NHS

Question 1

NHS creation

Answer 1

. 1942 Beveridge report proposed comprehensive health and rehab services
. 1946 National Health Service Act proposed that patients wouldn’t;t pay for treatment
. 5th July 1948 the NHS was born in it’s first instance
. The prime minister was Clement Atlee and it was a labour government

Question 2

Why the NHS was created

Answer 2

. Ambition - by investing in nations health, the cost of health services would fall in future years
. Funding - it was proposed that the NHS would be funded by taxation so affordable to everyone in employment

Question 3

NHS creation principles

Answer 3

. Collective approach tackling illnesses with input from many disciplines
. Comprehensive coverage so NHS treat all patients with any condition presented so no one is initially denied
. Free service to anybody who uses it
. Universal applicability so each of the core values are applicable to everyone
. All patients are treated equally, no one takes priority over the other
. Preserved professional autonomy, healthcare professions make decisions without being influenced by any external factors

Question 4

What is the NHS constitution?

Answer 4

. Th constitution is based on the 7 main principles to guide the NHS
. It’s not applicable by law
. Underpinned by NHS values

Question 5

What are the 7 principles of the NHS?

Answer 5

1. NHS provides comprehensive service to all
2. Access is based on clinical need not individuals ability to pay
3. Aspires to highest standards of excellence and professionalism
4. The patient will be at the heart of everything
5. Works across organisational boundaries (GMC, NICE)
6. Provides best value for taxpayers money
7. Accountable to public, patients and communities it serves.

Question 6

What are negative aspects of medicine?

Answer 6

. Financial - no one does medicine for the money, it doesn’t pay nearly as much
. Hours - the hours can be very bad given that it’s a 24-hour service
. Burnout - overwhelming condition of feeling helpless and inability to do anything
. Emotional burden - frequent contact with death can leave you drained and desensitized
. Responsibility - respected professional which comes with a responsibility to uphold
. Many doctors feel frustrated with the system
. Lack of autonomy as they always have to check guidelines
. Being a junior doctor is notoriously tough

Question 7

What are the NHS core values?

Answer 7

. Working together for patients 
. Compassion
. Respect and dignity
. Improving lives
. Commitment to quality of care
. Everyone counts (no one is denied treatment)

Question 8

How is the NHS structured?

Answer 8

.Department of health is at the top and settles what they want the NHS to do.
. NHS provides guidance to CCGs (clinical commissioning groups), Specialist services and primary care like GPs
. CCGs provide guidance to hospital, mental health and community services (funds hospitals)
. Public health England offers guidance to local authorities, NHS England

. NICE gives guidance to all of the above apart from department of health

Question 9

Breakdown of the structure

Answer 9

. Department of health set an annual mandate for the NHS
. HS england sets commissioning guidance for the CCGs
. CCGs are responsible for the majority of healthcare activity
. There are other bodies like NICE

Question 10

Some Arms-Lengths bodies

Answer 10

. CQC (care quality commisions)
. Public Health England
. NICE (national institute for health and care excellence

Question 11

Why does the structure of the NHS matter?

Answer 11

. The way it’s structured determines the way the entire system is funded so the resources can contribute to helping the greatest number of people
. Shows which organisation is accountable for the other
. If the structure had multiple overlapping organisations, patients could get lost and miss treatments

Question 12

How and why is the structure of the NHS changing?

Answer 12

. The CCGs are being reformed into sustainability and transformation plans to lead to greater integration of care and more streamlined funding
. This is so patients can access more services and get treated earlier in the disease pathway
. Health and social care plan 2012 then got a 5 year review and now its the NHS long term plan

Question 13

What are the regulatory organisations?

Answer 13

. GMC (general medical council)
. NICE ( national institute of care excellence)
. CQC (care quality commission)
. Royal colleges

Question 14

What do each of the regulatory organisations do?

Answer 14

. GMC provides oversite of the medical workforce and ensures it is in accordance of its guidance
.NICE informes the NHS of what treatments it can afford and helps them spend their budget effectively
. CQC assesses quality of each healthcare provider and reports on how each can improve care
. Royal colleges regulate and provide training to all specialists in the UK

Question 15

What is 999 and how does it work?

