Lives of the fellows

John Plaistowe Horder

b.9 December 1919 d.31 May 2012
OBE(1971) CBE(1980) BM BCH Oxon(1948) MRCP(1951) FRCGP(1970) FRCP(1972) FRPsych(1980) FRCP Edin(1981) Hon MD Lond(1985)

John Plaistowe Horder, who has been described as the ‘father of general practice’, was a former president of the Royal College of General Practitioners. Born in Ealing, London, he was the son of Gerald Morley Horder, a quantity surveyor, and his wife Emma Ruth née Plaistowe, a professional violinist, whose father, William, was a manufacturer. His grandfather was a Congregational minister and it may have been through his influence that he had a lifelong love of organ music. After attending Durston House Preparatory School and Lancing College, he originally planned to study music, possibly influenced by his mother, and went to Paris to train as a pianist and organist. Told by his music teacher that he did not have enough talent to turn professional, he then went up to University College, Oxford, initially to read classics, but, out of a great interest in human nature, and influenced by the imminent threat of war, turned to medicine instead. His studies were interrupted by the outbreak of the Second World War and, in 1940, he enrolled in the King’s Royal Rifle Corps as a lieutenant.

He served for two years but, because the thought of killing the enemy brought on an increasing depression, he was discharged and returned to Oxford. Qualifying in 1948, he did a number of house jobs at the London Hospital until 1951 and planned to specialise in psychiatry towards which he began a Jungian analysis. However, in 1951, he did a two week locum at the James Wigg Practice in Kentish Town, where his wife was already working as a GP. Fascinated by the work he remained at the practice, which eventually became the Kentish Town Health Centre, for 30 years.

Having initially felt that general practice was for those unable to find a specialism to devote themselves to, Horder found that he was inspired by being responsible for the primary care of thousands and the daily contact with his patients which expanded his experiences of human nature. In 1952 he published an article ‘The opinions of Sir James Mackenzie’ (Lond Hosp Gaz, 1952, 55, 138-42) in which he argued, with great eloquence, the case for the preservation of medical generalism in an age of specialism. He was disturbed by the common perception of a ‘medical hierarchy’ in which the hospital specialist had higher status than the general practitioner and wrote that this would inhibit medical progress. He claimed that he sometimes felt an ‘alien’ with his fellow medical professionals.

He became one of the original GPs to work with Michael Balint at the Tavistock Clinic on the way psychoanalytic ideas could be applied to medicine. Balint published these ideas in the book The doctor, his patient and the illness (London, Churchill Livingstone, 1957). Horder ultimately disagreed with Balint over the involvement of physical illness in mental disorders – Balint rejected this possibility – and left the group after two years. However he continued to be fascinated by the psychological aspects of illness and, possibly helped by his experience of his own recurrent periods of depression, was greatly sympathetic to his patients. He encouraged his students to consider not only the disease that the patient presented with, but also their feelings and their own reactions to what was revealed. One of his early patients was the poet, Slyvia Plath, and, in later life he talked of his misgivings that he could have done more to stop her committing suicide in 1963. Due to his interest in the psychology of diseases he was made a member of the Royal College of Psychiatrists in 1974 and a fellow in 1980.

In an attempt to generate more respect for, and self confidence in, his profession, he became a foundation associate of the College of General Practitioners (later the Royal College of General Practitioners (RCGP) in 1952. The college was founded against the vehement opposition of the older medical royal colleges and, indeed, Horder’s distant cousin, the eminent physician Baron Horder [Munk’s Roll, Vol.V, p.198]. For the college he carried out research on the importance of continuity of care in general practice and worked hard to develop vocational training for GPs. Chair of the group that produced the classic textbook The future general practitioner (London, RCGP, 1972), he had the satisfaction of seeing it run to several successful editions. He published numerous scientific papers on topics relating to general practice and medical education. From 1979 to 1982 he was president of the RCGP. A consultant advisor to the Department of Health and Social Security, he also set up networks of GPs throughout Europe and was the first GP to be appointed a consultant to the World Health Organisation. In 1987 he founded the Centre for Advancement of Interprofessional Education and was its first chairman for 10 years and then their president. He was made OBE in 1971 and CBE ten years later.

A talented man in many fields, he once remarked to an interviewer ‘What place is there in contemporary life for someone who is committed to three or four different fields of activity? I have never been an expert – as thinker, writer, doctor, musician, artist. Yet I believe society needs such people.’ Particularly gifted at painting in watercolours, his painting of the Royal College of Psychiatrists was reproduced in the British Medical Journal and he was president of the Medical Art Society from 1989 to 1992. An enthusiastic traveller, especially in Europe, he would usually return with several new landscapes. He also kept up his skills as a pianist and regularly played the organ at St Mary’s Church in Primrose Hill and at Tewksbury Abbey in Gloucestershire, although he had by then lost his early Christian beliefs and wrote that ‘medicine, with its exacting ideals of truth to reality and service to others, has allowed me a certain substitute for religion in its contemporary Christian form’.

In 1940 he married Elizabeth June née Wilson. He had met her in Paris before the war and he encountered her again when they were both studying medicine at Oxford. She also became a GP and they had two daughters and two sons. His eldest son, Timothy John, is a fellow of Jesus College, Oxford and a lecturer in embryology, and his younger son is a social worker. When he died, Elizabeth, his children and grandchildren survived him.

RCP editor

[Camden New Journal www.camdennewjournal.com/news/2012/jun/obituary-dr-john-horder-%E2%80%98father-modern-general-practice%E2%80%99-who-excelled-pianist-and-arti; J Roy Soc Med www.ncbi.nlm.nih.gov/pmc/articles/PMC1079677/; B J Psych Bull http://pb.rcpsych.org/content/37/3/118 - all accessed 9 November 2015]

(Volume XII, page web)

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