Doctors, capitation payments and the first Labour Government

The Health Funding Authority (HFA) proposes to change the way general practitioners (GPs) are paid for patient visits. Most doctors charge patients a fee for each visit, minus a subsidy from the general medical services benefit where applicable for those holding community services cards. Seeking to set strict limits on costs, the HFA proposes a block or 'capitation' payment for all practices based on the number and age of patients. Almost 60 years ago the first Labour government proposed just such a payment for the general practitioner service outlined in the Social Security Act 1938. Led by the local branch of the British Medical Association, doctors eventually persuaded the government to offer instead a statutory fee-for-service. They could charge their patients over and above this fee. This article shows how and why the Labour Government compromised in this way so that doctors' payment did not come wholly from the state, and that they remained independent professionals.