A New Kind of Doctor


1   Points of departure
2   Liberal retreat
3   Origins and limits of medical professionalism
4   New ideas in old structures
5   Measurement of omission
6   A crisis of accountability
7   Accountability for and to individuals
8   Accountability for and to groups
9   The necessity of community
10  A new social alliance

Other works by Dr  Julian Tudor Hart  MB BChir D CH FR CGP FR CP

A New Kind of Doctor: The General Practitioner’s Part in the Health of the Community

First published in 1988 by The Merlin Press Ltd., 78 Lawn Road, London NW3 2XB

© Julian Tudor Hart 1988 ISBN 0 85036 299 7  reproduced by permission


Many allies and opponents, some now dead, have contributed to ideas developed over the past forty years, and finally expressed here. I am particularly indebted to Hazel Ackery, Dr Henry Blaker, Prof. Archie Cochrane, Drs John and Jean Coope, Dr Alastair Donald, Prof. Michael Drury, Dr Hugh Faulkner, Prof. Ron Frankenberg, Dr John and Julie Frey, Dr John Fry, Dr Hugh Gainsborough, Dr Kate Gardner, Sir George Godber, Dr Steve Iliffe, Tal Jones, Dr John Horder, Prof. Harry Keen, Dr Bruce Lervy, Dr Irvine Loudon, Prof. Jerry Morris, Dr Guy Mouyen, Bert Pearce, Dr Dennis Pereira Gray, Annie and Trevor Powell, Dr Hugh Price, Prof. Geoffrey Rose, Dr Reg Saxton, Dr Conrad Seipp, Dr Cyril Taylor, Prof. Milton Terns, Prof. Sir Peter Tizard, Dr Cuys Van den Dool, and Dr Alastair and Olive Wilson.
I have had generous and loyal support from Dr Tom. Meade at the Medical Research Council’s Epidemiology Unit at the Clinical Research Centre, Northwick Park since 1973, and from my own practice and research staff, notably Betty Ackery, Mair Boast, Anita Davies, Dr Ann Delahunty, Susie Dixon, Cath Edwards, Prof. Andy Haines, Dr Adrian Hastings, Dr Cerys Humphreys, Janet Jones, Margaret Jones, Dr Alex Mills, Dr John Robson, Dr Ian Scott, Jaqueline Sexton, Evelyn Thomas, Margaret Thomas, Dr Martin Walsh, Pam Walton, Dr Graham Watt, Dr Bob Williams, Dr Richard Williams and Dr Marek Wojciechowski. I am particularly grateful to my partner Dr Brian Gibbons, Dr Bryn John, and Joy Townsend for reading the final draft and giving helpful criticism. The librarians at the Royal College of General Practitioners and the BMA Nuffield library have taken trouble to find and photocopy references. Martin Eve at Merlin Press has been encouraging and tolerant through­out. Finally, my wife Mary has led our research team since 1973 with warm flexibility and strict professionalism, run a home, raised a family, and yet made time and space for me to write books; I hope this book will eventually be as effective as she is.

To my parents

Dr Alison Nicol Macbeth, 1897-1951, MB BS London 1923, University College Hospital and Lausanne, South London Hospital for Women, Queens Hospital for Children Bethnal Green, Brompton Hospital for Diseases of the Chest, the Maudsley Hospital, and Organon Laboratories,


Dr Alexander Ethan Tudor Hart, 1901-, MRCS LRCP, St. Thomas’ Hospital, Major Spanish Republican Army 1937-8, Captain RAMC 1940-45, Booth Hall Children’s Hospital, St. Mary Abbott’s Hospital, Hampstead General Hospital, general practitioner Llanelli, Brixton and Colliers Wood,

who failed to deter me from becoming a doctor.