Below are two appreciations of the late Julian Tudor Hart by the two editors of Healthmatters who knew him well.
Readers are invited to add to these by sending their contributions to Paul Walker at firstname.lastname@example.org
1. As a young doctor in the 1960s general practice was a closed book. Lord Moran’s dictum that general practitioners were those who had fallen off the consultant career latter seemed to apply. So when I decided not to pursue a consultant career I did not even consider general practice and opted for public health.
In those days general practice was only loosely connected to the NHS management structure so I had very little contact with it until later in my career when I worked in Norfolk. There general practice was of a very high quality and included some very charismatic and involved characters of whom Tony Allibone, a fellow health authority member, was one.
By this time I had discovered the writings of Julian Tudor Hart which were a revelation and an inspiration. His writings became for me compulsory reading and I was lucky enough to hear him speak at a meeting of the local medical society in Norwich. In person he was as inspiring as on paper.
Moving to Wales in 1993 I got to know him well and as a direct result of his influence I joined the Labour Party and became an ardent socialist joining the Socialist Health Association of which he was a long term member and later President. He showed me that the inequalities in health-driven public health agenda was part of the broader socialist agenda and that general practice provides an ideal platform for delivering this public health agenda and for promoting public wellbeing.
In recognition and appreciation of his public health leadership role the Welsh Public Health Association (PHA Cymru) in conjunction with the Cardiff University School of Social Sciences established the annual Julian Tudor Hart lecture in 2005 with the aim of attracting and enthusing the academic community in Wales to this public health agenda.
Having spent much of my career working in the higher reaches of the NHS hierarchy in and around London I met a lot of impressive and inspiring people. Julian was one of the very few of them who changed my worldview.
2. Julian Tudor Hart inspired a cohort of GPs to focus in depth and detail on getting medicine right, especially for the most disadvantaged – the communities hurt by industrial decline, the least educated, those with only limited resources. Had he stayed in West London – where his imprint in discharge letters and medical records was faintly visible to a novice fan some 20 years later -he might have woven race into his understanding of class. He moved to a South Wales mining community, Glyncorrwg, in the Afan Valley and became one of the single handed GPs in remote places who still figure in GP mythology, like John Berger’s ‘Fortunate Man’, and the GP epidemiologist William Pickles.
His Lancet paper on the Inverse Care Law was published just as political debate amongst the ’68 generation of medical students was growing, and Julian helped a generation on the medical left to withstand the almost constant denigration of general practice by teaching hospital specialists. His generosity meant that many could see what he did, first hand, and even more could hear him speak at conferences and seminars, and on courses at the Communist University. He spurred the growth of the (short-lived) health student movement, and contributed to Medicine in Society, a left journal that continued until 1990. Although a zealot himself he was grounded enough to try and steer us away from the hazard that Peter Draper described, the redesigning of the NHS by saints, for saints. His advocacy of medical science in general practice was a counter to the then favoured psychosocial focus on the consultation.
Even when a member of the Labour Party Julian was a man of a special mould, a Stalinist in the non-pejorative use of the term. He was a ‘cadre’, an individual who has first-hand experience of the circumstances of their community, who is trusted by patients (and fellow-workers) and who brings to the organisation of work a flexible, immediate, policy-oriented dynamism and pragmatic adaptability. He was also a voluntarist, who believed that the will was as important as the intellect in bringing about change, a ‘Stakhanovite’ shock-worker capable of managing a prodigious workload, and a utopian who believed that one day money would disappear completely. In his writings he argued that capitalism was terminal, that private wards in NHS hospitals were barbarism, and that GPs would need to work harder and earn less – a prescient thought given the way that anticipatory care morphed into the Quality & Outcomes Framework. He followed a socialist tradition that intellectuals could redeem themselves by embracing proletarian culture and politics, which he summed up as shifting the doctor-patient relationship from ‘face-to-face to shoulder-to-shoulder’. Finally, he was a fierce heretic-hunter, denouncing doubters with show trial vigour.
How ironic, then, that this political culture should be played out in the sub-contractor franchise economy of general practice, at the end of the 20th century. Conventional wisdom has it that all political lives end in failure, but perhaps not in this case. The “University of Glyncorrwg” is still a force (even if its alumni are diminishing), inequality is fixed on the NHS agenda (even if we are ineffectual in reducing it), and anticipatory care is operationalised (however clumsily) in the GP contract. Some impact, some legacy!