Structure of NHS England

Question 1

Who is in charge of the NHS?

Answer 1

England = Central government
NI = Northern Ireland Assembly
Scotland = Scottish government
Wales = Welsh Assembly Government

Question 2

How is the NHS funded?

Answer 2

Under the Health and Social Care Act 2012 the NHS if funded directly by taxation

Responsibility for the pricing is given to NHS England

Question 3

What is the Department of Health?

Answer 3

• Ministerial department
• Oversees leadership and funding for health and social care in England
• Led by the Secretary of State for Health

Question 4

What is NHS England?

Answer 4

• Independent of the government
• Commissioner of primary care services
• Manages approx £100 billion of overall NHS budget
• Ensures CCGs spend money effectively

Question 5

What are the Integrated Care Boards (ICB)?

Answer 5

Replaced CCG’s in July 2022

• Clinically-led NHS bodies
• Responsible for planning and commissioning local healthcare services (allocation of funding)
• Members are GPs, nurses and consultants
• CCGs are responsible for over 60% of NHS budget

Question 6

What are health and well-being boards?

Answer 6

• Established by local authorities
• Bring together local commissioners e.g NHS, social care and public health
• Democratic decision making
• Strengthen relationship between health and social care services

Question 7

What is the National Institute for Health Protection (NIHP)?

Answer 7

• National leadership on public health and provision of expert services
• Coordination of national public health services
• Building evidence base to support public health services
• Supporting the public to make positive health choices
• Supporting the development of the health force
• Track and trace of infectious diseases and responding to public health threats

Public Health England + Track & Trace

Question 8

What are vanguards?

Answer 8

• 50 vanguards introduced as part of the NHS 5 Year Forward View in 2014
• Develop a new care model in order to support improvement and integration of services

Five types are:
1. “Integrated primary and acute care service” - Joining GP, hospital, community and mental health services
2. “Multispecialty community providers” - Moving specialist hospital care into the community
3. “Enhanced health in care homes” - Integrated health services for the elderly
4. “Urgent and emergency care” - Improving coordination of services and reducing strain on A&E
5. “Acute care collaborations” - Linking local hospitals to improve care cost and quality

Question 9

Define primary care

Answer 9

First point of care with NHS services

Includes:
- GP practices
- Dental practices
- Community pharmacies
- High street optometrists

Question 10

Define secondary care

Answer 10

Consultant-led hospital-based services such as elective or emergency

Question 11

Define tertiary care

Answer 11

Provided at specialist centres, upon referral

Question 12

Define community care

Answer 12

• Provided by district nurses and healthcare visitors
• Deliver healthcare interventions outside clinical settings
• Usually caters to individuals with chronic health conditions and public health interventions

Question 13

Who are the individuals involved in an MDT?

Answer 13

• Consultants
• Clinical nurse specialist
• Radiologist
• Histopathologist
• Dietitian

Question 14

Pro’s and con’s of an MDT

Answer 14

Pro’s:
- Patients more confident in care
- Clinical management protocols and audits are easily carried out
- Improved communication between team members
- Resource management is easier when everyone is present at once

Con’s:
- May undermine an individuals clinical judgement
- Meetings are time-consuming

Question 15

Career progression

Answer 15

Medical school, 5-6 years
Foundation training, 2 years
Core training (medicine, GP or surgery), 2 years
Specialist training, up to 6 years
Consultant

Question 16

What is NHS Improvement?

Answer 16

Was to do with ensuring all NHS care provided was safe, high quality and financially sustainable

Was merged with NHS England in July 2022

Question 17

What is the Care Quality Commission (CQC)?

Answer 17

• Independent regulators of health and social care in England
• Ensure care services are of high quality and benefit the public
• Inspect, monitor and regulate services

Question 18

What is the General Medical Council (GMC)?

Answer 18

• Independent organisation
• Manages the UK medical register
• Oversees the education and training of doctors
• Decides which doctors are qualified to work

Question 19

What was the Liverpool care pathway?

Answer 19

• Drawn up in the 1990s by the Royal Liverpool University Hospital and Marie Curies Institute
• Set out steps for when a patient was expected to die within hours or days

Concerns about the LCP:
- Decision the person was dying was not always supported by an experienced clinician or reviewed regularly
- Patient may have been sedated unnecessarily as a result of inappropriately prescribed medication
- Withdrawal of hydration, nutrition and medication may have had an adverse effect on patients

Question 20

What is the current end of life pathway?

Answer 20

1. The possibility of death should be recognised and clearly communicated
2. Sensitive communication between staff, patient and family
3. Patient and family should be involved in decisions about treatment and care
4. The needs of those important to the dying person are to be explored and met as much as possible
5. An individual plan covering food, drink, symptom control and psychological, social and spiritual support is agreed, coordinated and delivered with compassion

Question 21

What is the National Institute for Health and Care Excellence (NICE)?

Answer 21

Provides national guidance and advice to improve health and social care
1. The use of health technologies
2. Clinical practice
3. Guidance for public service workers on health promotion
4. Guidance for social care workers and users

Question 22

What is the BMA?

Answer 22

The largest trade union for doctors in the UK