Collectivising the Kulaks? General practitioners and Primary Care Groups in England

Abstract

It has previously been suggested that the English Department of Health seems, wittingly or not, to have drawn on the experiences of Stalinist Russia in devising policies for the National Health Service. The development of general practitioner fundholding during the 1990s could be compared to the Soviet support for the Kulaks (rich peasants with capital and entrepreneurship) in 1923. Both initiatives aimed to propel innovation and enhance productivity by giving increased market freedom to an elite group of entrepreneurial workers. Writing in 1991, Hughes and Dingwall speculated about the likelihood of general practitioners sharing the same fate as the Kulaks in 1928, namely forcible collectivisation. The current creation of Primary Care Groups (collections of about 50 general practitioners) raises the question of whether they are likely to be vulnerable to the same pathologies as collective agriculture, or has the metaphor become exhausted?