Healthcare in the United Kingdom

Each of the countries of the United Kingdom has a public health service that provides healthcare to all UK permanent residents that is free at the point of need and paid for from general taxation. However, since Health is a devolved matter, considerable differences are developing between the systems in the different countries. Though commonly referred to as the NHS across the UK, in fact the National Health Service just covers England with NHS Scotland covering Scotland, NHS Wales covering Wales and the Department of Health, Social Services and Public Safety providing healthcare in Northern Ireland. Though the public systems dominate, private health care and a wide variety of alternative and complementary treatments are available for those willing to pay.

For details of public healthcare in each country, see:

• Healthcare in England
• Healthcare in Northern Ireland
• Healthcare in Scotland
• Healthcare in Wales

Funding and cost control of public healthcare

Care by the four NHS systems is provided free to all permanent residents of the United Kingdom with the costs paid for from general taxation. An important principle is that care, and priority in getting care, is not dependent on the wealth status of patients. Therefore, it is not possible to top-up a given course standard NHS treatment at public expense with private treatment at one's own expense because this would create a two-tier service, with the wealthy getting better treatment than the poor.

Each NHS system has strict guidelines as to what services it will provide, but the range of treatments available is very wide and in practice it is rare for treatment to be refused that would be life improving, cost effective and meets a medical need. Cosmetic surgery can be provided, therefore, to correct congenital abnormalities or following injury Patients who want tests or treatments that their doctors do not believe necessary will be told to go to a private hospitals or clinics where they will receive what they want, but will have to pay. In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, the Scottish Medicines Consortium performs a similar role.

Each NHS system reserves the right to claim compensation for work done 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. The NHS in England currently recovers approximately £11 million per month (approx US$ 22 million) from the motor insurance industry.

The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland .

General practitioners

General practitioners are qualified doctors, typically working in business practices that deal exclusively with NHS patients. The business practice receives fees from the NHS based on the number of patients and the different services provided under the GP contract. Doctors are not allowed to charge for services provided as part of the contract, which almost all care is. All people are eligible for registration with a GP, usually of the patient's choosing, though the GP must be local to the area in which the person lives. GPs can only reject patients in exceptional circumstances.

The role of the GP is to be the primary carer for the patient and to make referrals to other specialist NHS services, as necessary, fot tests or treatment.

The GP will prescribe drugs and will follow the patient's progress treatment through to recovery. GPs do not usually follow their patients into hospital for elective treatment as is the practice in some countries, but they do get a comprehensive report from the hospital after discharge. In some cases the GP will be involved in the drawing up of a care plan for the patient before discharge if patient has special care needs. All treatments given at hospitals are reported back to the home GP, so there is a single record of a patient's medical history.

If patients are unable to get to the doctor or clinic because of illness or because the case is urgent and the surgery is closed, they may be seen at home by the GP or a doctor acting as locum for the GP.

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.

Pharmacies and prescriptions

In all countries of the UK, pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs. Pharmacists bill the relevant health service for the costs of prescriptions less any fees received from the patients.

In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £7.10 is payable per item.

In Northern Ireland, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.

In Scotland, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £5 is payable per item with the intention is to phase out prescription charges before 2011.

In Wales, prescription charges have been abolished in Wales and all prescription drugs are now dispensed without charge.

Hospital care

England

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.

At one time there were accusations that some NHS trusts were fixing the queueing system by delaying the decision to put patients onto a queue. To prevent this from happening the government is introducing an 18 week guarantee that means that the hospital must complete all tests and start treatment within 18 weeks of the date of the referral from the GP. Trusts are now working towards achieving this target by December 2008. Some hospitals are introducing just in time workflow analysis borrowed from manufacturing industry to speed up the processes within the system and improve efficiencies.

Almost all NHS hospital treatment, whether in-patient or out-patient, is free of charge along with all drugs administered in hospital, surgical consumables and appliances issued or loaned. 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 Department (traditionally known as Accident and Emergency) treatment is also free of charge. A triage nurse prioritises 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

Further information: Emergency medical services in England, Emergency medical services in Northern Ireland, Emergency medical services in Scotland, and Emergency medical services in Wales

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.

Advice services

England and Wales

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.

Scotland

Scotland has a similar system, called NHS24, which seeks to provide comprehensive up-to-date health information and self-care advice for the people of Scotland.

Dentistry

NHS dental services are provided through private dental practises and dentists can only charge NHS patients at set rates. Patients opting to be treated privately do not receive any NHS funding for the treatment. Not all dentists choose to do NHS work for adults though most provide NHS care for children. About half of the income of dentists comes from work sub-contracted from the NHS.

In recent months the amount of dentistry provided privately has increased to exceed NHS provision. This is due to several factors. The primary factor is the new NHS dental contract introduced in April 2006. Many dentists feel that this contract is ill conceived and unworkable and have chosen to reduce their commitment to zero (approximately 1200 dentists at the introduction of the contract). It remains to be seen how many dentists choose to continue to provide NHS care to patients under the new system post 2009 when funding will reduce even further. The second factor is patient demand for more complex and cosmetic procedures that due to increased expense (such as higher quality materials and laboratory procedures) and time spent mean that these procedures are not cost effective within the NHS constraints in general practice. Other factors such as increased costs placed upon dentists by regulatory bodies and increased litigation have also influenced the move from NHS to private dentistry.

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, Sue Ryder 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.

Private-sector medical care

The UK has an active private sector in health care providing similar treatments to the public healthcare systems. Private health care is sometimes funded by employers through medical insurance as part of a benefits package to employees though it is mostly the larger companies that do. Insurers also market policies directly to the public.

In England, 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.

Private medical care cannot be used as a top-up to NHS care. This is to prevent the creation of a two-tier health service with different access according to wealth.

See also

National Health Service - England

NHS Scotland - Scotland

NHS Wales - Wales

Health and Care NI - Northern Ireland

External links

• Common questions about NHS services and Treatments(only applies to NHS in England)