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					Primary care
Primary care is the first point of contact most people have with the NHS and is
delivered by a wide range of professionals, including family GPs, nurses,
dentists, pharmacists and opticians. This care focuses on the treatment of
routine injuries and illnesses as well as preventive care, such as services to
help people stop smoking. Primary care is mostly concerned with a patient’s
general health needs, but increasingly more specialist treatments and
services are becoming available in primary care settings closer to where
people live.
Primary Care Trusts (PCTs)
Assessing local health needs and commissioning the services to meet them
Primary Care Trusts (PCTs) are now at the centre of the NHS and control 80
per cent of the total NHS budget. Because they are local organisations, they
are in the best position to understand the needs of their communities.
PCTs are responsible for:

      Assessing the health needs of all the people in their local area and developing
       an insight into the needs of their local community.
      Commissioning the right services, for instance from GP practices, hospitals
       and dentists, to meet these needs.
      Improving the overall health of their local communities.
      Ensuring these services can be accessed by everyone who needs them.
      Listening to patients’ views on services and acting on them.
      Making sure that the organisations providing these services, including social
       care organisations, are working together effectively.
      Carrying out an annual assessment of GP practices in their area.

PCTs have been in place since April 2002 and report directly to their local
Strategic Health Authority. As well as buying and monitoring services, they
also play a crucial role in supporting NHS organisations. They help local GP
practices, NHS Trusts and other parts of the NHS think more innovatively
about how they deliver better, more convenient care to their local patient

GP practices
Diagnosing and treating a wide range of health problems in the local
General practitioners (GPs) look after the health of people in their local
community and deal with a wide range of health problems. They and their
teams also provide health education and advice on things like smoking and
diet, run clinics, give vaccinations and carry out simple surgical operations.
New primary care contracts which govern the way GPs and practices are
paid, are giving practice teams more freedom than ever before to develop
services that best match the needs of their local populations. So, if there is a
high incidence of heart disease, for instance, practices may choose to invest
in a GP or nurse with specialist knowledge of that condition.
Doctors usually work with a team including nurses, health visitors and
midwives, as well as a range of other health professionals such as
physiotherapists and occupational therapists.
Practices are offering an increasingly wide range of services and treatments –
including tests to diagnose conditions like coronary heart failure and lung
problems. But if a GP cannot deal with your problem themselves, they’ll
usually refer you to a hospital for tests, treatment or to see a consultant with
specialised knowledge.
Around 300 million consultations a year take place in England’s practices.
Every UK citizen has a right to be registered with a local GP and visits to the
surgery are free.

Routine and specialist care for teeth and gums
As a result of major changes to NHS dentistry (introduced in April 2006),
Primary Care Trusts (PCTs) are now responsible for commissioning dental
services - this covers routine care and specialised care services.
Routine care refers to the work undertaken by dentists and their team (ie
hygienists, therapists) in general practice - they undertake all the routine
dental care and treatment necessary to maintain good oral health. This
includes providing patients with treatments such as scaling and polishing,
fillings, extractions, as well as fitting bridges and dentures and advice on how
to look after teeth and gums in order to prevent oral health problems
Dental practices may provide a mixture of NHS and private care - the NHS
services your dentist provides depend on local oral health needs and the
contract they have agreed with your PCT.
For more specialised care such as surgery within the mouth, orthodontics
(straightening teeth), domiciliary care (at home), sedation (easing anxiety) and
more complicated root canal and bridge work, your dentist may refer you to
another dentist either at a hospital or to another general dental practitioner
who has an interest in this area.
Contact your PCT to find out about the availability of general and specialised
services within your local area.

