doctors’ Waiting Rooms’, Manchester Guardian, 15 October 1954, p. 6; G.P., ‘Doctors’ Waiting Rooms’, Manchester Guardian, 27 October 1954, p. 6.
32 See questions kept on file: TNA, MH 135/255, ‘Surgery and waiting room accommodation: policy, 1950–56’.
33 TNA, MH 135/255, 487/1952/3, ‘Doctors’ surgeries and waiting rooms’, 21 May 1953.
34 TNA, MH 135/255, 32/1953/4, ‘Doctors surgeries: non-oral answer’, 26 November 1953.
35 See Bivins’s chapter in this volume.
36 Martin Gorsky, ‘The Political Economy of Health Care in the Nineteenth and Twentieth Centuries’, in M. Jackson (ed.), The Oxford Handbook of the History of Medicine (Oxford: Oxford University Press, 2011), pp. 439–42. New Zealand had a smaller-scale tax-based system.
37 J. S. Collings, ‘General Practice in England Today: A Reconnaissance’, The Lancet, vol. 255, no. 6604 (25 March 1950), pp. 555–79.
38 Ibid., pp. 568 and 558 respectively.
39 S. Taylor, Good General Practice: A Report of a Survey (London: Oxford University Press, 1954), p. 6.
40 S. J. Hadfield, ‘A Field Survey of General Practice, 1951–2’, BMJ, 2:4838 (26 September 1953), p. 700.
41 TNA, MH 135/255, ‘Accommodation provided by doctors’, 17 June 1953, p. 1.
43 ‘The Practitioner under the Microscope’, The Practitioner, vol. 164, no. 983 (1950), pp. 382–3; Report of the Committee on General Practice, p. 22.
44 TNA, MH 135/255, ‘Accommodation provided by doctors’, pp. 1–4.
45 TNA, MH 135/255, ‘Surgery and waiting room accommodation provided by general medical practitioners’, draft E.C.L./54, 1954, pp. 1–4.
46 ‘Surgery Premises’, BMJ, Supplement, 2 October 1954, pp. 131–2.
47 Martin Gorsky, ‘Community Involvement in Hospital Governance in Britain: Evidence from before the National Health Service’, International Journal of Health Services, vol. 38, no. 4 (2008), p. 752; Mold, Making the Patient-Consumer.
48 Report of the Committee on General Practice, p. 23.
49 ‘Surgery Premises’, p. 132.
50 Civil servants used the CHSC report to push for inspections: TNA, MH 135/255, ‘Surgery and waiting room accommodation provided by general medical practitioners’, pp. 1–2.
51 Taylor, Good General Practice, p. 228.
52 Ibid., pp. 224–5.
53 Hadfield, ‘A Field Survey’, p. 700. See also L. J. Witts, ‘Airy Syllabub’, BMJ, 2:4782 (30 August 1952), 493.
54 ‘Annual Representative Meeting, Cardiff, 1953’, BMJ, Supplement, 18 July 1953, p. 34.
55 R. S. Phillips, ‘Inspection of Surgeries’, BMJ, Supplement, 23 October 1954, 154.
56 N. Elias, The Civilizing Process: Sociogenetic and Psychogenetic Investigations, trans. E. Jephcott (Oxford: Blackwell, 1978); V. Smith, Clean: A History of Personal Hygiene and Purity (Oxford: Oxford University Press, 2007); C. Hamlin, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge University Press, 1997); A. Forty, Objects of Desire: Design and Society since 1750 (London: Thames and Hudson, 1986); A. McClintock, Imperial Leather: Race, Gender and Sexuality in Colonial Contest (London: Routledge, 1995).
57 S. Virdee, Racism, Class and the Racialized Outsider (Basingstoke: Palgrave Macmillan, 2014). Tensions around colonial and Commonwealth immigration were rising in the 1950s, but also sparked anti-racist politics: Pat Thane, Divided Britain: A History of Britain, 1900 to the Present (Cambridge: Cambridge University Press, 2018), pp. 236–9.
58 Hadfield, ‘A Field Survey’, p. 700.
59 P.P., ‘The Medical Insurance Service’, p. 74.
60 ‘London Insurance Committee’, BMJ, Supplement, 14 April 1923, pp. 113–14. Criticism of such practices was bound up with broader debates about relative standards of treatment: Digby, Evolution of British General Practice, pp. 318–22.
