John Stuart Brown obituary | General doctors
In 1979, the British Medical Journal published an article by John Stuart Brown, a GP in Kent, entitled “Simple operations in general practice”.
Brown, who has died aged 90, wrote that performing an average of four minor surgeries a week in a GP surgery had significant advantages over referring patients to hospital. It was faster, more patient-friendly and cost-effective, saving the district health authority more than £15,000 a year. He estimated that the average cost of a procedure at his general surgery was £5, compared to £78.24 at hospital.
The fact that GP offices are still known as “surgeries” reflects a long history of GPs suturing wounds and performing minor surgical procedures. However, by the 1960s and 1970s, this had stopped and patients requiring any type of surgery were routinely referred to the hospital. The result has been longer waiting lists than ever before.
Speaking about carpal tunnel syndrome, a painful condition in which a nerve in the wrist becomes compressed, Tim Cantor, a GP who worked alongside Brown in the 1980s, said: “Waiting in hospital for surgery can easily take 18 months or more, during which time the trapped nerve can deteriorate. Whereas in general practice we can operate on people within two to three weeks.”
Brown was a general practitioner, but had a surgical background. After graduating in medicine in 1959 from King’s College London, he worked there in a variety of surgical capacities, before becoming a house surgeon and physician at the Royal Alexandra Hospital for Children in Brighton. In 1961, he became a general practitioner at Thornhills Medical Clinic in Larkfield, Kent.
He was a very practical man, and found it frustrating to have his patients wait for surgery in hospital if he was able to perform it himself. He became adept at purchasing and repairing hospital equipment such as an operating table and theater lights, and was soon performing hundreds of operations a year. Dermatology procedures, such as removing suspected cancerous warts or moles, predominated, but he also sutured wounds and treated hemorrhoids, varicose veins, and carpal tunnel syndrome.
Brown ended his paper in the British Medical Journal with a plea to the government: if other GP practices are to follow in his footsteps, they need funding. He wrote: “The main barrier to performing simple operations in general practice is financial… Paying £10, equivalent to the cost of referring a patient to hospital, will not only encourage more general practitioners to perform simple operations, but will enable them to buy their own instruments, equipment and dressings.”
Brown’s paper, and subsequent pressure on then-Prime Minister Margaret Thatcher, was the catalyst that led to the government’s 1987 white paper Promoting Better Health, which aimed to improve primary health care and – among other things – proposed financial incentives for GPs performing minor surgeries.
It formed the basis of a 1990 contract with GPs, who paid for surgeries such as removing skin lesions, treating varicose veins and joint injections. As a result, in the following year (1991) the number of surgeries performed by GPs rose by 41%, and concerns grew that patients might not receive the same standard of care as in hospital. It turned out to be unfounded.
Initiative However, it did not have a significant impact on hospital waiting lists. It appears to have instead led to increased demand, with more people coming forward to treat problems such as ingrown toenails or treat skin lesions.
Brown continued to work throughout his career, and by the time he retired from general practice in 2000, he had performed an estimated 20,000 procedures. He also trained fellow GPs, volunteered as ward surgeon at St John Ambulance and wrote a series of ‘how-to’ illustrated practical articles for Pulse magazine on minor surgery.
These became the basis of his textbook Minor Surgery: Text and Atlas, which was published in 1986 and has been in print for nearly 40 years. He was appointed MBE in 1997.
The eldest of three boys, Brown was born in Bradford, West Yorkshire, where he attended Belle Vue Boys’ Grammar School. His father, John, a schoolteacher, was an accomplished cartoonist, drawing characters such as Hair Oil Hal and Desperate Dan in the children’s comedy The Dandy. His mother, Winifred (née Scott), was a skilled gardener. While at school, he developed an interest in electronics, building a crystal radio radio when he was just 11 years old, and in 1953, with an inheritance of £13 from his grandmother, he built a tape machine to record the coronation of Elizabeth II.
While working at the Royal Alexandra Children’s Hospital, Brown met nurse Anne Price. They married in 1962 and had three children. After his retirement, the couple spent six months volunteering at a hospital in Zambia, and in 2012 they moved from Kent to Ponteland, near Newcastle upon Tyne, to be closer to their two sons. There Brown enjoyed gardening and country walks.
He is survived by Anne, his children Nick, Jeff and Hilary, six grandchildren and his brother Ian. His brother Richard predeceased him.