Supplying prescription and ‘over-the-counter’ medicines and health care
advice to patients and members of the public
Pharmacists (sometimes called chemists) are experts in medicines and how
they work. They play a key role in providing quality healthcare to patients.
Working in the community, in primary care and within hospitals, pharmacists
use their clinical expertise to ensure the safe supply and use of medicines.
They dispense prescriptions and can advise on a range of ailments such as
minor injuries, skin conditions and allergies. They can help you decide
whether you need to see a doctor. You can talk to your pharmacists in
confidence and you don’t need to make an appointment.
The Government is committed to making even better use of the skills of
pharmacists to widen the range of quality care and advice available in
convenient community settings. As part of this:

         Pharmacists can offer a repeat prescription service so patients don’t need to
          keep visiting their GP.
         More pharmacists are now being trained to prescribe medication.
         Some are offering tests to monitor conditions such as diabetes and high blood

Carrying out eye and sight examinations, prescribing and fitting spectacles
There are three kinds of opticians that provide eye services to the general
Ophthalmic medical practitioners are qualified doctors who specialise in
diseases and abnormalities of the eyes. They will test your sight, examine the
health of your eyes, and give a prescription for spectacles, although they do
not dispense them.

Optometrists (also known as ophthalmic opticians) are the opticians you are
most likely to visit for sight tests and spectacles. They are also trained to
recognise abnormalities and diseases that are revealed in the eye, such as
diabetes and glaucoma.
Dispensing opticians are qualified to fit and supply spectacles to a prescription
provided by an optometrist or ophthalmic medical practitioner.

NHS Walk-in Centres
Fast ‘no-appointment’ advice and treatments for minor conditions
NHS Walk-in Centres give you quick and easy access to health advice and
treatment for minor illnesses and injuries.
There are now 72 Walk-in centres throughout England, often situated near
A&E and in convenient locations such as high streets and train stations. They
are run by experienced NHS nurses and you don't need to make an
appointment. Most are open seven days a week, from early in the morning
until late in the evening, and offer a variety of services, such as:

      Assessment by an experienced NHS nurse.
      Treatment for minor illnesses (including coughs, colds and infections) and for
       minor injuries (such as cuts, sprains and strains).
      Advice on how to stay healthy.
      Information on other health services such as out-of-hours care and dental

NHS Direct
24-hour confidential nurse-led health advice over the phone
You can call NHS Direct on 0845 46 47 for confidential health advice and
information 24-hours a day, 365 days a year. The lines are staffed by nurses
and professional advisors.
NHS Direct has become a trusted first point of contact for patients seeking
medical help both inside and outside normal GP surgery hours. NHS Direct
can offer you information on:

      What to do if you or a family member feels ill
      Self care for particular health conditions such as coughs and scalds
      Local health services, such as doctors, dentists or out-of-hours pharmacies
      Self-help or support organisations.

They can help you decide if you need to see a doctor and help reduce the
worry of being ill or caring for someone else who is unwell.
Calls to NHS Direct cost a maximum of 4 pence per minute from a BT
landline. The cost of calls from mobiles and other networks may vary. Your
service provider may charge a minimum cost per call. For patients' safety,
calls to NHS Direct are recorded.
NHS Direct Online, makes a wealth of health information and advice available
through the internet, including a detailed Self-help guide.
The website will also help you find your local GP, dental, pharmacy and
optician services. The NHS Direct self-help guide is also available in the back
of the Thomson Local directory. NHS Direct Interactive digital TV has also
been launched to make health advice and information avialable through
satellite television, by simply pressing the interative button on your TV remote

Emergency and urgent care
Anyone at any time might need emergency or urgent care. Although people
can’t plan for these events, they need to be sure that, whoever they contact
as a first port of call in the NHS, they are routed swiftly to the right place for
the right treatment. This can include:

      Primary care out-of-hours services - where patients can get urgent face-to-face
       or telephone advice and treatment from a GP or other trained health
       professional outside of normal GP surgery hours.
      NHS Walk-in Centres – open from early in the morning until late at night and
       offering fast, convenient advice and treatment for minor conditions without
       the need to make an appointment.
      Ambulance services – where trained paramedics, some with advanced
       emergency care skills, treat the patients they can and transports the others
       safely and quickly to the right care provider.
      Hospitals - which provide emergency medical care.

Increasingly, these services are working together in networks across whole
communities and drawing in other care providers such as emergency social
services and emergency mental health teams. This type of joined up working
helps ensure that the most appropriate care is available to everyone across
the community.

