Pioneer of the profession

Former BMA council chair and committed life-long champion of the NHS John Marks has passed away. Neil Hallows looks back over the distinguished career of a man who fought tooth and nail to resist the privatisation of a beloved institution – and defend doctors’ jobs and patient care

Location: UK
Published: Thursday 29 September 2022
John marks

John Marks, who led the profession in a passionate defence of the NHS against the incursion of market forces, has died at the age of 97.

Dr Marks was BMA council chair from 1984 to 1990. In 1989, Margaret Thatcher’s Conservative government introduced a white paper which said, in Dr Marks’ words, that ‘efficiency in the health service could only come about through competition, in the so-called internal market, an unknown, untried and untested concept in a National Health Service’. It included plans for GP fund-holding and for hospitals to become self-governing trusts.

The BMA responded with a robust advertising campaign which portrayed a complete list of medical bodies supporting the government’s plans (it was blank), a steamroller captioned ‘Mrs Thatcher’s plans for the NHS’, and, most famously, the question: ‘What do you call a man who ignores medical advice? Mr Clarke.’

Ken Clarke, then health secretary, often referred back to the dispute with apparent bitterness in the decades that followed. Some adverts carried a slogan which Dr Marks devised himself: ‘The NHS – under-funded, undermined and under threat.’

Dr Marks later reflected that the poster aimed at Mr Clarke may have been counter-productive as it was a personal attack, but 2,000 doctors joined or rejoined the BMA during the period, a majority of the public polled believed the plans would lead to NHS privatisation, and the pressure may have helped the BMA win important concessions.


Abortion rights

Born in 1925, Dr Marks was the son of a poulterer turned publican. Despite being rejected by two London medical schools – one, he claimed, because he was not good enough at rugby and the other because he was Jewish – he was accepted at Edinburgh University.

He qualified on 5 July, 1948, the day the NHS began. In his early years as a doctor, he served in the Army in the Middle East, and in 1951 a child patient coughed in his face, leading to herpetic corneal ulceration and ultimately blindness in his left eye. He later became a GP in Hertfordshire.

Dr Marks campaigned to protect the rights granted through the Abortion Act. He was strongly influenced by a despairing patient, Betty, who had, in 1968, attempted an abortion at home, having no prospect of gaining one legally.

In his autobiography, The NHS: Beginning, Middle and End?, published in 2008, he wrote: ‘I can still see that young woman lying dead on the bathroom floor with the syringe in her hand and her clothes raised up around her waist.’

She left behind three young children. This was just months before the Act came into effect. Dr Marks rallied support at BMA annual representative meetings when there were parliamentary challenges to the Act, even though it exposed him at times to personal abuse.

I can still see that young woman lying dead on the bathroom floor with the syringe in her hand and her clothes raised up around her waist
Dr Marks

He is also remembered, during his time as council chair, for leading the BMA’s response to the new challenge of HIV through the publication of a guide, ‘AIDS and You’, in 1987.

The guide won a Plain English Award for its sober and straightforward mix of words and cartoons about how HIV was spread and how it could be avoided. Again, there were elements of the profession and public which strongly criticised him.

He also saw the BMA through a difficult period in which, at the 1987 ARM, the BMA representative body supported HIV-testing without, necessarily, the consent of the patient, a proposal with which Dr Marks strongly disagreed.

BMA council did not implement the resolution, and at the following ARM, representatives voted to change the position to one where doctors needed specific patient consent, with those believing they had grounds to depart from the rule needing to be willing to justify their decision before the courts and the GMC. He reflected in his autobiography that the BMA ‘temporarily took leave of its senses’.


Beating bigotry

CHISHOLM: Marks a 'giant of medical politics'

Dr Marks is remembered for his wit and fearlessness. When the Prince of Wales was BMA president in 1982, he caused consternation at a dinner by quoting a letter which accused the BMA of being ‘bigoted’. Dr Marks quickly responded by saying a bigoted organisation would never have elected a ‘Cockney Jewish grammar-school boy’ to its highest political office.

In his retirement, he was not heavily involved in medical politics, focusing on such interests as his stamp collection, a hobby he took up in the 1960s to help him quit smoking; a patient suggested that he spend his cigarette money on stamps instead.

He had hoped Labour would be the saviour of the NHS in 1997, and held his silence as the administration persisted with Conservative measures such as the private finance initiative, until a media interview in 2007 reflected his profound disappointment at the continued involvement of the private sector in the NHS.

When asked for his greatest achievement, he always gave the same answer – marrying his wife Shirley Nathan in 1954. She also became a GP at his practice, and survives him, along with his three children.

