NHS Structures And Management Flashcards
Three core principles of the NHS?
Universal
Comprehensive
Free at the point of delivery
What do commissioners do?
Act as customers
Choose between different care providers on patient’s behalf
What is the basis of how a commissioner makes a choice?
On basis of patient’s needs, cost and quality
What changed in the health and social care act of 2012?
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)
Role of the Secretary of State for health?
Overall accountability for the NHS
Role of the Department of Health?
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
What does NHS England do?
Authorises Clinical Commissioning Groups
Supports, develops and performance-manages commissioning
What do CCGs do?
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
What national guidance do CCGs get?
From NICE and NHS England
What is public health the responsibility of?
Local authorities
Where does money flow from and to?
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
What are the NHS providers of care?
Acute hospital trusts
Community health service trusts
Ambulance service trusts
GPs
How do NHS hospital trusts earn income?
Through services that CCGs and NHS England commission from them
From provision of undergraduate and postgraduate training
How can high performing trusts earn greater financial and managerial autonomy?
Gaining foundation trust status
What do monitors do?
Regulate and corporate governance of trusts
What does the care quality commission do (CQC)?
Focuses on quality of care provided to patients
What does NICE do?
Gives commissioning guidance to CCGs and quality standards to providers
What do commission support units do?
Provide analysis and expertise to CCGs to assist with commissioning decisions
What does public health England do?
Coordination and leadership for public health, now primarily in local authorities
What do clinical senates do?
Offer CCGs advice from hospital specialists and others
What are all clinicians meant to have the opportunity to become?
A partner - responsible for management of finite resources
A leader - work with other clinicians and managers to change systems where it will benefit patients
What are clinical directorates?
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
What are the roles of the clinical director?
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
What is the medical director responsible for?
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
Role of the medical director?
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
What management skills are needed as a doctor/director?
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
What can be some problems with collegial relations?
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
When do problems arise with managing a team?
Poor communication
Unclear responsibility
What is the GMC guidance for managing a team?
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
When was the NHS created?
1948
