Department of english language and literature

3.2. How the NHS Works

Each country of the UK has its own NHS. This thesis concerns mainly the NHS in England, but similar principles of service and management are common to all four sister organizations (NHS in Wales, Scotland and Northern Ireland).

The NHS consists of three main parts and their interaction. These parts are those in need of medical care, those practicing skilled care and those who take care of financial matters. The largest part of the NHS is expense, approximately 80 per cent of which is funded by the income tax system. The rest is paid by National Insurance contributions and by charges made for prescribed drugs which are not subsidized. The NHS uses external companies for cooking and cleaning because it is more cost-efficient.

The NHS is organized centrally, by the UK government, and has had very little interaction with the private sector. It is established especially on General Practitioners (GPs).

Care under the NHS can be divided in two parts - Primary care and Secondary care. Within the primary care there are NHS Directs, NHS Walk-in Centres, GP Practices, Dentists, Opticians, and Pharmacists. Emergency and Urgent care, Ambulance Trusts, NHS Trusts, Mental Health Trusts and Care Trusts belong to the secondary care. The chapters Primary Care and Secondary contain very brief information about each item of the cares. More detailed and up-to-date information is available directly on the NHS website About the NHS – How the NHS works.

3.2.1. Primary Care

Fig.1 Primary Care in England

If people in England have minor injuries, or suffer from minor illnesses, the quickest way to get some treatment is to go to a Walk-in Centre. In England there are approximately 84 such centres frequently situated near A&E departments (Accident and Emergency Department) or on high streets and at train stations. People do not need to make an appointment to go there. Most of the centres are accessible seven days a week from morning till evening. The centres are managed by experienced NHS nurses and provide services such as:

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  Assessment by an experienced NHS nurse.
  
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  Treatment for minor illnesses (including coughs, colds and infections) and for minor injuries (such as cuts, sprains and strains).
  
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  Advice on how to stay healthy.
  
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  Information on other health services such as out-of-hours care and dental services.⁹
  

If patients only need some medical advice, they can call NHS Direct (0845 46 47). This service is available non-stop, 24 hours a day, 365 days a year. The staff who man the lines are experienced nurses and professional advisers who can give information to people about:

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  What to do if you or a family member feels ill
  
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  Self care for particular health conditions such as coughs and scalds
  
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  Local health services, such as doctors, dentists or out-of-hours pharmacies
  
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  Self-help or support organisations.¹⁰
  

The other possibility to obtain quick advice is by NHS Direct Online via the Internet. There is a Self-help guide available, which contains many questions about people’s current state of health, which patients are required to answer. Afterwards, the guide advises on possible illnesses and a course of action. Moreover, the guide will help patients to find GP, dental, pharmacy and optician services close to the patient’s home.

The information about GPs and Dentists is in separate subheads 3.3.1.4. and 3.3.1.5.

If people are experiencing eye problems, they can make an appointment with an optician. In England, ophthalmic care is provided by three kinds of opticians. The general public may be under the care of ophthalmic medical practitioners, optometrists or dispensing opticians. The first group, ophthalmic medical practitioners are doctors whose main speciality is diseases and abnormalities of the eyes. These opticians will prescribe patients spectacles but they will not dispense them. Moreover, they examine the health of the eyes and test sight. The other kind of optician is an ophthalmic optician or simply an optometrist. Optometrists test patient’s sight as well and also prescribe spectacles. They are able to identify diabetes and glaucoma which are diseases manifested and revealed in eyes. Whereas optometrists and ophthalmic medical practitioners prescribe spectacles, a dispensing optician fits and supplies patients with them. He can advise patients on which types of lens or spectacles they can have but he does not perform eyes tests.

Pharmacists are specialists in drugs and their effects. Their main task is to dispense prescriptions but they are also able to give advice on minor injuries or less serious illnesses. They can assess if the patient should see a doctor, and provide help without having to make an appointment. According to the NHS information “pharmacists use their clinical expertise to ensure the safe supply and use of medicines.”¹¹

Moreover, the Government wants to use pharmacists’ skills better. They are supposed to do this:

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  Pharmacists can offer a repeat prescription service so patients don’t need to keep visiting their GP.
  
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  More pharmacists are now being trained to prescribe medication.
  
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  Some are offering tests to monitor conditions such as diabetes and high blood pressure.¹²
  

3.2.2. Secondary Care

Fig.2 Secondary Care in England

This subchapter deals with very short descriptions of each item regarding secondary care in England. Secondary care mostly takes place in NHS hospitals. This care involves two parts; elective care and emergency care. The first mentioned includes various kinds of planned medical care such as hip replacement operations, kidney dialysis and others. Naturally, a referral from a GP or other medical specialist has to be made first. Secondary care includes so-called Day surgery and Treatment centres. Day surgery provides relatively quick care to patients. Patients can receive minor surgery which does not require a hospital stay. Patients are allowed to go home the same day as the operation. Treatment centres might be private or managed by the NHS. “They offer patients fast, safe and streamlined surgery and diagnostic tests in several specialities, particularly concentrating on orthopaedics and ophthalmology.” ¹³

Emergency and urgent care exists for members of the public who are in life threatening situations and therefore, in need of immediate medical help. Situations which are considered to be critical or life threatening are:

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  Loss of consciousness
  
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  Heavy blood loss
  
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  Suspected broken bones
  
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  Persistent chest pain for 15 minutes or more
  
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  Difficulty breathing
  
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  Overdose, ingestion or poisoning¹⁴
  

Ambulance Trusts are the next part of the system of secondary care. If people need immediate medical help out of the normal working hours of their GPs and the situation is serious, they can call 999. Well-experienced professionals who answer the calls will decide how urgent the situation is. There are three categories. A means a life threatening situation and an ambulance is immediately sent to the place. B represents a serious situation but not immediately life threatening and C is non urgent and sometimes might be solved on the phone and an ambulance may not have to be dispatched. When the ambulance reaches the patient, the highly trained staff assesses the situation and provides necessary pre-hospital emergency care. They then decide if the patient needs hospital care. Patients might be treated at the scene if the situation is not serious and afterwards they may be advised or given a referral to their GPs or a specialist to receive the necessary care. Ambulance Trusts take care of people who need acute care outside their GPs regular working hours. Moreover, they enable patients’ transportation to and from hospitals if needed, in cases where the patient does not have anybody to take them home.

NHS Trusts; also known as acute Trusts, run the NHS hospitals and check whether the quality of medical care in hospitals is high enough and if hospitals budget carefully. Most of the medical staff is employed by these NHS Trusts. The services they provide are both treatments which require admission to hospitals or day surgery without the necessity for a patient to stay in a hospital overnight; they also provide out-patient services.

If people need help concerning psychiatric problems or suffer from serious anxiety, they can approach a Mental Health Trust. They provide various kinds of treatment “from psychological therapy, through to very specialist care for people with severe mental health problems.” ¹⁵

Care Trusts provides twofold care – social and health as well. Nowadays, there are approximately ten Care Trusts but in the future, their number should rise.
The healthcare provided under the NHS is primarily free; the exception to free medical care is dental treatment and spectacles which is also the case in most other European countries. The exception does not concern old age pensioners and children under 16, for them these items are also free because of subsidy.

Patients have the right to choose their GPs and they are treated as equal partners in their care. They can choose when and where to be treated and they are asked for their views which are very important for ratings of hospitals and others medical institutions. Patients can find their rights and other information on www.nhs.uk.

Treatment in hospitals under the NHS is fully free for British people, European Union citizens and for people from countries which have exchange health agreements with Great Britain. Unless the country has an agreement, its people have to pay for hospital treatment and entire health care.