NHS Structures And Management

Question 1

Three core principles of the NHS?

Answer 1

Universal
Comprehensive
Free at the point of delivery

Question 2

What do commissioners do?

Answer 2

Act as customers

Choose between different care providers on patient’s behalf

Question 3

What is the basis of how a commissioner makes a choice?

Answer 3

On basis of patient’s needs, cost and quality

Question 4

What changed in the health and social care act of 2012?

Answer 4

Devolved power, especially commissioning, to GPs and others in primary care
Shook up NHS structure
-opportunities for NHS staggering set up their own care organisations (social enterprises)

Question 5

Role of the Secretary of State for health?

Answer 5

Overall accountability for the NHS

Question 6

Role of the Department of Health?

Answer 6

Sets national standards
Shapes direction of NHS and social care services
Sets national tariff - fee for services charged by service providers eg hospital trusts, to commissioners ie CCGs

Question 7

What does NHS England do?

Answer 7

Authorises Clinical Commissioning Groups

Supports, develops and performance-manages commissioning

Question 8

What do CCGs do?

Answer 8

Bring together GPs, nurses, public health, patients, the public and others to commission secondary and community healthcare services

Responsible for the flow of about 65% of the NHS budget

Question 9

What national guidance do CCGs get?

Answer 9

From NICE and NHS England

Question 10

What is public health the responsibility of?

Answer 10

Local authorities

Question 11

Where does money flow from and to?

Answer 11

From CCGs and NHS England to NHS trusts and other providers through the commissioning process.

Commissioners can also place contracts with private or voluntary sector providers too

Question 12

What are the NHS providers of care?

Answer 12

Acute hospital trusts
Community health service trusts
Ambulance service trusts
GPs

Question 13

How do NHS hospital trusts earn income?

Answer 13

Through services that CCGs and NHS England commission from them
From provision of undergraduate and postgraduate training

Question 14

How can high performing trusts earn greater financial and managerial autonomy?

Answer 14

Gaining foundation trust status

Question 15

What do monitors do?

Answer 15

Regulate and corporate governance of trusts

Question 16

What does the care quality commission do (CQC)?

Answer 16

Focuses on quality of care provided to patients

Question 17

What does NICE do?

Answer 17

Gives commissioning guidance to CCGs and quality standards to providers

Question 18

What do commission support units do?

Answer 18

Provide analysis and expertise to CCGs to assist with commissioning decisions

Question 19

What does public health England do?

Answer 19

Coordination and leadership for public health, now primarily in local authorities

Question 20

What do clinical senates do?

Answer 20

Offer CCGs advice from hospital specialists and others

Question 21

What are all clinicians meant to have the opportunity to become?

Answer 21

A partner - responsible for management of finite resources

A leader - work with other clinicians and managers to change systems where it will benefit patients

Question 22

What are clinical directorates?

Answer 22

Hospital trusts are organised into them
Based on a specialty/group of specialties eg radiology, cardiology
Each is led by a clinical director who is a doctor
Will also have a lead nurse and a general manager (non-clinical) who is subordinate to the clinical director

Question 23

What are the roles of the clinical director?

Answer 23

Manage their directorate as a whole

• provide continuing medical education and other training
• design and implement directorate policies about Jr doctor’s hours of work, supervisors, tasks, responsibilities
• develop management guidelines and protocols for clinical procedures
• induction of new doctors

Question 24

What is the medical director responsible for?

Answer 24

Quality of medical care
They communicate between the board and medical staff
Leadership of medical staff - sets out strategy, positive values and implement change
Work in partnership with human resources and personnel functions

Question 25

Role of the medical director?

Answer 25

Approve job descriptions
Interview panels
Equal opportunities
Discretionary pay awards
Disciplinary process
Sit on board of directors as a link between senior management and medical staff
Lead on organisation’s clinical policies and standards
Strategic overview of medical staff’s role in organisation

Question 26

What management skills are needed as a doctor/director?

Answer 26

Strategic - able to plan, analyse and make decisions

Financial - set priorities and manage on a budget

Operational - run things and execute plans

Human resources - manage people and teams

Question 27

What can be some problems with collegial relations?

Answer 27

Medical culture hostile to clinical and non-clinical managers but they are expected to have a strategic role
NHS prone to hostile collegial relationships - implications for quality and safety of care
Can be difficulties in managing change and imposing authority - trading on toes and changing power relationships

Question 28

When do problems arise with managing a team?

Answer 28

Poor communication

Unclear responsibility

Question 29

What is the GMC guidance for managing a team?

Answer 29

Each member 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 in place to monitor, review and improve quality of the team’s work
Teams should be appropriately supported and developed
Be clear about their objectives

Question 30

When was the NHS created?

Answer 30

1948