health system

1. Health System in UK
By Group 5a
Samindra Fernando
Rushikesh Panchal
Goran Baiz
Omar Yunis
Mark Gitterman

2. THE BEVERIDGEan MODEL(1948)
• Named after Sir William Beveridge, the social
reformer who designed Britain's National Health
Service.
• In this system, health care is provided and
financed by the government through tax
payments
• Mostly, hospitals and clinics are owned by the
government (Not all)
• Government doctors collect their fees from the
government.
• In Britain, you never get a doctor bill.
• Low costs per capita ( Government controls what
doctors can do and what they can charge)

3. Healthcare system in UK
• Mostly a state run healthcare system. Ranked one of the best in the
world.
• National Health Service (NHS)
• Shared name of three of the four publicly funded healthcare
systems in UK:
1.National Health Service-England
2.NHS Scotland
3.NHS Wales
4.Health and Social Care in Northern Ireland (HSC)-Northern Ireland
• Each system operates independently
• Politically accountable to the relevant government: the Scottish
Government, Welsh Assembly Government, the Northern Ireland
Executive, or the UK government (for the English NHS)
• All citizens/ permanent residents are entitled.

5. • Secretary of state for health
This is the government minister responsible for the NHS
in England, and he or she is answerable to Parliament for
the work of the NHS.
• Department of Health- responsible for the overall
planning, regulation and inspection of the health
service- develops policies and decides the general
direction of healthcare.
• Strategic health authorities
- 28 strategic health authorities in England.
-look after the healthcare of their region
- link between the Department of Health and the NHS.
- make sure that national health priorities (such as cancer
programmes)are integrated into local health plans.

6. Clinical Commissioning Groups (CCGs)
• These are responsible for planning and
purchasing of NHS services by requesting NHS to
pay for them.
• They assess the reasonable needs of their
populations and using their buying power as
purchasers to secure services that are affordable
and of the best quality from healthcare
providers- (hospitals, drugs, equipment etc) by
choosing which one to buy.
• All GP practices are required to be a member of a
CCG.
• Members- GPs, nurses, Consultants, Non medics.
“GPs will purchase the necessary medical services
for their patients through the relevant CCGs”

7. General practitioners (GPs)
• GPs have been self-employed professionals who provide services to
the NHS under contract. (There may be GPs with other private
contracts)
• Over 99% of the population are registered with GPs
-provide 24-hour access
- preventative, diagnostic and curative primary care services (those not
registered with GPs tend to be homeless people and those in temporary
accommodation).
• Approximately 90% of patient contacts with the NHS are with GPs.
• Patients may select a GP of their choice
-restricted within geographical areas. Most people have a long-standing
relationship with their GP.
• Patient referral to hospital specialists is made by GPs. This GP
‘gatekeeping’ role is an important element of the NHS. Unlike many
other countries, NHS patients do not have direct access to specialists
other than in special circumstances, e.g. attendance at hospital
accident and emergency departments.

8. Patient
(Usually
registered at a
GP)
GP
Secondary care
Tertiary care
[“Trusts “]
Under the
commissioning of
CCG
NHS
Only in urgent
situations- accidents
and emergencies,
maternity etc.
Payment
Payment
Treatment
-Drugs, tests
etc. purchased
Copayment
Monitored by National Institute for
Health and Care Excellence
(NICE) guidelines and the Care Quality
Commission's (CQC)
Referral

9. Primary care
• covers everyday health services such as GPs’ surgeries,
dentists and opticians
• delivered by “primary care trusts”
Secondary and Tertiary care
• specialized services such as hospitals, ambulances and
mental health provision.
• Specialist Consultants work in these.
• Can offer services usually only after a GP referral. Other
than in emergencies etc.
• delivered by a range of other NHS trusts.

10. NHS “Trusts”
• - Distinct legal entities within the NHS –
• These are the healthcare provider organizations eg-
hospitals, clinics, transport etc.
- Run by a board of directors and a chairman appointed
by the Secretary of Health.
- Rationale: stimulate a managed care system, with
incentive to reward efficiency, quality and cost
effectiveness and provide citizens with choices.
• Work to attract referrals from GPs to the hospitals or
services managed by them and therefore may have
competition between Trusts themselves .

11. The different types of Trusts
• Primary care trusts
• about 300 primary care
trusts in England.
• Primary care trusts are
responsible for services you
access directly such as:
-GPs
-Dentists
-Pharmacists
-Opticians
-NHS Direct
-NHS walk-in centres
• decide on the amount and
quality of services provided
by hospitals, dentists,
patient transport and
population screening.
• responsible for generally
improving local health
• make sure that NHS
organizations work
effectively with councils.
• Receive about 75% of the
NHS budget.
• control funding for
hospitals, which are
managed by NHS trusts
called "acute trusts".
May also provide services in
timings other than usual
working hours

12. Other NHS Trusts
• Run most hospitals and are responsible for
specialised patient care and services, such as
mental health care.
• Make sure that hospitals provide high quality
health care and spend their money efficiently
and some pay for private treatment to clear
backlogs and waiting lists.
• Employ most of the NHS workforce from hospital
doctors and radiographers to security staff.
• NHS trusts oversee 1,600 NHS hospitals and
specialist care centres.

