NHS organisation and Management Flashcards
What were the 3 core principles of the NHS when i was founded?
Three core principles – universal (covering everyone) – comprehensive (covering all health needs) – free at the point of delivery – available to all based on need not ability to pay
What is commissioning?
Commissioning – A key part of markets: commissioners act as ‘customers’, choosing between different care providers on patients’ behalf – Commissioners choose on the basis of patients’ needs, cost and quality.
What did the 2012 Health and Social care act do?
Health and Social Care Act (2012) – Devolves power (especially commissioning) to GPs and others in primary care – Shakes up the NHS’s structure significantly – Increases use of markets, with opportunities for NHS staff to set up their own care organisations (‘social enterprises’) – requires efficiency savings of £20bn per annum (on a budget of c.£100bn)
What are the roles of the secretary of state, department of health, NHS and Social care services, and NHS england?
Secretary of State for Health – Overall accountability for NHS
Department of Health – Sets national standards – Shapes direction of NHS and social care services – Sets ‘national tariff’ (fee for services charged by service providers, e.g. hospital trusts, to commissioners, i.e. CCGs)
NHS England – Authorises Clinical Commissioning Groups – Supports, develops and performance-manages commissioning – Commissions specialist services, primary care, and some others
What are medical directors, clinical directors, consultants and GPs
Medical director (overall responsibility for medical quality)
Clinical director (overall responsibility for directorate)
Consultant (responsibility for team)
General practitioner –practice principal or partner
Any level (including training grades) will involve managerial responsibilities of some kind
Many other senior and middle managerial roles rarely filled by doctors (e.g. chief executive, general manager roles) in the UK, though often by nurses and AHPs
What is a clinical director?
Hospital trusts are usually organised into clinical directorates (like faculties in a university)
Directorates are usually based on speciality or group of specialities e.g. radiology, women’s health, cardiology
Each is led by a clinical director, who will be a doctor (not the same as the medical director)
Alongside the clinical director, the directorate will usually include a lead nurse and a general (non-clinical) manager too
Manager has an important role but is subordinate to clinical director
What is the role of a clinical director?
To manage her/his directorate as a whole – Provide continuing medical education and other training – Design and implement directorate policies on junior doctors’ hours of work, supervision, tasks and responsibilities – Implement clinical audit – Develop management guidelines and protocols for clinical procedures – Induction of new doctors
What is a medical directors role?
Responsible for quality of medical care (i.e. care provided by doctors in the hospital)
Communicates between the board and the medical staff
Leadership of medical staff: sets out strategy, exemplifies positive values, helps to implement change
Will work in partnership with human resource / personnel functions
Approves job descriptions; interview panels & equal opportunities; discretionary pay awards
Disciplinary processes
Leads on organisation’s clinical policy and clinical standards
Strategic overview of medical staff’s role in the organisation
Sits on the organisation’s Board of Directors—a key link between senior management and the medical staff
when do problems arise with these managerial roles?
Problems can arise when communication is poor or responsibilities are unclear
Each member of the team should know where responsibility lies for clinical and managerial issues and who is leading the team. Systems should be in place to facilitate collaboration and communication between team members. Systems should be in place to monitor, review and, if appropriate, improve the quality of the team’s work. Teams should be appropriately supported and developed, and be clear about their objectives
What are CCG’s
Crucial bodies in the new organisation of the NHS – Bring together GPs, nurses, public health, patients, public and others to commission secondary and community healthcare services – Must account for national guidance (from NHS England, NICE etc.) in these decisions
Responsible for the flow of much of the NHS budget (around 65%) – Public health now the responsibility of local authorities – General primary care services now commissioned by NHS England
CCGs and NHS England commission providers to provide care for the populations they serve – NHS acute trusts (hospitals) for much acute care – Community healthcare trusts – Other providers, including the private sector
Money flows from CCGs and NHS England to NHS trusts and other providers through the commissioning process
Commissioners can place contracts with private/voluntary sector providers too