61 Juvenis, ‘Mechanised Medicine’, BMJ, 2:3954 (17 October 1936), p. 787.
62 M. Douglas, Purity and Danger: An Analysis of the Concepts of Pollution and Taboo (London: Ark, 1984), p. 35.
63 Ibid., p. 2.
64 B. Campkin, ‘Placing “Matter out of Place”: Purity and Danger as Evidence for Architecture and Urbanism’, Architectural Theory Review, vol. 18, no. 1 (2013), pp. 53–7.
65 Claire Langhammer, ‘“A pub is for all classes, men and women alike”: Women, Leisure and Drink in Second World War England’, Women’s History Review, vol. 12, no. 3 (2003), pp. 423–43; Thane, Divided Britain, pp. 203–5; David Kynaston, Austerity Britain, 1945–51 (London: Bloomsbury, 2007). Of course, some such issues had pre-war precedents: Ross McKibbin, Classes and Cultures: England, 1918–1951 (Oxford: Oxford University Press, 1998), pp. 188–98, 206–71.
66 K. Paul, Whitewashing Britain: Race and Citizenship in the Postwar Era (New York: Cornell University Press, 1997); D. M. Haynes, Fit to Practice: Empire, Race, Gender and the Making of British Medicine, 1850–1980 (New York: University of Rochester Press, 2017).
67 Taylor, Good General Practice, p. 223.
68 Private patients disappeared ‘much more rapidly than doctors [had] envisaged’: Digby, Evolution of British General Practice, p. 333.
69 Taylor, Good General Practice, fig. 11 on inserts between pp. 208 and 209. M. Arnold and J. Ware, ‘The Doctor’s Surgery: Structure and Materials’, The Practitioner, vol. 175, no. 1047 (1953), pp. 321–7.
70 Arnold and Ware, ‘The Doctor’s Surgery’, p. 326.
71 ‘The Soap Ration’, BMJ, Supplement, 14 March 1942, p. 45.
72 ‘Heard at Headquarters’, BMJ, Supplement, 27 November 1948, p. 194.
73 National Health Doctor, ‘Abuses of the Health Service’, Manchester Guardian, 18 October 1950, p. 6.
74 ‘Local Medical Committees’ Conference’, BMJ, Supplement, 5 November 1949, p. 199.
75 ‘Heard at Headquarters’, p. 194; L. P. Phillips, ‘Loading the First 1,000’, BMJ, Supplement, 9 August 1952, p. 94.
76 F. H. Tyrer, ‘The GP and the Industrial Medical Officer’, BMJ, Supplement, 27 June 1953, p. 314; W. M. Jablonski, ‘Form O.S.C.1’, BMJ, Supplement, 22 October 1955, p. 96.
77 A. G. Hassan, ‘Unwelcome Visitor’, BMJ, Supplement, 1 September 1951, p. 103. On night calls, see also ‘Heard at Headquarters’, p. 194.
78 See Millward’s chapter in this volume.
80 M. Balint, The Doctor, his Patient and the Illness (London: Pitman Medical, 1957).
82 Respectively: National Health Doctor, ‘Abuses of the Health Service’, p. 6; Phillips, ‘Inspection of Surgeries’, p. 154.
84 Digby, Evolution of British General Practice, pp. 53–65, 287–305.
85 Rivett, From Cradle to Grave, pp. 83–4. Some GPs retained junior or part-time posts in smaller cottage hospitals: Digby, Evolution of British General Practice, p. 339. Others recalled a sense of localism underpinning positive working relationships with hospitals and high morale: Smith and Nicolson, ‘Re-Expressing the Division in British Medicine under the NHS’, pp. 938–48.
86 For the ‘renaissance’ framing see J. Horder, ‘Conclusion’, in Loudon, Horder, and Webster (eds), General Practice under the National Health Service, p. 278.
87 Simpson, Migrant Architects of the NHS, esp. pp. 45–50, 244–78.
88 However, professional opposition and resource constraints largely derailed visions for health centres as local government-led sites for multidisciplinary preventive and curative health work: Charles Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 1998), pp. 49–50.
89 ‘Towards the Health Centre’, BMJ, Supplement, 15 September 1951, p. 114.
