Nhs Flashcards
Principles of nhs
Meet the health needs of everyone
- enable everyone to get help with any health issues, through same system
Free at point of delivery
- possible to see a healthcare professional for free & be directed to other services needed
Based on clinical need, not ability to pay
- level of care equal regardless of treatment
Act for mental help
Mental health act 1959
Allowed people with mental health problems to access the services
Prescriptions
Charges of 1 shilling introduced in 1952
U16 & people in recipient of national assistance or war disability pension and/or general diseases exempt
Vaccines
Polio and diphtheria vaccine rollout 1958
- before rollout, diphtheria cases as high at 70k, 5k deaths. Polio cases as high as 8k.
- everyone u15 vaccinated > immediate reduction in cases
First transplant
Kidney in 1960
On an identical set of 49 yr old twins , success going on to live a further 6 years.
Heart lung and liver transplant in 1987
Abortion
1967
24 weeks if carried out by registered physician and if 2 other doctors agree its in patients best interest
Most common reason - 985 risk to woman’s mental health , roughly 200k in england
NHS underlying principles that form nhs constitution
Provides comprehensive service, available to all
Access is based on clinical need, not ability to pay
NHS aspires to highest standards of excellence & professionalism
Patient at heart of everything nhs does
NHS values
Working together for patients
Respect and dignity
Commitment to quality of care
Compassion
Improving lives
Everyone counts
How is nhs paid for
Public Health Service that is government funded
Everyone who pays taxes contributes to running of nhs > budget is set for each department > 2018/19 department of health and social care spent £130.3billion
5.9 billion for capital spending (investment in buildings and equipment) and rest on revenue, e.g. salaries and medicines
Majority, 113 bill to nhs
- 30 billion on services planned at national level e.g. rare cancer treatments
- majority of that 85 bill to local clinical commissioning groups
CCG amount depends on number of people in local area and factors e.g. age and level of deprivation as linked to how much health care they need.
- assess health needs of local population & make decisions about health services they need > buy services from providers e.g. hospitals, gps etc
Primary care
Community based care for patients making first approach to health services regarding a health problem
E.g. gp surgeries, dentists, pharmacies
90% of meetings with patient here
7% of NHS budget
Secondary care
Provision of higher-level care in a centre with specialist staff and resources e.g. hospital
Cannot normally be accessed with a referral from primary care or via emergency admission
Costs more money to run v primary, 70% of nhs budget
Tertiary care
Very high level care provided at specialist centre focusing on only one discipline e.g. hospice or a neurohabilitation centre
Normally accessed through referral from primary or secondary
21-22 figures
320 mill appointment in general practice
- 50% with gp
- 50% with other practice staff
Primary care staff
Administrative / non-clinical staff
GPS
Nurses
Other providing direct patient care e.g. pharmacists, phlebotomists
Secondary care staff
Clinical - nurses & health visitors
Midwives
Scientific & technical staff - radiographers, healthcare scientists
Support to the clinical - healthcare assistants, maternity support workers, radiography assistants
Kings fund
4/5 people believe nhs is crucial to British society and we must do everything we can to maintain it
Importance of taking a patient history
Asking series of questions - active listening to obtain information to try figure out what is wrong
Refined skills, years of practice
Requires excellent communication skills to know what to ask and how
Building rapport is key to enabling them to feel comfortable with disclosing sensitive information
General medicine council
Keeps register of all qualified doctors, no doctor can practice without being registered
Fostering good medical practice by issuing guidance on standards doctors need to adhere to, such as good medical practice, the modern equivalent to the Hippocratic oath, ensuring doctors are regularly re validated
Promoting high standards of medical education & training., monitors standards for post-undergraduate and post-graduate trainees. Produces guidance to ensure doctors are supported in continuing professional placement
Dealing with doctors who may not be fit to practice . Investigated & struck off from medical register
Harold shipman.
Harold shipman case - gp convicted of murder of 15 patients, forging wills > charged with murder and forgery
Move away from single-handed gp practices
- few opportunities for colleagues to check on what people are doing
Tighter regulation on use of controlled drugs
- shipman capable of getting hold of large quantities to murder
Tighter regulation of death certificate
- many patients cremated, which required 2 doctors signature. Now plans to report all death to coroner
Review of re validation process
- which ensures doctors have necessary skills to practice
- convicted with opiate addiction, fined £600, barred from jobs with access to controlled drugs
Revalidation
Protect patients from poorly performing doctors, promote good medical practice and increase public confidence
Submit records of appraisals incl personal development plans and feedback
Maintain portfolio of supporting information from their practice which how they are meeting principles and values set out by good medical practice framework
- general info, personal details
- continuous professional development record, courses and conferences
- review of own practice, quality improvement activities and clinical audit
- feedback on own practice inc colleague and patient feedback
Clinical governance
Set of principles and behaviours all doctors should adhere to in order to ensure they offer their patients the best quality clinical care
Doctors should ensure practice is compliant with latest evidence
- keep up to date and ensure they constantly adjust their practice to match new guidelines and new evidence from research
Provide safe care to their patients and ensure they do not place patients at risk (e.g. wash hands, check drugs they prescribe), feel comfortable of owning up to mistakes & learning
Ensure they recognise when they have reached their limitations and should be willing to ask for help when necessary
Constantly develop their skills and train and educate others
Autonomy
Patients are entitled to their own opinion and to make decisions for themselves
Right to choose treatment they feel is best for them & have the right to refuse treatment
For this principle to apply, patient must be in a position to understand and process the information to make an informed decision
Beneficence
Doctors must do good and act in patients best interest
Non-maleficence
Doctors should act in a way that doesnt harm the patients,
Whether it is actively or by omission
