Chelsea Saxby reflects on public feelings about the NHS through TV viewers’ nostalgia for inter-war GPs
What might audience responses to a ‘feel good’ Sunday night drama, set in the Scottish Highlands between the wars, tell us about people’s feelings towards the NHS in the 1960s?[1]
Dr Finlay’s Casebook (1961-1971) was the BBC television adaptation based on the works of the GP-turned-novelist, Dr A.J. Cronin. In the series, Dr Finlay (Bill Simpson) is the idealistic junior partner of the general medical practice at Arden House where he lives with Dr Cameron (Andrew Cruickshank), the craggy senior partner, and their housekeeper and receptionist, Janet (Barbara Mullen). Episodic in nature, each instalment tended to focus on one medical case the three characters were working to treat within the tight-knit Highlands community. ‘The Arden trio’s’ friendship, ‘lovely countryside’, ‘careful attention to period detail’ and faithful explanations of inter-war medicine kept some 9.75 million viewers returning to the fictional town of Tannochbrae every week.[2]
Doctors’ Reception
The viewing public’s appetite for Casebook didn’t escape the attention of the medical profession. The serial couldn’t be an aid to good health – as one correspondent in the Proceedings of the Royal Medical Society noted, Casebook’s period setting meant it dealt with ailments and treatments that had long since become ‘irrelevant’ – but it was thought to offer free, positive PR for a section of the medical professional who felt they badly needed it.[3]
The BBC’s contribution to the proliferation of medical screen-fictions in the 1960s was applauded for bucking the trend of neglecting general practice in favour of the ‘flashier’ settings of London teaching hospitals. This focus of much of television’s medical narratives was thought to ‘denigrate’ the general practitioner, ‘putting him in a second-rate position’ during a wider crisis of status wherein GPs felt anxious about their place in the changing landscape of post-war healthcare.[4] Jane Lewis has shown that, by the early sixties, there was around a 48% gap in earnings between GPs and consultants, a situation characterised by Frank Honigsbaum as ‘The Division’ in British medicine.[5] General practitioners were certain that the poor condition of practices, combined their relative professional isolation, meant that they couldn’t compete with the ‘modern’ medicine being practiced in hospitals, and they’d soon be replaced by consultants.[6]
Casebook, however, showed ‘examples of real human problems, and the enterprise with which a good GP may meet them’. The serial imagined a more capacious role for primary healthcare providers, extending beyond the treatment of organic illness: Dr Finlay was also a father-confessor and a one-man social service for his Lochside town.[7] But rather than feeling bolstered by this presentation of their role as indispensable and integral to communities, some GPs worried that Casebook produced in their patients’ ‘unrealistic expectations’ that were ‘stuck in the past’.[8]
In the 1960s, ‘one [could] no longer be a Dr Finlay.’[9] As one GP told the Daily Mirror, whereas in the Highlands between the wars, Finlay might have had to call on a child with tonsillitis three or more times to administer them with aspirin, now modern drugs could cure such an infection in no time at all. Moreover, a GP in a highly populated area might have some 3,000 patients on their list – there simply wasn’t the time to sit and listen to individual patient woes.[10]
In GP’s reception to a period medical drama we can see their contemporary anxieties about lay demands on their time during a moment when doctor/patient relations were especially fraught. GPs were complaining with increasing intensity in the sixties that they were at the beck and call of those often presenting with trivial ailments, who nevertheless felt entitled to medical attention due to their National Health stamp contributions. As it was put by a group of Lanarkshire doctors surveyed by the BMJ, and quoted by Lewis, GPs were now the ‘slaves of free patients’.[11]
Whatever Happened to Dr Finlay?
A review of the contemporary press suggests that GPs’ anxieties about the public’s reception of this serial were not unfounded. The Stage, for instance, in accounting for Casebook’s huge public appeal, cited that ‘for many viewers [it] evoked nostalgia for the old style of family doctor’ who had a ‘deep and genuine interest in his patients and their varied problems.’[12]
We might, then, be tempted to think of viewers’ nostalgia for Finlay as a wistful longing for a type of therapeutic relationship that was either irretrievably lost, or that probably never existed. But Andrew Higson’s work prompts us to ask how nostalgia can be a profound and productive means for viewers to comment on the shortcomings of the present.[13] Following Higson’s arguments, I want us to think of viewers’ nostalgia for Finlay as ‘a response to and a re-organisation of the contemporary experience’. This is not to deny that nostalgia viewing is essentially an act of imagination, but to assert that this experience of fantasy about the past is used ‘to enter into a dialogue about the present.’[14]
Thinking this way allows us to explore how nostalgia for Finlay could be a productive vehicle for patients to express concerns about their healthcare in 1960s. For example, The Daily Mirror’s agony aunt, Marjorie Proops, published snippets from letters she had received wherein readers described ‘impatient’ GPs who they felt they didn’t really know. ‘Whatever happened,’ they asked, ‘to Dr. Finlay and his ilk?’[15]
Where have they all gone, those dedicated, tender-hearted, compassionate creatures who could be relied upon to sit there attentive and smiling warmly as they said: “Now tell me, Mrs Jones, what seems to be the trouble…?” They’ve all gone to the TV screen […] They no longer exist in real life.[16]
Viewers’ responses to Tannochbrae’s GP were constructed in terms of what the present was felt to lack: a socially familiar and personally concerned family doctor. Home visits under the NHS were becoming less common across Britain, and David Cowan’s research into Aberdonian’s attitudes towards their healthcare suggests that this, combined with the decline of single doctor practices from 1966 onwards, had left some patients feeling they lacked an individual and personal relationship with their GP.[17]
While this could have practical ramifications for their medical treatment (Cowan describes a patient being prescribed the wrong drugs by a new GP who was unfamiliar with his medical records), these snippets of TV reception would also suggest that some patients no longer felt cared for.
