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The NHS…

Ultimately, as an aspiring medical/dental student, you’re heading towards a career working in the NHS in most cases! Would you buy a ticket to a holiday destination without researching into it before? Nah. So why would you enter a life-long journey without having much idea of your destination!? Let’s take you on a bit of a whistle-stop tour. This sort of knowledge is a necessary foundation before you embark on any other sort of medical or dental school interview preparation! 😄

A brief history… 🏛️

The NHS was formed on the 5th July 1948, by the Minister of Health at the time, Aneurin Bevan, upong the long standing idea that good healthcare should be available for all. At the heart of this, were 3 core principles

  • That healthcare must meet the needs of everyone
  • Healthcare should be free at the point of delivery
  • Healthcare provision should be based upon clinical need and not necessarily one’s ability to pay

This was a drastic change compared to the situation before, where the ability to access healthcare was based on an individual’s ability to pay. Only the most affluent could afford the highest quality of care, resulting in clear healthcare inequalities at the time. The introduction of such a system was a massive leap in reducing these healthcare inequalities, ensuring that everyone had access to free healthcare and was a major step towards improving life expectancy, pregnancy survival rates and overall public health.

Now, we’ve entered the 8th decade of the NHS! Although it has had an amazing impact, verily, nothing in this life is perfect. Going forward into the future, there’s plenty of challenges facing our healthcare system such as the ramifications of COVID, staff shortages, aging populations and more.

The structure… 🧱

The NHS is structured into 4 levels of care – have a think as to why they’re important!

  • Primary care – this is everyone’s first point of call. The first level of the NHS that they access. Services coming under this include GP, community pharmacy, dental and optometry services.
  • Secondary care – this is also referred to as ‘hospital and community care’ – these services give patients access to specialists and are often associated with specific systems, e.g. cardiology. Generally, they are accessed through referral by a GP.
  • Tertiary care – these are services accessed through referral from secondary care services and are usually located in specialist hospitals. This type of care is highly specialised and often involves complex procedures and more advanced medical equipment such as neurosurgery.
  • Quaternary care – this refers to extremely specialised care and is provided to those with very rare conditions. These services are often limited in number and cover both experimental medicine and uncommon diagnostic and surgical procedures.

The constitution… ⚖️

This is an official document that basically outlines the objectives of the NHS and describes the commitments towards the rights of patients, the public and staff. All services within the NHS operate under this constitution, and it’s designed to make sure that the NHS continues to meet needs.

All NHS staff, regardless of their role or position in the structure, must adhere to and demonstrate the following values as part of the constitution.

  • Working together for patients
  • Respect and dignity
  • Commitment to quality of care
  • Compassion
  • Improving lives
  • Everyone counts

There’s also seven core principles in the constitution

  • Provision of a comprehensive service, available to all
  • Access to NHS services is based on clinical need, not an individual’s ability to pay
  • Aim to provide the highest standards of excellence and professionalism
  • The patient is at the heart of everything the NHS does
  • Working across organisational boundaries
  • Providing best value for taxpayers’ money
  • The NHS is accountable to the public, communities and patients that it serves

Have a think and reflect for yourself as to why these things are important! Let us know your thoughts :)

Future challenges… 😮

Now you’ve got a bit of an introduction to the impact that the NHS had, and the principles that underpin it, let’s have a think about some of the challenges facing it!

  • An aging population – life expectancy is increasing and the population is growing as a result. As you get older, your chances of developing chronic health conditions increases, requiring more NHS resources. This is putting extra strain on an already burdened healthcare system!
  • Funding and staffing shortages – understaffing has been an issue plaguing the NHS for years now, and the COVID-19 pandemic has only accentuated it even further. Despite the government giving extra funding to the NHS in 2020/21, there’s still a clear need for more resources allocated to the NHS, with waiting times etc. ever increasing.
  • Waiting times and backlogs – one of the pledges in the NHS constitution is that at least 95% of patients attending A&E should be admitted to hospital, transferred to another provider or discharged within four hours. However, this target is still not met consistently. Alongside this, due to cancellations and restricted numbers of procedures due to COVID-19, millions of people are waiting for treatment in a backlog that might take years to clear.
  • Non-communicable diseases – smoking, excessive alcohol intake, fast food etc. are all things increasing the prevalance of ‘preventable’ cases of disease, putting further strain on the NHS.

The Long Term Plan… ✍️

The NHS is always trying to tackle the challenges that face it, as part of the commitment to provide the best possible care for patients. The Long Term Plan explains the priorities that the NHS has to improve the service it delivers and how it adapts to evolving future needs. It has been drawn up by staff on the frontline, patient groups and national experts in order to be as realistic as possible, whilst remaining ambitious.

There’s 7 core chapters that come under the NHS Long Term Plan. Don’t go into too much detail, but be aware of them as they highlight some important public health issues!

  • A new service model for the 21st century – Integrated Care Systems
  • More NHS action on prevention and health inequalities – pledges to reduce smoking, obesity etc.
  • Further progress on care quality and outcomes – e.g. improving management of learning disabilities, and overall child health.
  • NHS staff will get the backing they need – expanding the workforce and bringing in wellbeing support
  • Digitally-enabled care will go mainstream across the NHS
  • Taxpayers’ investment will be used to maximum effect – extra funding.
  • Next steps – local healthcare systems will manage their budget.

Cool, what now 🤔

We could have gone on and on, but we didn’t. Why? Because you don’t need to know the exact ins and outs of the NHS – even medical/dental students don’t know! Having this introductory appreciation of things like the structure is essential though, because knowledge like this will always come in handy at interviews. Even if a question isn’t directly asking you about it, you can slot your knowledge in, for example, when talking about challenges facing doctors/dentists!