Archive of the National Medical Union, Manchester branch

Archive of the Manchester branch of the National medical Union, a doctors' pressure group opposed to the medical provisions of the National Insurance Act, 1911. The majority of this archive comprises minutes of various committees of the NMU, mostly dating earlier than the reorganisation of the Union in late 1913. The are minute books for the executive committee, the general committee, general meetings and of the Union's various sub-committees, the press and election committee, the organisation committee and the finance and defence committee. Some administrative papers also survive (NMU/9) which contain interesting documents on the NMU's insurance proposals and its political activities.

The National Medical Union was established in Manchester in late 1911 to co-ordinate opposition by doctors to the health insurance sections of the National Insurance Act 1911. A mass meeting of doctors at the Midland Hotel, Manchester on 14 December 1911 agreed to establish the "National Medical Union" to campaign against the Act.

The National Insurance Act 1911 introduced social insurance for selected groups of workers. The main purpose of the Act was to offer protection to these workers and their families from loss of income due to unemployment and sickness. Insured workers contributed to an insurance pool, along with their employers and the state, and drew benefits as required. The implementation of the scheme caused considerable controversy, particularly from the three interest groups most affected by it: the friendly societies, the insurance companies and the medical profession.

Under the insurance scheme medical benefits would be paid to sick workers based on their contributions. These payments were disbursed by approved societies on receipt of a sickness certificate provided by the general practitioner undertaking treatment of the claimant. Most doctors participated in the system as part of a 'panel' under contract to the approved societies and were paid according to a capitation fee. The British Medical Association, the representative body of the doctors, had serious reservations about this system. Doctors were aggrieved that they had not been properly consulted about the proposals, and, at least in the original scheme, had only been given a limited role in the administration of medical benefits. The panel system was also felt to be unduly restrictive, replicating the unpopular contracts that some doctors had with the friendly societies. Doctors were unhappy about the proposed level of fees, and they felt that eligibility for medical benefit had been set too low, leading to a possible loss of income from private practice. In response, the BMA declaredsix cardinal points as minimum conditions for their cooperation with the Act. These were: 

• an income limit for those insured (so those who could afford private practice did not use service),
• free choice of doctor for patients,
• medical benefits administered by local health committees rather than friendly societies,
• the method of payment of doctors to be decided locally,
• payment should be adequate,
• the profession should have adequate representation.

The NMU represented the militant wing of this medical opposition to the health insurance scheme. It exerted pressure on the BMA to maintain its uncompromising support of the "six cardinal points", as well as proposing its own alternative schemes of health insurance. Opposition to the health insurance provisions of the Act had been particularly strong in the Lancashire and Cheshire area, and initially the NMU drew most of its support from the local region. The Union's membership was made up of a mixture of the Manchester medical elite (most of whom would not have been directly affected by the Act) and local GPs. The chairman was G. A. Wright (1851-1920), professor of systematic surgery at the University of Manchester and a consultant at the Manchester Royal Infirmary. Other senior figures involved were Ernest Reynolds (1861-1926), a neurologist on the honorary staff of the MRI and professor of clinical medicine at the University, Archibald Donald (1860-1937), a honorary gynaecological physician at MRI and professor of obstetrics and gynaecology at the University of Manchester and John Howson Ray (1870-1946), a surgeon at MRI. The general practitioners included William Coates (1860-1962), James Brassey Brierley, J. Skardon Prowse (d.1947), T. Wheeler Hart, T. Arthur Helme (d.1921), and Ernest William Floyd (d.1930). The GPs tended to be the most active members.

By late 1912, the tide appeared to be turning against the doctors. The government had made significant concessions on remuneration, bolstered by evidence that many general practitioners stood to gain financially from their panel work. The government had also threatened to set up a state medical service with salaried doctors, if the medical profession maintained its opposition. As the state doctors would have been able to take over private treatment of an insured person's dependents, other GPs were threatened by a significant loss of income. By January 1913 many thousands of doctors had signed up for panel work.