Secondary care
Secondary care - also known as acute care – can be either elective care or
emergency care and usually takes place in an NHS hospital.
Elective care means planned specialist medical care or surgery, usually
following referral from a primary or community health professional such as a
GP. Examples of elective care include a hip replacement operation or kidney
dialysis. Elective care patients may be admitted either as an inpatient or a day
case patient, or they may attend an outpatient consultation or clinic.
Increasingly, patients are benefiting from quicker and more convenient
elective care services through, for example:

      Day surgery – where patients are treated and can go home on the same day.
       There has been an increase in the number of procedures that can be done as
       day surgery, as a result of developments in clinical practice such as minimally
       invasive (keyhole) surgery. The benefits for patients include being able to
       recover at home and less disruption to their work and home life.
      Treatment centres – run either by the NHS or independent sector companies.
       They offer patients fast, safe and streamlined surgery and diagnostic tests in
       several specialities, particularly concentrating on orthopaedics and

Emergency care – also known as Accident and Emergency (A&E) – is when
patients attend hospital as a result of an accident or trauma and require
emergency treatment. Some patients will come to A&E themselves and others
will arrive in an ambulance.
Examples of emergency care include responses to a sudden onset of chest
pain or a road traffic accident. Patients using A&E can now expect to be seen,
treated and discharged - or admitted to a ward for further care - within four
hours. They can also expect a better overall experience within A&E as a result
of improved facilities such as designated areas for children.
Other examples of secondary care services include specialist services for
mental health, learning disability and older people.

NHS Trusts
Emergency and planned hospital treatment
Hospitals in the NHS are managed by NHS Trusts (sometimes called acute
Trusts). These Trusts make sure that hospitals provide high quality health
care, and that they spend their money efficiently.
Their wide-ranging services are commissioned – or purchased - on behalf of
patients by Primary Care Trusts (PCTs) and include treatments where
patients are admitted to hospital, day surgery which does not requre an
overnight hospital stay for the patient, as well as out-patient services where
patients attend consultations and clinics.
Increasingly, NHS Trusts are being commissioned by PCTs to provide
services in the community closer to where people live.
NHS Trusts employ most of the NHS workforce: consultants, doctors, nurses,
hospital dentists, pharmacists, midwives and health visitors, managers and IT
specialists, as well as people doing jobs related to medicine -
physiotherapists, radiographers, podiatrists, speech and language therapists,
dieticians, counsellors, occupational therapists and psychologists.
There are many other support staff including receptionists, porters, cleaners,
engineers, caterers and domestic and security staff who all make a key
contribution to the overall experience of patients.
Except in the case of emergencies, hospital treatment is arranged through a
GP. This is called a referral. Appointments and treatment at NHS hospitals
are free.
NHS Foundation Trusts are a new type of NHS hospital run by local
managers, staff and members of the public. Only the highest performing
hospitals can apply to become NHS Foundation Trusts – a status which gives
them much more freedom in running their services than other NHS Trusts.
The creation of Foundation Trusts clearly illustrates the shift of decision-
making power to frontline-staff and the local communities they serve.
However, Foundation Trusts remain firmly within the NHS and its framework
of standards.

Ambulance Trusts
Responding to life-threatening and urgent conditions
NHS Ambulance Trusts are the local organisations responsible for responding
to 999 calls; transporting patients; and increasingly for providing out-of-hours
If you call 999 for an emergency ambulance your call will be prioritised into
one of three categories:

       Category A emergencies - which are immediately life threatening
       Category B – conditions which are serious but not immediately life
       Cateogory C – non-urgent conditions.
The control room at the ambulance trusts decides what kind of response you
need and whether an ambulance is required. For all three types of call, they
may send a rapid response vehicle, crewed by a paramedic and equipped to
provide treatment at the scene of the emergency.
Ambulance staff will assess the patient at the scene and decide whether the
patient needs to go to hospital. If the patient does need to go to hospital, staff
will treat and stabilise the patient so they can be transported. Ambulance
crews are highly trained in all aspects of pre-hospital emergency care, ranging
from road traffic injuries to cardiac arrest.
Added to this, increasing numbers of paramedics are being trained in new
skills, including the administration of clot-dissolving drugs to heart failure
patients before they get to hospital – a treatment which can greatly increase
their chance of recovery.
Patients who do not need to go to hospital may be treated at the scene and
given advice on follow-up care, including referrals to other health
professionals if necessary. Or for some Category C calls, patients may be
offered over-the-phone advice or referred to their GP or NHS Walk-in Centre.
Ambulance Trusts also provide a range of others services such as providing
care outside of normal GP practice working hours; transporting patients to or
from hospitals and day care services; and providing first aid