Andrew Seaton has shown how this contributed to a romanticised ideal of ‘the family doctor’, which formed an important facet of organised right-wing opposition to nationalisation and socialism in the NHS’ early and vulnerable years; both were felt to interfere with the autonomy of general practice and impose restrictive bureaucracy that constrained an individual GP’s ability to care for their patients.[18] These nostalgic TV responses are representative of quieter but perhaps more widespread, vernacular complaints about elements of the NHS that are sometimes missing from our stories of post-war healthcare.
Conclusion
GPs’ ambivalent reception of Dr Finlay adds texture to our understanding of a period when the wider medical profession was redrawing its relationship with the mass media: the emergence in the 1960s of a public health discourse concerned with the risks of individual behaviour (as opposed to sanitation and environment) saw a new willingness on the part of medicine to engage with television as ‘doctors reoriented their role so that they spoke to the public, not just the rest of the profession’.[19]
But medical screen-fictions proved tricky – their content could not be controlled by doctors, and their reception among audiences was not always neatly bounded to the meanings preferred by the medical establishment. Casebook was not straightforwardly good PR for GPs, instead, its viewers transformed the meaning of the text, using the serial’s nostalgia as a means to respond to and critique their contemporary experiences of the NHS.[20]
Nostalgia for the doctors of the past provided a space for viewers to express their expectations for healthcare in the present. To borrow Charlotte Greenhalgh’s phrasing – these viewers ‘played games with time’.[21] Their laments for ‘men of Finlay’s ilk’ arguably reproduced and helped sustain GPs’ professional crises in the 1960s, with television proving a useful site to trace this recursive relationship.
Chelsea Saxby is a PhD student at the University of Birmingham’s Centre for Modern British Studies. Her thesis explores how television could represent sex, bodies and romance in the long 1970s. Twitter: @ChelseaSaxby
Notes
[1] My thanks to David Cowan for his thoughtful comments on an early draft of the thesis chapter this work sits within
[2] The Stage, 17th September 1970; TAM (Television Audience Measurement) ratings throughout the serial’s run consistently place Casebook in the Network Top Twenty, seeing its ratings keep pace with the period’s most popular programme, Granada’s Coronation Street, and routinely outperforming other BBC favourites such as Steptoe and Son. See, for example: The Stage, 5th December 1963; The Stage, 7th December 1967
[3] Proceedings of the Royal Medical Society, Volume 16, February 1968, p.155; An example of an ‘irrelevant’ treatment might be, for instance, an episode broadcast in 1965 which reflected how, in the 1920s, raw liver was the only known cure for anaemia. Evening Express, 2nd January 1965
[4] Proceedings of the Royal Medical Society, Volume 16, February 1968, p.153
[5] Jane Lewis, ‘The Medical Profession and the State: GPs and the GP Contract in the 1960s and the 1990s’, Social Policy and Administration, 32:2, (1998), pp.132-150, p.136; Frank Honigsbaum, The Division in British Medicine: A History of the Separation of General Practice from Hospital Care, 1911-1968, (New York, 1979), pp.301-314
[6] Ibid; The Lancet, 2nd January 1965
[7] Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine, (London, 1988)
[8] Proceedings of the Royal Medical Society, Volume 16, February 1968, p.15
[9] The Birmingham Post, 9th May 1969
[10] Daily Mirror, 7th March 1969
[11] British Medical Journal, 19th December 1964
[12] The Stage, 28th May 1964
[13] Andrew Higson, ‘Nostalgia is not what it used to be: heritage films, nostalgia websites and contemporary consumers’, Consumption Markets and Culture, 17:2, pp.120-142
[14] Ibid, p.124
[15] Daily Mirror, 7th March 1969; These comparisons have persisted long since Finlay finished his rounds on screen. In 2011, for example, the Telegraph ran headline reading ‘Farewell Dr Finlay: patients think GPs are rude and rich’, The Telegraph, 5th December 2011
[16] Daily Mirror, 7th March 1969
[17] David Cowan, The Politics of the Past in Britain c. 1930-1990’, (2019), PhD thesis, University of Cambridge
[18] Andrew Seaton, ‘Against the ‘Scared Cow’: NHS Opposition and the Fellowship for Freedom in Medicine, 1948-72’, Twentieth Century British History, 6:3, (2015), pp.424-449, p.439
[19] Virigina Berridge, Marketing Health: Smoking and the Discourse of Public Health in Britain, 1945-2000, (Oxford, 2007), p.53
[20] Stuart Hall, ‘Encoding and Decoding in the Television Discourse’, Stencilled Occasional Papers of the CCCS, (1973); David Morley, Television, Audiences and Cultural Studies, (London, 1992)
[21] Charlotte Greenhalgh, Ageing in Twentieth-Century Britain, (California, 2018), p.133