90 ‘Health Centre for New Town’, BMJ, Supplement, 9 February 1952, pp. 49–50. Cf. ‘The William Budd Health Centre’, BMJ, 1:4858 (13 February 1954), p. 388.
91 ‘The William Budd Health Centre’, p. 391.
92 ‘Health Centres’, BMJ, 1:4602 (19 March 1949), pp. 495–6.
93 ‘Health Centres’, BMJ, Supplement, 11 September 1948, p. 115.
94 ‘Metropolitan Counties Branch of the BMA’, BMJ, Supplement, 10 July 1937, p. 23; ‘One Hundred and Eighteenth Annual Meeting of the British Medical Association’, BMJ, 2:4673 (5 August 1950), pp. 275–6.
95 On other/self frameworks see E. Said, Orientalism (London: Penguin, 2003); Linda Colley, ‘Britishness and Otherness: An Argument’, Journal of British Studies, vol. 31, no. 4 (1992), pp. 309–29.
96 ‘Health Centres’ (1948), p. 115.
97 Taylor, Good General Practice, pp. 211–12.
98 ‘Special Conference’, p. 30.
99 H. Bloxsome, ‘Insurance Medical Records’, BMJ, Supplement, 15 January 1921, 18.
100 D. Vincent, Privacy: A Short History (Cambridge: Polity, 2016), pp. 91–9.
101 As Victoria Bates has argued, ideals of ‘domestic scale’ became integrated into new directions in hospital design as part of ideologies of ‘humanization’, especially from the 1960s onwards: Bates, ‘“Humanizing” Healthcare Environments’, pp. 11–16.
102 ‘Health Centre for New Town’, p. 49.
103 ‘Central Health Services Council’, BMJ, Supplement, 3 July 1954, p. 2.
104 Taylor, Good General Practice, pp. 209–10.
105 Michal Shapira, The War Inside: Psychoanalysis, Total War, and the Making of the Democratic Self in Postwar Britain (Cambridge: Cambridge University Press, 2013); Bar-Haim, ‘“The Drug Doctor”’, pp. 124–5.
106 TNA, AN 13/2518, untitled letter by H. Morrison to A. Barnes, 13 January 1949.
108 Some commentators had discussed ‘cheerfulness’ in relation to hospital labour during the 1950s, but it become more fully part of discussions about humanised hospital design in the 1980s and 1990s: Bates, ‘“Humanizing” Healthcare Environments’, pp. 14–15.
109 ‘Health Centre for New Town’, p. 49; Taylor, Good General Practice, p. 227.
110 Report of the Committee on General Practice, p. 24.
111 Arnold and Ware, ‘The Doctor’s Surgery’, p. 325.
112 Hadfield emphasised the same features: Hadfield, ‘A Field Survey’, p. 700.
113 ‘A Notice to Insured Persons’, BMJ, Supplement, 21 April 1923, p. 119; J. P. O’Hea, ‘Witnessing of Signatures by Doctors’, BMJ, Supplement, 27 August 1932, p. 167.
114 ‘Health Campaign: BMA Posters’, BMJ, Supplement, 1 January 1938, p. 4.
115 ‘General Medical Services Committee’, BMJ, Supplement, 1 September 1951, p. 85; Gareth Millward, Vaccinating Britain: Mass Vaccination and the Public since the Second World War (Manchester: Manchester University Press, 2019).
116 ‘A Review of General Practice, 1951–2’, BMJ, Supplement, 26 September 1953, p. 126.
117 ‘Heard at Headquarters’, BMJ, Supplement, 14 April 1951, p. 153; W. M. E. Anderson, ‘Patients’ Addresses’, BMJ, Supplement, 26 May 1951, p. 216.
118 Anderson, ‘Patients’ Addresses’; A. G. Salaman, ‘BMA Poster’, BMJ, Supplement, 14 April 1951, p. 155.
119 Taylor, Good General Practice, p. 227.
120 ‘Bright-While-you-Wait is Doctors’ New Plan’.
121 On the general weakness of contemporary managerial tools see Moore, Managing Diabetes, Managing Medicine, p. 52.

Posters, protests, and prescriptions

Cultural histories of the National Health Service in Britain

Editors: Jennifer Crane and Jane Hand

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