Care Trusts
Combining NHS and social care
Care Trusts are one of the ways of bringing health and social care services
closer together under a single organisational structure. This benefits patients
who do not have to navigate their way round two systems to get the care they
They carry out a range of services and are designd to provide more joined-up
care for people whose needs are more complex. For instance, an older
person suffering a fall may need urgent hospital treatment, followed by a
period of intermediate care to get them back on their feet, and then longer-
term support at home.
Care Trusts aim to make the patient’s ‘journey’ back to health as smooth as
possible by co-ordinating a full care package which doesn’t get stuck in the
gaps between different organisations and different parts of the system.

Mental Health Trusts
Specialist care for people with mental health problems
About two in every thousand people need specialist care for conditions such
as severe anxiety problems or psychotic illness. This level of care is normally
provided by NHS Mental Health Trusts, working in partnership with local
council social services departments.
The services provided by Mental HealthTrusts range from psychological
therapy, through to very specialist care for people with severe mental health
Other, less complex and severe mental health problems can often be treated
by your GP or other primary care services – for example depression, stress or
anxiety. Treatments might include counselling, psychological therapies,
community and family support, or general health screening. With the right
support and medication, many people are able to manage their mental illness

    The GP works out of a surgery or health centre which usually
    comprise a number of other professionals, such as:

               district nurse
               health visitor
               practice nurse
               community psychiatric nurse
               chiropodist
               therapists (speech, occupational)
               social worker
               receptionist
               medical secretary

    A GP contracts with the FHSA to provide services and is paid on a
    self-employed basis. services which all GPs provide are:

               prescription
               health check-ups
         cervical smears
         immunisation
         'sick notes' for patients unable to work because of an illness.

Depending on the facilities available, GPs can also provide:

         health promotion clinics
         contraception
         minor surgery
         counselling
         medical examinations for insurance (many life insurance policies require
            this). A fee is payable for this.
         maternity services
         complementary medicine (homeopathy etc).

In 1993, there were in England 26,289* fully qualified GPs providing
the basic range of medical services. Of these, roughly 10% (2,688)
worked single-handed (mostly in rural areas or in inner-city areas). In
1972 nearly 20% of doctors were 'one-man bands' but the trend
towards larger practices had already begun by 1982, long before the
NHS reform were introduced.
[* The figure for the UK as a whole is 30,000].
Where two or more doctors work together, this is called a GROUP
PRACTICE. Sometimes more than one group practice works under
the same roof of a HEALTH CENTRE: these can provide a very wide
range of services (dental, chiropody etc and some minor surgery) but
some patients dislike the (inevitably) impersonal atmosphere of a
health centre.
It is important to remember that a considerable proportion of a GP's
work is not strictly 'medical'. Many patients attend a GP's surgery
with what appear to be medical problems but which turn out to be
social and/or economic stresses. The GP needs to be adept at
distinguishing a problem which requires treatment from one which
requires comfort and/or advice. Communication skills are only now
beginning to form part of a doctor's training (and many trainees have
been appalled at their own abrupt manner when re-played on video!)
A GP is the gateway to other medical services. Everyone in the UK
has the right to be registered with a GP and nowadays you can
change your GP at will. (Formerly you had to obtain your GP's
permission to transfer to another doctor's list).
You could cross-refer here to the Patient's Charter in The Patient's
Charter (Department of Health) [00020]
The GP then has the responsibility of 'referring' you for any specialist
or hospital treatment he thinks you might need. The Office of Health
Economics estimate that we visit our GP an average of 4.4 times a
One of the factors which has increased GPs' workloads in recent
years is our tendency nowadays to seek treatment at the GP's
surgery for ailments or minor injuries which twenty years ago would
have been dealt with at home. This is especially true of patients
wanting medical treatment for coughs and colds and for children's
cuts and grazes