Collings report on general practice in England in 1950: unrecognised, pioneering piece of British social research?

Publisher Website
Google Scholar
Abstract
Origins and publication of the report The Collings report is unusual in several regards. Firstly, Collings seems an improbable choice as researcher. An Australian, he had previously worked in New Zealand as a general practitioner and in Canada as a medical officer of health. At the time of the report he was a research fellow at Harvard University School of Public Health. Despite this wide ranging experience, he had never visited Great Britain so was unfamiliar with the health system and conditions there. Secondly, Collings was funded by the Nuffield Trust, which had hitherto been exclusively concerned with representing provincial voluntary hospitals in the national health policy debate.8 9 Collings's research was its first excursion into general practice. Apart from one later survey,10 the trust's interest in general practice at this time was confined to funding pilot health centre projects. Thirdly, the report's status was ambiguous. Almost uniquely, Collings's study was not published by the trust. It did approve it--but only after it had been edited by Theodore Fox, editor of the Lancet. There are other indications that the trust failed to anticipate the report's impact. Although a later source refers to the sensation it created,11 in contemporary official records it was completely unreported.12 Indeed, elsewhere, it is described as an unofficial document.10 Collings's main findings and recommendations Findings “The overall state of general practice is bad and still deteriorating” “The development of other medical services…has resulted…in wide departure from both the idea and the ideal of family doctoring” “Some [working conditions] are bad enough to require condemnation in the public interest” Inner city practice is “at best…very unsatisfactory and at worst a positive source of public danger” Rural practice is “an anachronism” and suburban practice a “casualty-clearing” service Recommendations “An attempt should be made to define the function of general practice within…the NHS” “Group practice units…should be formed” Finally, the form of the published article is perplexing. In 1950 the Lancet did not consistently observe the modern conventions of scientific publishing.13 The format of articles therefore varied considerably. Even so, Collings's report stands out in several respects. That year the Lancet published 356 Original and Special Articles. Their median length was two pages (interquartile range 2-4). Only 21 articles (6%) exceeded six pages and, apart from the Collings report, the longest was 12 pages.14 Collings's article was 30 pages. It deviated stylistically in two further respects: it was the only article reporting original research that was not headed as either an Original or a Special Article and it alone was entirely unreferenced.