The NMU had its own alternative health insurance schemes, which they claimed would increase patient choice, protect the interests of doctors and be economical to run. The NMU took up an insurance scheme which had been devised by the Stockport, Macclesfield and East Cheshire branch of the BMA. This gave considerable freedom to the GP in treating insured patients, and to claimants in choosing their doctor. The scheme involved the insured making two payments into a medical benefit fund: a deposit based on two weeks income, and weekly payments to be consolidated in a general pool. It was hoped that the original deposits could be funded by monies released from friendly society accounts no longer active in this area. It does not appear that the insurance pool would have been supplemented by employer or state contributions. The insured would draw their medical benefits initially from their personal deposit fund, and thereafter from the pool. They would be allowed to draw benefit for dependents. Doctors fees would be charged to the insurance fund according to standard tariffs. It was believed that the initial charging to the personal fund would discourage 'malingering'. Exhausted deposit accounts would have been replenished in part from unspent reserves of the general pool. Insurance pools were to be underwritten by the Treasury or local authorities. The NMU was also prepared to consider a salaried state medical service to deal with those unable to insure themselves in this way. It should be pointed out that his scheme was not the same as the 'Salford' Scheme, used in the Manchester-Salford area by a number of panel GPs, which paid doctors fees according to attendance rather than by capitation.

By the end of 1912, with the BMA on the defensive, the NMU recognised that continued opposition to the National Insurance scheme was only possible through amalgamating with other anti-insurance groups. Following a meeting of these groups at the Waldorf Hotel, London on 29 November 1913, the National Medical Union was re-founded as a national federation of non-panel associations. Prominent amongst these associations were the London Medical Committee and the Edinburgh Medical Guild, as well as the original National Medical Union. The latter was now renamed the Manchester branch (sometimes district) of the National Medical Union. The national body's headquarters was in London. Once the health insurance system was operative, the NMU concentrated less on proposing schemes of its own, and more on gaining a better deal for non-panel doctors. It campaigned for further amendments to the National Insurance Act, and on practical matters such as the eligibility of certificates signed by non-panel doctors for medical benefit.

The work of the Union was inevitably disrupted by the outbreak of war in 1914, although the body survived into the post-war period. By the early 1920s the Manchester branch had lost much of its membership, apparently having less than fifty members. It was maintained by a small group of enthusiasts, with Howson Ray acting as chairman, Skardon Prowse as secretary and E.W. Floyd as treasurer. The last references to the Manchester branch date to 1924, and it is assumed that it became defunct some time after this.

The NMU was an important if brief manifestation of political militancy amongst British doctors. Its hardline attitude on national health insurance indicated dissatisfaction with growing state interference in health matters, going beyond its traditional role in public health, and with what was seen as an insufficiently robust response from the medical establishment in the BMA. The Union's support base in the Manchester area also indicated a degree of provincial independence and assertion from the London-based BMA. In the event, the NMU's high political profile in 1912-1913 proved difficult to sustain once the panel system was up and running, and by the time the national body was created its momentum had been lost.

The surviving archives consists of relatively few documents, mostly in the form of bound minute books. It has been decided not to divide the archive into series, given the basic similarity of the records.

Former reference: H 2 z a

The collection is open to any accredited reader.

Photocopies and photographic copies can be supplied for private study purposes only, depending on the condition of the documents.

A number of items within the archive remain within copyright under the terms of the Copyright, Designs and Patents Act 1988; it is the responsibility of users to obtain the copyright holder's permission for reproduction of copyright material for purposes other than research or private study.

Prior written permission must be obtained from the Library for publication or reproduction of any material within the archive. Please contact the Head of Special Collections, The John Rylands University Library, Oxford Road, Manchester M13 9PP.

The history of the archive before it came to the Library is unknown. The archive was formerly treated as part of the Manchester Medical Collection (reference: H 2 z), but it is believed that it was not acquired by Ernest Bosdin Leech, the original creator of the Collection (although Leech had been involved in the Union in its early days).

The National Register of Archives does not record any archives for the federal National Medical Union or for the Edinburgh Medical Guild.

The Manchester Medical Collection in the custody of JRUL has a section on health insurance (MMC/11) which includes general material on the administration of the N.I. system in the Manchester area.