Healthcare in the United Kingdom

The vast majority of health care in the United Kingdom (UK) is provided by the four National Health Services (commonly referred to in the singular as "the" NHS) which are funded by the taxpayer and are not insurance based systems.

This article focuses on how the UK health system appears to users of the system and how it works.

Although the social medicine model prevails in the United Kingdom, there are also many private medical practitioners and private hospitals funded either by insurance (paid either directly by the patient or, very commonly by employers as a fringe benefit).

NHS Care
Care by the NHS is provided to all permanent residents of the United Kingdom as the main instrument providing a nationally based universal health care system.

The NHS is not funded by insurance. Instead, it is funded directly from taxation. NHS patients do not receive medical bills, although people of working age (except full time students) do pay a contribution towards their drug and dental costs.

A government minister, the Secretary of State for Health, holds political responsibilty for the operation of each health service. However, day to day medical matters are managed by doctors not administrators.

Core principles of the NHS
According to the NHS Web-site

The NHS is commited to providing quality care that meets the needs of everyone, is free at the point of need, and is based on a patient's clinical need, not their ability to pay. The NHS will not exclude people because of their health status or ability to pay.

The main aims are


 * To provide a universal service for all based on clinical need, not ability to pay
 * To provide a comprehensive range of services
 * To shape its services around the needs and preferences of individual patients, their families and their carers
 * To respond to the different needs of different populations
 * To work continuously to improve the quality of services and to minimise errors
 * To support and value its staff
 * To use public funds for healthcare devoted solely to NHS patients
 * To work with others to ensure a seamless service for patients
 * To help to keep people healthy and work to reduce health inequalities
 * To respect the confidentiality of individual patients and provide open access to information about services, treatment and performance

Childbirth
Most British people are born in an NHS hospital. The parents are not charged for pre-natal care, the birth, or any post-natal care. The parent(s) will leave the hospital with the baby and often a free package of baby consumables sponsored by private companies.

GP
All people are eligible for registration with a GP (general practitioner), usually of the patient's choosing. The only rule is that the GP must be local to the area in which the person lives. The GP cannot reject a patient except in very exceptional circumstances.

The GP is a qualified doctor, typically working in a business practice dealing exclusively with NHS patients. The NHS pays the doctor a salary based on the number of patients under his or her care. The doctor is not allowed to charge the patient for any services provided if those services are part of the NHS contract, which almost all care is.

The role of the GP is to manage the health care needs of his/her patients, keep full records, be the primary carer for the patient and only make referrals to other specialist NHS services if that is necessary.

If a person is ill, an appointment is made with the doctor. Most doctors also provide a walk in and wait service for urgent needs, with the patient waiting until the doctor is free.

The GP will prescribe drugs and will follow the patient's progress treatment through to recovery.

Pharmacies
Pharmacies are privately owned but have contracts with the NHS.

Patients take the prescription to a local pharmacy.

The pharmacy will check the prescription and issue the drug(s). Patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. Otherwise a fixed charge of £6.85 is paid (about US$13).

The pharmacist bills the NHS for the prescriptions less the flat fees it has received from the patients.

Investigations
If the GP judges that a blood, urine or other specimen needs to be taken, or if some other investigation is needed to aid diagnosis or management, the patient is referred to a hospital for the test. The results of the test are returned to the referring doctor.

Hospital care
If the GP judges that the patient needs specialist care at a hospital or clinic he or she will inform the patient of the choice of hospitals and will help the patient to come to a decision on where to go. If the patient chooses a private hospital, the patient becomes liable for the hospital fees. However, there will always be a choice of free NHS hospitals and most people naturally choose an NHS hospital.

The GP informs the hospital of the patient's condition and the hospital then judges how urgent the need is against those of other patients. If the need is urgent the patient will be seen almost immediately. If less urgent an appointment will be made in the future. The median wait time for a consultant led first appointment in English hospitals is a little over 3 weeks.

The patient is initially seen as an out-patient at the hospital, but if the consultant judges that the patient needs to be admitted to the hospital, either for more investigations or for surgery or other treatment, then the patient will be admitted to the hospital as an in-patient. The timing of the in-patient admission is based on a combination of medical need and the time waiting. Thus very urgent cases will result in immediate admission whereas minor issues will require a future appointment. However, even the most minor procedures will be dealt with eventually. At any time the patient can ask for a private hospital referral which may provide the treatment sooner, but this will be at full cost to the patient. For those not admitted ímmediately, the median wait time for in-patient treatment in English hospitals is a little under 6 weeks Ibid.

Almost all NHS hospital treatment as hospital patient, either in-patient or out-patient, is free of charge as are all drugs administered in hospital, surgical consumables and appliances issued or loaned. In other words, the patient is never billed. However, if a patient has chosen to be treated in an NHS hospital as a private fee paying patient by arrangement with his consultant, the patient (or the insurance company) will be billed. This can happen because at the inception of the NHS, hospital consultants were allowed to continue doing private work in NHS hospitals and can enable private patients to "jump the NHS queue". This arrangement is nowadays quite rare as most consultants and patients choose to have private work done in private hospitals.

