Policy and inauguration

The National Health Service Bill

The National Health Service Bill, which was published in March 1946, embodied Bevan's ideas. Publication of the bill initiated a period of conflict between the government and the British Medical Association. The association was determined to resist the transfer of practitioners to state salaries and fought to maintain remuneration according to numbers of patients treated. While Bevan was successful in abolishing the sale of medical practices, he conceded in the bill that consultants could continue to use hospital beds for private practice and that the remuneration of general practitioners would be determined by numbers of patients treated rather than fixed salary. In spite of opposition to these clauses, the bill was enacted in May 1946.

In 1946, because of the British Medical Association's opposition to remuneration by salary, implementation of the National Health Act was still not a foregone conclusion. The Remuneration of General Practitioners Committee, which had been set up under the Conservative government, recommended that GPs continue to be remunerated according to patients treated. The BMA demanded the salary component of remuneration be abolished, plans for determining the distribution of GPs in the country abandoned, and the sale and purchase of practices reinstated.

Inauguration of the NHS

By February 1948, the British Medical Association and government were still in deadlock. In April, Bevan conceded that a full-time salaried service would not be implemented, and that the salary component of GPs' remuneration would be optional. Thereafter, GPs rapidly signed to the government lists. The National Health Service was inaugurated on 5 July 1948. In 1949, the National Health Service (Amendment) Act guaranteed the independent status of general practitioners who were entitled to have private patients and to receive part of their remuneration by the number of patients treated.