13. Acute trusts :look after
hospitals that provide
short-term care, such as
Accidents and
Emergencies, maternity,
surgery, x-ray
175 acute NHS trusts
Care trusts: work in both
health and social care and
they can carry out a variety
of services, such as mental
health services.
• Generally set up when
the NHS and a local
authority decide to work
closely together
Mental health trusts:
number of specialist
mental health trusts in
England, providing care,
such as psychological
therapy and specialist
medical and training
services for people with
severe mental health
problems
60 mental health trusts
Ambulance trusts:There
are over 30 ambulance
services for England,
each run by its own
trust.Responsible for
providing transport to
get patients to hospital
for treatment
12 ambulance trusts

14. Foundation trusts
: High-achieving NHS trusts can
opt out of NHS control and receive
foundation status,
-more freedom
-financial flexibility
-less central control and monitoring.
-owned by their community, local
residents, employees and
-patients have the power to manage their
own budgets and shape their healthcare
provision according to local needs and
priorities
-more access to funds for investment
(public or private sector)
currently 115 available

15. Private Health Care
• Smaller than the NHS and does not have the same
structures of accountability.
• Does not have to follow national treatment guidelines and
health plans and it does not have responsibility for the
health of the wider local community.
• Private health insurance pays for the patients who have
obtained their insurance or the patients pay by themselves.
• Secondary care in the private sector: specialized health
treatment
- Diagnostic tests for certain conditions, one-off specialist
treatment such as visiting a dermatologist, specific operations
in a private hospital, non-essential treatment such as cosmetic
surgery and treatment for addiction or rehabilitation

16. Private hospitals
• Over 300 private hospitals in the UK.
provided by private hospital groups and the
NHS also provides a number of private
patient units within its hospitals.
• Licensed by the local healthcare authority,
which conducts two inspections a year.
• Not regulated by the national inspection
bodies that monitor NHS organizations.

17. Practice nurses, community nurses,
and Pharmaceuticals
• Practice nurses are
generally registered
general nurses who are
employed by GPs to work
within practices
• Community-nursing staff
- district nurses, midwives,
health visitors, chiropodists
and various therapists (e.g.
physiotherapists,
occupational therapists).
District nurses are registered
general nurses who provide
skilled nursing care for
patients in their own homes
• Pharmaceutical services
are provided mainly by
community pharmacists,
who supply drugs and
appliances prescribed by
GPs.
*Majority of the drugs bill
for NHS prescriptions is met
by central government
funding.

18. Health Finance
• 93.7% of gross spending on the NHS in England was met
from these two sources:
- 81.5% from the Consolidated Fund, that is, general
taxation,
-12.2% from national insurance (NI) contributions
• The remainder of NHS finance (6.3%) was raised
through
-user charges (2.1%) – mainly charges for
pharmaceutical prescriptions and dental charges;
-from repayments of NHS trust interest bearing debt
(3.0%); and
-from other miscellaneous sources (1.2%) such as
health authority capital repayments.

19. Voluntary (private) health insurance
• Private medical insurance takes two main forms:
1.Employment-based, company insurance (which
represents 59% of the total) and
2. Individual insurance (which accounts for 31%).
• The remaining 10% is made up of voluntary employee
paid groups whereby professional associations or
trades unions act as umbrella organizations, but
employees meet the costs of premiums themselves.
• People who can afford may tend to obtain these
(about 10%) to avoid being in waiting lists for
treatment and for more personal convenience of being
treated at private hospitals, NHS private clinics or
relevant GPs

20. Total expenditure on health
as % of GDP (2014)
9.1 %

21. Payment of health care professionals
• GPs are paid by the NHS -by “cost plus” principle. The
payments they receive cover both their expenses (the
“cost”) in providing General Medical Services and a net
income for doing so (the “plus”).
• 1. Capitation fees -annual fees payable for each patient
registered on their list
• 2. Allowances
• 3. Health promotion payments- eg:- chronic disease
management programmes, achieving target levels of
coverage for childhood immunizations
• 4. Item of service payments – paid every time a GP
provides certain services, contraception services being
an example

22. • Hospital doctors -directly employed by the NHS on
a salaried basis. Their actual salary scales are
determined by the government each year
• Full-time NHS consultants (i.e. senior specialists)
are permitted to earn up to 10% of their gross
income from private practice.
• Paid fee-for-service for private consultations and
activity either
-directly by the patient who may then be
reimbursed by a private insurance company if he/she
is a policyholder, or
- by the private hospital/clinic at which the
services are provided.

23. Pros and Cons of UK system
Pros
• Improve public health- equal
access.
• Widespread accessibility in
almost entire Britain
• No discrimination
• Full coverage
• Generous system with lot of
welfare for public.
• Less paperwork for insurance
etc.
• Promote human rights.
• Most patients and citizens are
satisfied with the system and
quality.
Cons
• Takes time for implementing
and changes
• Lack of options. People have
to be satisfied with what is
available for diagnosis and
treatment, since government
(NHS) is cost-effective when
purchasing these.
• Low wages for nurses and
doctors.
• Long waiting times for
treatment and hospitalizing
accompanied by bureaucratic
hurdles.

24. References
• Healthcare Systems in Transition –United
Kingdom.
• https://www.nhs.uk/NHSEngland/
• The UK Health Care System - Josh Chang, Felix
Peysakhovich, Weimin Wang, Jin Zhu

25. Thank you