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How the NHS works

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Jon Ferdinand

on 27 September 2017

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Transcript of How the NHS works

How does the NHS Work?
Dr Jon Ferdinand
GP at Wickhambrook Surgery
CGC GP Co-ordinator
WSCCG Associate GP

September 2017
Aneurin Bevan
Image from Royal College of Physicians Facebook page
1944 White paper: A National Health Service
1946 The NHS act
Launched 5th July 1948
"Cradle to the grave"
Healthcare available to all regardless of wealth
World's largest publicly funded health service
Funded through taxation
Demand would fall as illnesses cured
Expenses increased
population lived longer
more expensive treatments became available
£437 million (9 billion)
£109 Billion
How do you improve patient care, reduce spending on the NHS and manage the increasing demands from a population who is living longer?
Before April 2013
Create national policy and legislation
Provides funding for health and social care system
Public Health England
Making the public healthier by:

researching, collecting and analysing data to improve our understanding of health and come up with answers to public health problems

support local authorities and the NHS to plan and provide health and social services such as immunisation and screening programmes

reduce health inequalities

the national health protection service, and preparing for public health emergencies
NHS England
Implement and support DH & Public health initiatives / policies
Devised the "Five year forward view "
Improve patient experience (Friends & Family, consultant outcomes)
Support and work with Clinical Commissioning Groups
Commission primary care (GP surgeries, dentists, opticians)
Commission specialist Services
Quality improvement (Revalidation, 7 day working)
Majority of board are GPs + one hospital doctor, and one nurse, and lay representation

Accountable Officer

Every GP practice is a member of a CCG

Support sustainability and transformation plans (STPs)

Plan and design local healthcare, redesign and commission health services
(secondary care, mental health, community services, private and voluntary sector etc)

Responsible for monitoring performance of providers (A&E, infections, safety, complaints)

Responsible for keeping within budget as well as QIPP savings (Quality, Innovation, Productivity, Prevention)

Independent regulator of health and social care
Quality assurance of all care services in England both NHS and private.
Incl. hospitals, care homes, dental and GP surgeries
Safe, effective, compassionate and high-quality care
All providers must be registered with CQC
Monitor, inspect and rate services
Since April 2016 became NHS improvement
Regulator overseeing foundation trusts and NHS trusts
Assesses if NHS trusts are eligible to become FTs
Partnership working with NHS England and CQC
Engages the public over health and social care services
Represent the voice of patients - gathers views and experiences
National organisation with 152 local branches
Works with CCGs, NHS England, Local government in running, planning and redesigning services
Can raise concerns to CQC
Annual survey identified priorities
1) mental health services
2) access to primary care
3) social care services
Department of Health

Clinical Commissioning Groups

Public Health England


NHS England (National Commissioning Board)

Local Authority


Care Quality Commission


Mental Health services

GP practices

Dental Services

Out of Hours

Voluntary services



Bariatric surgery

Hospital Foundation Trusts
Understand why the NHS was created and the ongoing challenges of having a free health service

Have a better understanding of the financial and governance structures of the NHS since the 2013 reform

Know who the regulatory bodies of the NHS are and how they influence it.

Gain some insight into future developments on both a national and local level and how this may affect you as future doctors.

The Future?
"New models of care"
Sustainability and Transformation Plans
Accountable care organisations
Delegated Primary care commissioning to CCGs
Multispecialty community provider (MCP) contracts
"7 day working" and various contract changes
Development of electronic records and online access for patients
Further reading
Full transcript