After he stepped down as chair he always sat next to me in council in the eyeline of the next chair
Dr Everington
Phil Banfield BANFIELD: He made a real difference to the lives of doctors and patients

BMA council chair Phil Banfield said: ‘John was an inspirational figure and exceptional advocate and campaigner who made a real difference to the lives and rights of doctors and patients.’

He described Dr Marks as ‘much loved and respected’, and that he ‘could only aspire’ to fulfil the example his predecessor as council chair had set.

John Chisholm, the former chair of the BMA’s GPs and ethics committees, described Dr Marks as a ‘giant of medical politics’. He said: ‘John’s leadership of the BMA campaign against the Thatcher-Clarke NHS reforms, which proposed the establishment of an NHS internal market, self-governing hospitals and GP fund-holding, was masterly and principled.’ He said the campaign influenced public and political opinion and won concessions.

Dr Chisholm said Dr Marks was ‘on the right side of debates about AIDS, HIV infection and abortion’. He added that the practice Dr Marks had in Hertfordshire with his wife Shirley was ‘innovative, progressive and involved in medical education’. (Read his personal tribute below, 'His legacy lives on')

sam everington EVERINGTON: Dr Marks displayed a passion for patient care

Sir Sam Everington, a former deputy council chair, said: ‘In 1989 when I was a junior doctor leading the national campaign to reduce junior doctors’ hours, one of the things we did was land a writ on University College Hospital for making its doctors work unsafe and dangerous hours.

It was done in the name of a friend Dr Chris Johnstone, who worked there. I paid the £80 for the High Court writ, but after a few weeks our costs had increased to £4,000. John took very little persuading to take over the case. Normally the BMA will not take over responsibility for cases started by others.

 Lawrence buckman BUCKMAN: 'John Marks' boy'

‘Eventually we won in the House of Lords and persuaded Virginia Bottomley, the secretary of state, to give us a new deal. I have been on BMA council for 32 years and John was an outstanding chair with a clear value set based on a passion for patient care, the NHS and for doctors.

'After he stepped down as chair he always sat next to me in council in the eyeline of the next chair! He was a great and wise mentor to me and always had a mischievous sense of humour. He never grew old and always understood the pressure on younger doctors. He was one of the few in my life that I list as an inspirational leader.’

The former BMA UK GPs committee chair Laurence Buckman was a GP partner of Dr Marks. He said: ‘I became John Marks’ last trainee in 1983. Our first meeting started with “You’re a failed hospital doctor. Why don’t you go and make the tea?” Things improved greatly after that. He was an excellent teacher and knew how to encourage his trainees to be more enquiring without making them feel bad for their ignorance.

'He broke me of all my bad hospital doctor habits and showed me how to view the family as the key unit. He knew all his patients and their problems, reciting them often when we were visiting patients at home. Underneath his gruff exterior, there was an empathic caring doctor, who spent much of his time increasing his understanding why his patients needed him. He was a very popular GP who was also a shrewd and well-informed clinician.

‘We got on very well and he became my mentor for the next 39 years. He invited me to become one of his partners and I joined his nine-partner practice in Borehamwood. After several happy years working with John, politically and medically, he retired from the practice – a significant loss for his patients and me.

'Later I moved practice, but we continued to meet and talk often as he guided me through running my practice and medical politics – I was called “John Marks’ Boy” almost until I retired [as GPC UK chair] in 2013 – and he came with his wife Shirley to my retirement dinner to see that I was really going to demit office. He was a source of inspiration and advice throughout my professional and political life, as well as a good and close friend. I will miss him.’

John was a plain-speaking, fearless man of principle and conviction
Dr Nagpaul

Chaand Nagpaul, who in June stepped down after five years as BMA council chair, said: ‘John Marks was BMA council chair when I qualified as a GP in 1989. It was at the time of the infamous government white paper proposing an internal market in the NHS which I felt represented the antithesis of the NHS’s founding principles.

I recall how proud I felt that under his leadership the BMA was defiantly standing up to the government each time I saw the billboard, "What do you call a man who doesn't listen to medical advice? Kenneth Clarke".

chaand nagpaul NAGPAUL: 'John was inspirational'

‘John was a plain-speaking, fearless man of principle and conviction and inspired me to get involved with the BMA. I also recall requesting the honour of him nominating me to stand for election on to the BMA GPs committee.’

Dr Marks described the NHS as ‘one of the greatest achievements in history’. He was one of the last to have been a doctor at the time of its foundation, and he spent a lifetime defending it.