General

Question 1

Before the NHS

Answer 1

25% voluntary hospitals
Local government hospitals 50% & asylums
Still difficult for poor to access healthcare
Emergency medical scheme 1939- helped military casualties during second world war.
This was extended to civilians as casualties rose.

Question 2

Birth of the NHS

Answer 2

Clement Atlee labour government
Nye Bevan Created the NHS on 5th July 1948 at trafford general hospital
NHS core principles outlined;
Met the needs of everyone
Free at the point of delivery
Based on clinical need, not the ability to pay

Question 3

NHS structure

Answer 3

Primary Care- Gp’s contracted by NHS- some may have special interests
Secondary care- Gp’s refer to specialties in hospitals
Tertiary care- Even more specialised and only found at certain hospitals

Question 4

Roles of the GMC

Answer 4

Keeps a list of registered UK doctors
Sets professional and ethical standards
Monitors education standards in UK medical schools
Deal with concerns regarding eligibility to practice
Doctors can be refered to panel hearings
Can strike or suspsend doctors off the medical register

Question 5

NICE

Answer 5

Produce internationally recognised health guidelines
Assess new healthcare treatments and technologies

Question 6

Career path of Doctor

Answer 6

Medical School- 4-6 years
Foundation training- 2 years
Core training 2-3 years
Specialty 3-8 years

Question 7

Hippocratic oath

Answer 7

Free access to healthcare
Beneficence
Non- maleficence
Confidentiality

Question 8

Revalidation

Answer 8

Doctors must do it once every 5 years
Responsible officer makes reccomendations to GMC

Question 9

Criteria for consent

Answer 9

Permission granted in full
Knowledge of possible concequences including risks and benefits

Question 10

Case study for consent

Answer 10

Montgomery vs Lanakshire health board-2015
Montgomery was insulin dependant
Was not informed about increased risk of shoulder dystocia for child
Birth of child didn’t go according to plan- shoulder dystocia resulted in child getting cerebral palsy

Question 11

What information must doctors give to obtain informed consent

Answer 11

All treatment options- conservative, medical or surgical
Aim of the intended procedure- Benefits and all serious/ common risks
What would happen with no treatment

Question 12

Criteria for capacity

Answer 12

Understand the imformation given
Retain the information long enough to make a decision
Weigh up the information
Communicate the decision back to you

Question 13

Mental capacity act 2005

Answer 13

Assume a person has capacity unless proven otherwise
Do not treat people as incapable of making a decision unless all practical steps have been tried to help them
A person should not be treated as incapable of making a decision becaue their decision may seem unwise
Always do things or take decisions for people withougt capacity in their best interest

Question 14

Example of case with an under 16 and contraception

Answer 14

Gillick vs West Norfolk
Department of health decided giving contraception to an under 16’s was at the doctors discretion
This was challenged by Victoria Gillick
House of lords decided that an underage girl can consent if they meet the fraser guidelines

Question 15

Fraser Guidelines

Answer 15

• The girl will understand the advice, despite being under 16
  -They cannot pursuade the girl to inform parents
• They are likely have sex with or without contraception
• Its in the girls best interests to give contraception without parental consent

Question 16

The audit cycle

Answer 16

1- Identify the issue
2- Obtain or define standards
3- Collect data
4- Compare performance with standards
5-Implement change
6- Re-audit