Answer 15

. The emergency services for life threatening situations
. e.g loss of consciousness, collapse, allergies, severe burns, difficulty breathing. categorise each call by severity and done by ambulance
. category assigned determines how long the ambulance will take to arrive from 7 to 180 mins

Question 16

What is 111 and how does it work?

Answer 16

. An online and phone service for non-urgent medical emergencies
. Can then refer patients to appropriate services or otc medication
. referrals include GPs, nurses or pharmacists

Question 17

Has the NHS 111 worked?

Answer 17

. 28% of callers would have attended A&E
. 16% of callers would have asked for an ambulance
. Has taken the pressure off the emergency services
. BMJ article says it has not been comprehensively proven to have worked when compared to initial criteria

Question 18

What is burnout?

Answer 18

. State of mental, physical and emotional exhaustion caused by prolonged and excessive stress
. It’s not just feeling tired and should be taken seriously as it can lead to may other health issues
. Not just physical, emotional burden of seeing death can cause burnout
. Results on poor perception of their own ability to meet demands

Question 19

Article stats on burnout

Answer 19

. Government session on workforce burnout in the NHS
. In 2019, 40.3% of people reported feeling unwell due to work-related stress and it rose from 36.8% in 2016 and then during the pandemic has risen to 46.4%

Question 20

What causes burnout?

Answer 20

. Predisposing - low tolerance to workload, exposure to high emotional burden, past experiences, education on burnout and how to prevent it

. Precipitating - support network, illness, diet, personal events

. Perpetuating - poor coping mechanism, poor mental health, attitudes to help, financial pressures

Question 21

How to treat and prevent burnout?

Answer 21

. Talking therapies for NHS workers to unload
. Removing causes of stress and taking leave
. Medication is all else fails for sleeping or depression
. Relaxation techniques
. Improving diet and lifestyle
. Time management skills
. Maximum weekly hours

Question 22

What are levels of healthcare?

Answer 22

. Primary - Services recieved for basic health needs (GPs, pharmacy, dentist)
. Secondary - Health professionals based in a hospital or clinic that don’t usually have first contact (St marys hospital)
. Tertiary - Highly specialised treatment like neurosurgery ( Shouldice hospital in US specialised in hernias)
. Quaternary - Extension of tertiary care that’s even more specialised (experimental medicine)

Question 23

How are the levels changing?

Answer 23

. Traditional focus was on providing funding on hospital services and A&E to combat waiting times. They try and keep up with demands
. New focus focuses on prevention and is cheaper than treatement so spends on primary and tertiary services. Leads to better prevention and greater treatement efficiency

Question 24

Why is important to know about mistakes?

Answer 24

. Mistakes can impact a patients health
. Can make patients lose trust in HCPs
. Guilt and fear of being let off can contribute to doctors burnout
. Learning from mistakes can improve patient care, but doctors fear it

Question 25

Organisations involved in helping with mistakes

Answer 25

. Medical protection to protect doctors involved in legal disputes . License to practice organisations determine whether a HCP is fit to practice-based o their mistakes and other past factors . NHS resolution is part of NHS England and deals with legal proceeding and payouts in court

Question 26

What are the causes of mistakes?

Answer 26

. Burnout is one as staff are much more likely to make a mistake . Inevitability as it's impossible for doctors never to make a mistake, that's human nature . Publics expectancy is that doctors never make mistakes and if they do it is highlighted and increases the likelihood of more happening . Stress of the system can also be a cause of mistakes

Question 27

What is NHS screening?

Answer 27

. Screening people at a higher risk for a health problem is used to treat people really and help them make informed decisions . It's run by the PHE (public health England) and is offered to individuals in the highest risk age bracket . A panel of experts decide which screening programmes take place . Factors such as the sensitivity of the screening and cost will be considered

Question 28

Why does the NHS do screening?

