In 1979, the British Medical Journal published an article by a Kent GP, John Stuart Brown, titled “Minor operations in general practice”.
Brown, who has died aged 90, wrote that undertaking an average of four minor operations a week in his GP surgery had huge advantages compared to referring patients to hospital. It was faster, more convenient for patients and cost-effective, saving the area health authority more than £15,000 a year. He estimated the average cost of a procedure in his GP surgery was £5, compared to £78.24 in hospital.
That GPs’ offices are still known as “surgeries” reflects a long history of GPs suturing wounds and carrying out minor surgical procedures. However, by the 1960s and 70s this had fallen into abeyance and patients needing any type of surgery were routinely referred to hospital. The result was ever longer waiting lists.
Talking 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 80s said: “The hospital wait for an operation could easily be 18 months or more, during which time the trapped nerve could deteriorate. Whereas in general practice we could undertake people’s surgeries within two to three weeks.”
Brown was a GP, but he 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 children’s hospital in Brighton. In 1961 he became a GP at Thornhills medical practice in Larkfield, Kent.
A staunchly practical man, he found it frustrating to make his patients wait for a hospital surgical procedure if he was capable of performing it himself. He became adept at procuring and repairing cast-off hospital equipment such as a surgical theatre operating table and theatre lights, and was soon doing hundreds of operations a year. Dermatology procedures predominated, such as removing warts or suspect cancerous moles, but he also sutured wounds and treated haemorrhoids, varicose veins and carpal tunnel syndrome.
Brown ended his BMJ paper with a plea to government: if other GP practices were to follow his lead they needed funding. He wrote: “The chief disincentive to performing minor operations in general practice is financial … A payment of £10, equivalent to the cost of referring the patient to hospital, would not only encourage more general practitioners to undertake minor surgery, but would enable them to purchase their own instruments, equipment and dressings.”
Brown’s paper and his subsequent lobbying of the then prime minister, Margaret Thatcher, was the catalyst that led to the 1987 government white paper Promoting Better Health, which aimed to improve primary healthcare and – among other things – proposed financial incentives for GPs undertaking minor surgery.
It formed the basis of the 1990 contract with GPs, which paid them for surgical procedures such as removing skin lesions, treating varicose veins and injecting joints. As a result, the following year (1991) the number of surgical procedures by GPs rose by 41% and fears that patients might not receive the same standard of care as in hospital were shown to be unfounded.
The initiative did not, however, make a large impact on hospital waiting lists. It seemed to lead instead to increased demand, as more people came forward to get problems such as ingrowing toenails or skin lesions treated.
Brown continued to operate throughout his career and by the time he retired from general practice in 2000 he had carried out an estimated 20,000 procedures. He also trained GP colleagues, volunteered as a divisional surgeon in St John Ambulance and wrote a series of illustrated practical “how-to” articles for the journal Pulse on minor surgery.
These became the basis of his textbook Minor Surgery: A Text and Atlas, which was published in 1986 and has remained in print for nearly 40 years. He was made MBE in 1997.
Brown, the eldest of three boys, was born in Bradford, West Yorkshire, where he attended Belle Vue boys’ grammar school. His schoolteacher father, John, was an accomplished cartoonist, drawing characters such as Hair Oil Hal and Desperate Dan for the children’s comic the Dandy. His mother, Winifred (nee Scott), was a keen gardener. While at school he developed an interest in electronics, building a crystal wireless radio set when he was just 11, and in 1953, with a legacy of £13 from his grandmother, constructing a tape machine to record Elizabeth II’s coronation.
While working at the Royal Alexandra children’s hospital, Brown met Anne Price, a nurse. They married in 1962 and went on to have three children. After he retired, the couple spent six months volunteering in 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 walking in the countryside.
He is survived by Anne, his children, Nick, Geoff and Hilary, six grandchildren, and his brother Ian; his brother Richard predeceased him.
John Stuart Brown, general practitioner and surgeon, born 22 February 1935; died 26 October 2025