Emergency Care
Emergency Department (traditionally known as Accident and Emergency) treatment is also free of charge. A triage nurse prioritizes all patients on arrival. Waiting times can be up to 4 hours if a patient goes to the Emergency Department with a minor problem or may be referred to other agencies (e.g. pharmacy, GP, Walk in clinic). Emergency Departments try to treat patients within 4 hours as part of NHS targets for emergency care. The Emergency Department is always attached to an NHS general hospital. Private hospitals do not provide emergency care services.

Ambulance Services
Ambulance services are not usually charged to the patient if the ambulance is called for a life-threatening emergency or is ordered by the hospital or GP because the patient needs the specialist transportation only available from an ambulance crew.

See also Emergency medical services in the United Kingdom.

Clinics and Walk in Centres
The NHS also provides local clinics where nurses and other practitioners can provide treatment. Most children are given vaccinations and check-ups at local clinics. Ophthalmology, sexually transmitted diseases, some dentistry, and nurse-administered care such as re-dressings, earwax removal, etc. are conducted at local clinics rather than at the hospital. Walk-in centres deal with regular issues such as fractures, sprains, and minor injuries. The services of clinics and walk-in centres are free of charge.

Home Visits
Patients unable to get to the doctor or clinic because they are too ill to move, or because the case is urgent and the surgery is closed, may be seen at home, either by the GP or a nurse, or a doctor acting as locum for the GP. There is no charge for this service providing the call was one of genuine need.

Home visits can be provided by District and Community Nurses as part of continuing care following discharge from hospital. Community Matrons have a caseload which he or she manages in order to prevent people from returning to secondary healthcare. Community Matrons, Community and District Nurses are usually (but not exclusively) attached to GP practices. GPs and hospitals commission their care based on individual patient needs.

Advice services
The English and Welsh NHSs run a 24 hour confidential advisory service called NHS Direct. There is a telephone-based service which is staffed by professional nurses and health advisors, an interactive digital TV service and a web site.

Dentistry
The NHS provides subsidized dental services through private dental practises. Private dentists accepting NHS funding for a patient can only charge the patient at the standard NHS rate. If the patient opts to be treated as a private patient, he or she will not receive any funding for the treatment from the NHS.

Most dentists provide NHS care for children but not all dentists choose to do NHS work for adults. About half of the income of dentists comes from work sub-contracted from the NHS.

Cost control
As the service is free to use, costs are controlled via gatekeepers in the system. The function of the gatekeepers is to ensure that only people who are entitled to treatment receive it, and that medical or psychological need is genuine. The GP is the primary gatekeeper, but the hospital consultants, some nurses (e.g. triage nurses in the Emergency Department) and administrators managing waiting lists also have gatekeeper functions.

If a person asks his doctor for a test for some condition and the doctor does not believe that the test is necessary, the patient will be told to go to a private hospital or clinic and pay for the test him/herself. The NHS has strict guidelines as to what services the NHS will provide. For instance breast augmentation is almost certainly something that the NHS would not fund, but most normal medical or mental health services are covered. Cosmetic surgery is possible to correct congential abnormalities or following injury

The National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners in the NHS as to how various conditions should be treated and whether or not a particular treatment is funded by the NHS. Factors such as cost and Quality-adjusted life years are used to determine whether a treatment is available on the NHS.

The NHS reserves the right to claim compensation for work it has to do as a result of the negligence of others. The main example of this is the Injury Costs Recovery Scheme, where compensation is received from motor insurance companies following the determination of fault in motor accidents. It currently recovers approximately £11 million per month (approx US$ 22 million) from the motor insurance industy.

Prioritizaton
Prioritization throughout the NHS is based on patient need rather than ability to pay. Quality of life benefits and life expectation, are examples of factors that may be taken into consideration. Thus a 99 year old man might not be offered a multiple coronary by-pass.

Palliative Care
The NHS also provides end of life palliative care in the form of Palliative Care Specialist Nurses. The NHS can also commission the expertise of organisations in the voluntary sector to compliment palliative care. Such organisations include Marie Curie Cancer Care and Macmillan Cancer Support. Despite their names, these services are designed for all palliative conditions, not exclusively cancer. All palliative care services provide support for both the patient and their relatives during and after the dying process. Again, these are all free of charge to the patient.

Records
All treatments given at the hospital are reported back to the home GP, so there is a single record of a patient's medical history.

Cost
The taxpayer picks up the cost of the NHS.

NHS Organization and History
'For more information see the main article National Health Service.'

Private Sector Medical care
Parallel to the NHS is an active private sector in health care.

The parallel system can provide the same treatments as the NHS, and the principal reason for using the private sector is often that waiting times can be less and that the hospital may be less "public" and more "personal".

The private sector is now doing subcontracting work for the NHS. Thus an NHS patient can be treated in the private sector as an NHS patient if the Health Services has subcontracted work to the hospital. This development is still in its infancy and quite rare.

Some private hospitals are business enterprises and some are non-profit-making trusts.

Some hospital groups provide insurance plans (e.g. BUPA) and some insurance companies have deals with particular private hospital groups.

Some private sector patients can be treated in NHS hospitals in which case the patient or his/her insurance company is billed.

There are a wide range of private sector practitioners, especially in areas such as ophthalmology, dentistry, as well as in areas such as less mainstream areas such as chiropractic, herbal medicine, Chinese medicine, etc.