Tuesday, August 26, 2008

An NHS Glossary

For the sake of both UK and overseas readers I will develop here a glossary of National Health Service abbreviations and terms and will link to this post right so I don't have to explain every bit of jargon or abbreviation every time I post on UK medical matters or politics. Here is a start and I will expand upon it as I come across more acronyms ...

A & E - Accident and Emergency. Where you rush off to or are rushed off to after after car accident/call the emergency services or just feel bad, out-of- hours etc etc.

ACUTE HOSPITALS TRUST - the trusts that run our general hospitals. Confusingly, an acute hospitals trust as I have explained before, is not often not called an acute hospitals trust. Fortunately, the trust running our local general hospital is called the Pennine Acute Hospitals Trust. Not that it made any difference to trust services when the Strategic Health Authority (the next rung up the bureaucracy - see below) decided to "rationalse" the hospital services in our own part of its region.

BMA - the British Medical Association. It is sometimes called the "trade union" of UK doctors. Many UK doctors consider it as as being totally pathetic in representing the interests of UK doctors (see Remedy UK below).

DoH - Department of Health. In the UK we don't always call a "Ministry" a Ministry, Thus we have a Ministry of Defense but a Home Office administrating internal affairs and a Department of Health covering health services both pubic and private. And although the head of the DoH has a positition in the Prime Minister's cabinet, he is not known as a Minister, but as a Secretary of State.

FOUNDATION TRUST - a new form of the administrative unit known as a trust which has more control of how it spends its budget allocation. A Foundation Trust features a Board of Governors with wide participation from non-NHS entities including Jane and Joe Public. The RMCH (see below), where Kezia is being treated, is part of a trust in the process of transforming into a Foundation Trust.

GMC - General Medical Council, the regulatory body that decides whether you are fit to be a Doctor or not. If a Doctor commits a misdemeanour, it can also place limitations on what that Doctor is allowed to do or, in extreme cases strike off him/her from the central register of Doctors.

GP - General Practioner. Your family doctor. In many countries of the world such a thing as a dedicated family doctor does not exist - one turns up at the local health post and sees whoever is on duty. In the UK one registers with a local General Practice, and with a specific General Practioner. That does not mean to say you won't see another GP at the same practice if your own GP is on holiday, or that if you are travelling within the UK, then you cannot visit another GP practice. GP practices are private but are contracted by the local Primary Care Trust to provide primary care services. The advantage of the GP system is that your GP knows you and your health personally. Current UK government plans are for you to be able to walk-in to a "polyclinic" where there is a general clinician paid a salary by a multinational company who cannot access your medical records over the so-far failure of a centralised IT system.

MENTAL HEALTH TRUSTS - self-evident ?

MMC – Modernising Medical Careers. Both this and the next entry are a reform plan for postgraduate doctor training introduced from 2005 onwards. MTAS was, an online application process was introduced in 2007. The whole reform process and its implementation have come under heavy criticism. I will refer you to the Wikipedia entries on the subject (here and here) as it is a complex issue.

MTAS – Medical Training Application Scheme. See above.

NAO - National Audit Office. Audits the workings and spending of government departments.

NHS CHOICES - lets us choose where we want to receive treatment anywhere in England. Most patients would choose their local hospital so family and friend can visit them.

NHS DIRECT/ NHS 24 – the former in England and Wales, the latter in Scotland. When the GP contract was renegotiated in 2004, GPs were no longer obliged to provide Out-of-Hours Services. The DoH believed the the NHS could pick up the slack through a new service called NHS 24 whereby a non-medically member of staff evaluates over the phone whether you need emergency care or not ... or suggests you visit your GP in the morning.

NHS Next Stage Review (NSR) - a "consultation exercise " commissioned by the Department of Health and led by surgeon on minister Lord Darzi on the future of the NHS.

NICE - the National Institute for Health and Clinical Excellence. It evaluates drugs and treatments. It does not evaluate their clinical effectiveness (that is the reponsibility of a European medical authority) but on their cost-effectiveness. Trusts are not legally obliged to follow NICE guidelines but most often do until legally challenged in the judicial system

QOF – Quality and Outcomes Framework. When the government introduced the new GP contract in 2004, it set performance targets under the Quality and Outcomes Framework whereby 120+ critera applied and for each one achieved, the GP Practice is financally rewarded by the PCT. The truth has been that the OOF targets have been so easy to achieve - thus the GP Practices have been raking the money in, leaading to enor,ous media and political criticism of GPs but not of the government that drew up the QOF and forced the contract on the GPs.

OOH - Out-of-Hours service. When the government renogiated and enforced the contract between GP practices and the NHS in 2004, it decided it could provide "emercency" care more cost-effectively through NHS Direct/NHS24, A & E and and Ambulance Services than through GP call-outs. But now the government is turning around and wants the GPs to provide OOH again as A & E, NHS 24 and the ambulance trusts cannot cope

PCT - Primary Care Trusts. Self-evident really. The administrative units of the NHS that commisson the GP Practices etc to provide non-hospital based healthcare to the community.

POST-CODE LOTTERY - the UK postal system is based on post-codes - much like US zip codes. I can write snail-mail to Nanda with just her name, a post-code and a country. Depending upon your postcode, you will fall under this or that NHS trust, Some NHS trusts will provide you treatment options strictly along the lines of the NICE guidelines (non-legally-binding but described above). Other trusts will be challenged in the Courts for the trust to provide the drug/treatment to be provided and yet other trusts will automatically provide the drug/treatment. It will all depend under which your post-code falls.

REFORM UK - an association of junior doctors (i.e. not yet consultants and "so-to-speak" still in post-graduate training), which amongst other things, has led the campaign protesting MMC/MTAS. It is highly critical of the current government's NHS reforms and has also been critical of the BMA's responses to government reforms.

RMCH - the Royal Manchester Children's Hospital - where our daughter, Kezia, is being treated for T-cell Acute Lymphoblastic Leukaemia - and which is fuckin' marvellous!

SHA - Strategic Health Authority. This is the next level up in the NHS bureaucracy from the Trusts whether an Ambulance Trust, a PCT, an acute hospital trust, a mental health trust etc etc. Thus England has a North-West Stragetic Health Authoritiy covering every trust from Cheshire up to the Scottish border.

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