Organisation of Health Services
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When was the NHS established?
1948
What is the NHS constitution?
Defines common set of values and principles, reviewed every ten years, legally binding on government
Name 7 principles underpinning the NHS
• Provides comprehensive service for all • Access to services is based on clinical need • Aspires to highest standards of excellence • Patient will be at the heart of everything • Work across organisational boundaries • Committed to providing best value for taxpayers • Accountable to the public, communities and patients it serves
How is NHS managed at government levels?
The policy and spending decisions have been devolved, leading to considerable divergence over time
From NHS England, describe routes the budget can be distributed
• Specialised services • Primary care (directly and via clinical commissioning groups) • Better Care Fund via clinical commissioning groups • Hospital services via clinical commissioning groups
Name 4 examples of commissioners in England
• Clinical Commissioning Groups • NHS England • Local authorities • Greater Manchester Devolution
Name 4 providers of health care in England
• Private providers • Voluntary sector • GPs / Primary care • NHS Trusts / Foundation Trusts
Name 2 regulators of health care providers in England
• Care Quality Commission 2. NHS Improvement
How are dental services organised?
Outcome of health care policy both in financing and service provision
Name 3 things that organisation of dental services determine
• How clinicians are paid for providing care • How patients are charged for treatment • How services are provided
Describe the two scales which determine how health care is provided
• Public Care to Private Care 2. No patient charges at delivery of service to patients pay all cost at delivery
Describe the type of care provided when public care is crossed with patients pay no charge at point of delivery
Public service with universal coverage e.g. Nordic and UK model for children’s dentistry
Describe the type of care provided when public care is crossed with patients pay a charge at point of delivery
Public service with some patient co-payments e.g. adult NHS dentistry in the UK
Describe the type of care provided when private care is crossed with patients pay no charge at point of delivery
Service choice between public and private, with full public financing or insurance system e.g. many European countries
Describe the type of care provided when private care is crossed with patients pay a charge at point of delivery
Service based on full patient payment supplied by private practitioners e.g. most of US system with insurance through employer
Describe the population coverage and patient co-payment in the UK
Universal entitlement and co-payment in one of three bands with nurses, pregnant women, children and means-tested benefits patients being exempt from co-payments
Describe the population coverage and patient co-payment in France
Universal entitlement under social health insurance which covers 70% of cost of health services including dental care
Describe the population coverage and patient co-payment in Germany
Entitlement under social health insurance with co-payments of up to 50% for bridges and dentures
Describe the population coverage and patient co-payment in the Netherlands
Universal entitlement to basic package of health services with co-payments of 25% for dentures
Describe the population coverage and patient co-payment in Canada
Special groups only e.g. indigenous, armed forces, refugees and some low income groups, where eligible groups may pay user charges which vary
Name 3 mechanisms governments use to pay dentists and therapists
• Fee per item • Capitation • Salary
What is a “fee per item” mechanism?
A charge is made for each item of treatment provided
What is a “capitation” mechanism?
The providing dentist receives a lump sum to provide care for a set of patients
What is a “salary” mechanism?
Providing dentist is paid as a salary to provide care