Answer 28

. Screening identifies individuals with a higher risk of disease when they are pre-symptomatic to catch a disease in it's early course so that it can result in earlier and more effective treatment with higher rates of survival . Monetary benefit as catching diseases early can offset the cost of expensive treatments from more advanced illnesses . Screening tests are never 100% accurate and can lead to false positives and false negatives. They are not diagnostic

Question 29

Examples of screening

Answer 29

. Pregnancy to check for certain infections or anomalies . Neonates to screen for 9 rare conditions in newborns offers blood and hearing check . Diabetes patients can be screened for diabetic retinopathy for the eyes . Abdominal aortic aneurysm offered to men 65> . Cervical every 3 years for 26-49 and every 5 years for 50-64 . Breast screening offered to women aged 50-70 . Bowel (FIT) to everyone aged 60-74 and endoscopic screening

Question 30

Why is resource allocation so important and what is it?

Answer 30

. The NHS has finite monetary resources so has to decide how to distribute it's funding in the fairest way possible . Resource allocation is the process of deciding how to distribute those funds to maximise patient outcomes . Important to determine what the NHS does and doesn't use its money for . Raises ethical questions like what is a year of life worth in monetary terms

Question 31

What are QALYs?

Answer 31

. A QALY is quality adjusted life years . 1 qualy is a year at full health or 0.5 years of 50% health . They are used by NICE to perform cost benefit analysis, helping to determine what the NHS should and shouldn't fund . NICE determines that £30k is a guide for what 1 QALY is worth.

Question 32

What are the 3 main specialities?

Answer 32

. GP - Most GPs do similar work but has been a surge in portfolio GPs (various other clinical practice and research) or GP WSI (GP with special interest) . Surgery - each surgeon specialises in a part of the body or organ system . Medicine - medical specialties tend to be divided by organ or patient presentation

Question 33

What is a Multi-Disciplinary Team?

Answer 33

. Each member of the team with varying specialities contributes to the patients care and usually host formal meetings. . MDT is needed to ensure all aspects of patients health is addressed . This ensures the value of a collaborative approach is fulfilled . Input from various specialities ensures more comprehensive diagnosis and greater treatment

Question 34

Example of MDT

Answer 34

. Discussion of patient with suspected cancer . Radiologist which provides detail on the size and shape of the tumour . Histopathologist which gives detail of the type and aggressiveness of the tumour . Nurse - Indicates the patient has poor blood saturation and could impact fitness for surgery and also updates on the day-to-day life of a patient . Anesthetist - considers difficulties associated with giving a patient general anaesthetic . Pharmacologist - could highlight to the anaesthetist that the patients current medication could interact with the patients GA drugs . Surgeon gives an opinion on how to operate on the tumour and plans the surgical approach

Question 35

What are the main roles of a doctor?

Question 36

GMC main roles of a doctor

Answer 36

. Knowledge . Safety . Communication . Trust

Question 37

GMC guidelines on knowledge

Answer 37

. Have to maintian scientific knowledge . Maintain clinical skills, always give patients best standard of care . Know your own limits

Question 38

GMC guidelines on safety

Answer 38

. Always keep patients safety in mind and keep it top priority . Take action if you think safety is being compromised

Question 39

GMC guidelines on communication and teamwork

Answer 39

. Treat patients as individuals with dignity and respect . Always give patients information in ways that they can understand . Work with patients in partnership, not paternalistic on their treatment plans . Respect patients rights to their own healthcare

Question 40

GMC guidelines on trust

Answer 40

. Always act with honesty and integrity to patients . Never discriminate against patients . Never abuse patients trust, keep everything confidential

Question 41

What is the GMC?

Answer 41

It's the organisation responsible for regulating and registering doctors in the UK. It also ensures that medical schools meet the minimum requirements

Question 42

What is the BMA?

Answer 42

The BMA represents medical doctors in the UK. It's key role is negotiating with the government for things like better pay and working conditions. Also speaks up for med professionals about certain issues

Question 43

What are Royal Colleges?

Answer 43

Specialities within medicine have professional bodies called royal colleges that improve the standards for training within that specialty. They also set postgraduate exams which have t be passed before you can train to be a gp or surgeon for example

Question 44

What is NICE?

Answer 44

National institute for health and clinical excellence. They set up and standardize treatments available across the country. They publish reports on the evidence of new treatments and makers recommendations about cost effectiveness.