Julian Tudor Hart
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Julian Tudor Hart (born 9 March 1927, London) is a British General Practitioner.
He worked for 30 years as a general practitioner in Glyncorrwg, West Glamorgan, Wales, where his partner was Dr Brian Gibbons, later minister for health in Wales. He is a passionate advocate of the National Health Service and of socialism. He is President of the Socialist Health Association.
In 2006 he was awarded the inaugural Discovery Prize by the Royal College of General Practitioners as " a general practitioner who has captured the imagination of generations of GPs with his groundbreaking research... His practice in Glyncorrwg, Wales, was the first in the UK to be recognised as a research practice, piloting many Medical Research Council studies. He was also the first doctor to routinely measure every patient’s blood pressure and as a result was able to reduce premature mortality in high risk patients at his practice by 30%. Graham Watt, Professor of General Practice at the University of Glasgow, nominated Dr Tudor Hart for the award. Professor Watt said: “His ideas and example pervade modern general practice and remain at the cutting edge of thinking and practice concerning health improvement in primary care. His work on hypertension showed how high quality records, teamwork and audit are the keys to health improvement. His life-long commitment to the daily tasks of general practice has always given his work and views a salience and credibility with fellow general practitioners. Julian Tudor Hart has been and will remain an inspiration to health practitioners and the communities they serve.”
He is the author of many books and scientific articles. His most recent book, The Political Economy of Health Care: A Clinical Perspective explores how the NHS might be reconstituted as a humane service for all (rather than a profitable one for the few) and a civilising influence on society as a whole. The book provides 'a big picture' for students, academics, health professionals and NHS users that Tudor Hart hopes will inspire them to challenge received wisdoms about how the NHS should develop in the 21st century.
Hart lists nine (9) characteristics of the National Health Service in its founding that are distinctive and essential to it.
- A united national service devoted directly and indirectly to care, fully available to all citizens.
- A gift economy including everyone, funded by general taxation, of which the largest component was income tax.
- Its most important inputs and processes are personal interactions between lay and professional people.
- Its products were potentially measurable as health gains for the whole population.
- Its staff and component units were not expected to compete for market share but to cooperate to maximize useful service.
- Continuity was central to its efficiency and effectiveness.
- Its local staff and local populations believed they had moral ownership of and loyalty to neighborhood NHS units.
- None of its decisions and few of its procedures could be fully standardized. All of its decisions entailed some uncertainty and doubt. They were therefore unsuited to commodity form, either for personal sale or for long-term contracts.
- The NHS was a labour-intensive economy. Every new diagnostic or therapeutic machine generates new needs for more skilled staff able to control and interpret the work of the machines and translate them into human terms.
His other writing includes many articles on the management of high blood pressure and on the organisation of health services. His most influential, The Inverse Care Law, published in the Lancet 1971 asserts: "The availability of good medical care tends to vary inversely with the need for the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced."
- Hart JT. Semi-continuous screening of a whole community for hypertension. Lancet. 1970; ii:223-6.
- Hart JT. The Inverse Care Law. Lancet. 1971; i:405-12.
- Hart JT. Milroy Lecture: the marriage of primary care and epidemiology: continuous anticipatory care of whole populations in a state medical service. Journal of the Royal College of Physicians of London. 1974; 8:299-314.
- Hart JT. Management of high blood pressure in general practice. Butterworth Gold Medal essay. Journal of the Royal College of General Practitioners. 1975; 25:160-92.
- The Black Report: a challenge to politicians. Lancet 1982;i:35-7.
- Hart JT. Measurement of omission. British Medical Journal. 1982; 284:1686-9.
- Watt GCM, Foy CJW, Hart JT. Comparison of blood pressure, sodium intake, and other variables in offspring with and without a family history of high blood pressure. Lancet. 1983; i:1245-8.
- Watt GCM, Foy CJW, Hart JT, Bingham G, Edwards C, Hart M, Thomas E, Walton P. Dietary sodium and arterial blood pressure: evidence against genetic susceptibility. British Medical Journal. 1985; 291:1525-8.
- Hart JT. Practice nurses: an underused resource. British Medical Journal. 1985; 290:1162-3.
- Hart JT, Humphreys C. Be your own coroner: an audit of 500 consecutive deaths in a general practice. British Medical Journal. 1987; 294:871-4.
- Hart JT. Primary medical care in Spain. British Journal of General Practice. 1990; 40: 255-8.
- Hart JT, Thomas C, Gibbons B, Edwards C, Hart M, Jones J, Jones M, Walton P. Twenty-give years of audited screening in a socially deprived community. British Medical Journal. 1991; 302:1509-13.
- Hart JT. Two paths for medical practice. The Lancet. 1992 sept 26; 340
- Hart JT. Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. British Journal of General Practice. 1992; 42:116-9
- Hart JT, Edwards C, Haines AP, Hart M, Jones J, Jones M, Watt GCM. High blood pressure screen-detected under 40: a general practice population followed for 21 years. British Medical Journal. 1993; 306:437-40.
- Hart JT. Clinical and economic consequences of patients as producers. Journal of Public Health Medicine. 1995; 17:383-6.
- Hart JT, Dieppe P. Caring effects. Lancet. 1996; 347:1606-8
- Hart JT. Our feet set on a new path entirely: To the transformation of primary care and partnership with patients (Editorial). British Medical Journal. 1998; 317:1-2.
- Hart JT. Thoughts from an old GP. Lancet. 1998; 352:51-2
- Hart JT. The National Health Service as precursor for future society. 2002
- Hart JT. The National Health Service: in England and Wales. Communist Party of Great Britain; 1970.
- Hart JT, Communist Party of Great Britain.The National Health Service in England and Wales: a marxist perspective. London Health Students Branch. Research and Study Group, Marxists in Medicine; 1971.
- Hypertension: community control of high blood pressure. First edition. 1980.
- Hart JT. An exchange of letters: hospital referrals. MSD Foundation; 1985.
- A new kind of doctor: the general practitioner’s part in the health of the community. London: Merlin Press; 1988.
- Hart JT, Stilwell B, Gray M. Prevention of coronary heart disease and stroke: a workbook for primary care teams. Faber; 1988.
- Hart JT, Pickering G. Hipertensión: su control en la comunidad. Doyma; 1989.
- Hypertension: community control of high blood pressure. Third edition. Oxford: Radcliffe Medical Press; 1993.
- Feasible Socialism: National Health Service past, present and future. London: Socialist Health Association; 1994
- Going for Gold: a new approach to primary medical care in the South Wales valleys. Swansea: Socialist Health Association; 1997.
- Going to the doctor. In: Cooter R, Pickstone J (eds). Medicine in the 20th Century. Amsterdam: Harwood Academic Publishers; 2000. p. 543-58.
- Hart JT, Savage W, Fahey T. High Blood Pressure at Your Fingertips: The Comprehensive and Medically Accurate Manual on How to Manage Your High Blood Pressure. McGraw-Hill Australia; 2003.
- What you need to know in nine pages. In: Fahey T, Murphy D, Hart JT. High Blood Pressure. Excerpt from High Blood Pressure at your fingertips. Third edition: London: Class Publishing; 2004.
- Hart JT. Storming the Citadel: from romantic fiction to effective reality. In: Michael PF, Webster C (eds). Health and Society in Twentieth Century Wales. University of Wales Press; 2006. p.208-15.
- Hart JT. La economía política de la sanidad. Una perspectiva clínica. Madrid: Ediciones GPS Madrid; 2009.
- Hart JT. The political economy of health care: Where the NHS came from and where it could lead (2 ed). Bristol: Policy Press; 2010.