the NHS Flashcards
healthcare in the uk BEFORE the NHS
The 20th Century
- healthcare was increasingly provided by other bodies
- a network of charitable and voluntary organisations and local municipal authorities established hospitals
Medical care provided by visiting specialists who lucrative private practices elsewhere
how were mentally ill people treat before the NHS
generally sent away to large forbidding institutions, not always for their own benefice, but because that was how the system worked
- admission was often for life
under poor conditions the patient became worse rather than better and institutionalized
there was a basic standard for food and accommodation
how were older people treat before the NHS
-older people who could not look after themselves were particularly fared badly
many ended their lives in Public Assistance Institutions
One of the early achievement in the NHS was the development of geriatrics, which tackled the problem of the “back wards” seldom vised by doctors where people went to end their days
what drove the change for existing services
The main drivers for change included the following:
- the emergence of a view that healthcare was a right not something bestowed erratically by charity
- an increasing view among the younger members of the medical profession that there was a better way of doing things
what was the first steps of making a Nationalised Health Service
- the war obliged the government to establish an Emergency Medical Service- all types of hospitals were registered, funded and centrally to prepare for large numbers of expected casualties
Beveridge Report described a vision for welfare reform based on eradication of the five giants of: idleness, squalor, hunger, disease and ignorance
when was the NHS formed
1948
what are the principles of the NHS
That it met the needs of everyone
that it be free at the point of delivery
that it be based on clinical need, and not ability to pay
how is healthcare provided in the UK
healthcare is provided using a GP gateway model # This means with the exception of walk in services, patients need to go to a GP first before being granted access to a specialist service
Primary care
refers to first point of contact in the healthcare system
in the NHS, the main source of primary healthcare is general practice (GP)
The aim:
an accessible route to care
what is primary care based on
caring for people rather than specific diseases
what are GPs
best known provider for primary care
important role:
- acting as the patients advocate and coordinating the care of many people who have multiple problems
how do GPs usually work
in practices with other GPs
not employed by NHS and are effectively businesses
secondary care
provided by medical specialists and healthcare professionals who generally do not have fist hand contact with the patient
e.g. cardiologists
usually referred by GP
tertiary specialists
super specialists
e.g. plastic surgeons neurosurgery
Quaternary care
very specialised which a few people with vert rare problems will ever need it
e.g. uncommon diagnostic
how do hospitals operate in the UK
In England, each hospital essentially operates as an independent business
what is commissioning
awarding contracts to private hospitals as they may provide better quality of care
why can’t CCGs commision GP services
they are GP services themselves
and they can’t commission services that need to be provided on a more global scale because of he specialist nature, such as heart and lung transplant surgery or eye cancer care for two reasons:
- they don’t have the skills and knowledge to understand the exact nature of the services
- those services are provided on a regional or national basis
who commissions primary care services and specialists services
NHS commissioning Board
which is called the NHS England
what is a block contract
before 2005 hospitals were paid a fixed amount of money every day to cover the cost of healthcare
what is a block contract
before 2005 hospitals were paid a fixed amount of money every day to cover the cost of healthcare
if hospitals need more money then the government would simply pay more money to that hospital
if the hospital was paid less money then they would pay it back to the governemnt
what is the issue with the block contract
the problem with the approach were that there was no incentive for hospitals to save money or work efficiently
what is the payment result
Labour government introduced this principle
hospitals no longer receive a fixed amount of money instead be paid for each activity undertook
e.g. a hip replacement might have a tariff of £5,000, which would cover the cost of the hospital stay,imaging,the surgery and some follow up
what is the problem with payment result
it did not encourage hospitals to provide quality care
actions made to make sure good care was provided e.g. ensuring hospitals are penalised for poor qualities
private practice doctors
they have to use their own money unless that have private insurance
what do private companies often do
“cherry - pick” they easy cases that are the most profitable, leaving the NHS
Wales
reorganisation of NHS in Wales created local health organisations that are responsible delivering all healthcare services within a geographical area
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what are the distinct four roles of the GMC
- keeping a register of all qualified doctors
- fostering good medical practice - by issuing guidance or standards that doctors need to adhere to
- promoting high standards of medical education and training
- dealing with doctors who may not be fit to practice - those doctors are investigated and in some cases may be suspended
what is the GMC
The General Medical Council - one of the key parties
what are the royal colleges
the royal colleges are institutions charges with setting standard within the field and for supervising the training of doctors
what is the British medical association
The BMA is essentially the trade union representing doctors
Unlike the GMC and Royal Colleges, membership is not compulsory
