The recent appointment of Dr Christopher Chiswell as a public health medicine consultant in Morecambe Bay’s acute sector reflects national policy commitments around integration and population health management. His career trajectory embodies this shift, coming from a background working in specialist trusts rather than conventional bastions of public health. This shift aligns with policy debates between historical public health and new population health, and the location of medical leadership. Using the past to illuminate enduring tensions in the present, this paper considers those involved in changing community medical leadership in Lancaster between 1968 and 1992 through the career of Dr John Dyer, arguably Morecambe Bay’s first combined public health doctor.