The UK Primary Care System –

Analysis and Comparison with

the Italian Primary Care System Dr. Genevieve Allum

17th September 2015

Contents

• The National Health Service (NHS)

• The Structure of the NHS in 2015

• A Day in the Life of a General Practitioner (GP) in UK

• Comparison with Italian GP practice

• Similarities

• Differences

A bit about me…

• GP

• Medical School in Edinburgh 2005-2010

• Training in South East England – Maidstone, London, Brighton

• Working in Brighton, UK

• Finished training in August 2015

• Here on an Hippocrates Programme exchange

The National Health Service

• Launched July 5th 1948

• By Health Minister, Aneurin Bevan

• Based on 3 principles:

• That it meets the needs of everyone

• That it will be free at the point of delivery

• That it is based on clinical need, not the ability to pay

Funding the NHS

• 98.8% comes from taxpayers

• Over 16, earning >£155 per week

• Pay more if you earn more money

• 1.2% comes from patient charges

• Optical care

• Prescriptions

• Dental care

Structure of the NHS

• Very complicated as it is the 5th biggest employer in the world!

• Big changes in 2012

• GPs now have control of a large portion of money

• Cli i al Co issio i g Groups CCGs

• GPs

• Hospital doctors

• Nurses

• Members of the Public

• Financial expert

A Day in the Life of a GP in the UK… • Get to work at 8-9am

• 3 hour clinic in the morning with 30 minute break

• 10 minute appointments

• Phone calls for about 30 minutes

• Home visits

• Paperwork

• Prescriptions, referral letters, test results

• 2 hour clinic in the afternoon

• Leave work at 5.30-7pm

• When on call:

• Answering nurses queries throughout the day

• Seeing any walk in /emergency patients

• Taking extra phone calls

Similarities between the Italian &

British Primary Care Systems • Patient centered care

• Gate-keeping role

• Out of hours service

Differences between the Italian & British

Primary Care Systems – Prescribing

• Repeat prescriptions for chronic conditions

Differences between the Italian & British

Primary Care Systems – Prescribing

• Repeat prescriptions for chronic conditions

• Generic not branded medications

• Lyrica

• Epilepsy medications

• Sometimes cheaper to prescribe by brand

• Limited availability of generic medications

• Payment of prescriptions

• £8.25

• Exemptions

Differences between the Italian & British

Primary Care Systems – Prescribing

Differences between the Italian & British

Primary Care Systems – Appointments

• Booked appointments

• Pre-bookable / book on the day

• Walk in patients for emergencies only

• Exception:

• walk i e ters

Differences between the Italian & British

Primary Care Systems – Children

• In UK we see everyone including children

• 6 week checks

Differences between the Italian & British

Primary Care Systems – Role of Nurses

• Every practice has practice nurses / health care assistants

• Chronic conditions

• Asthma

• Hypertension

• Diabetes

• Chronic Kidney Disease

• Injections

• Immunisations for children

• Contraceptive injection

• Prostate cancer injections

• Dressings

• Cervical cancer screening

Differences between the Italian & British

Primary Care Systems – Investigations

• Urinalysis

• Infections

• Haeamaturia

• Pregnancy

• Blood tests – in house

• XRs – local polyclinic

• Share computer system with the hospital

• Check all test results

Differences between the Italian & British

Primary Care Systems – Confidentiality

• Sharing of information (patients notes)

• Between doctors in the practice

• Between other staff members in practice

• Between hospital & GP clinic

• Exceptions

• GUM clinic

• HIV clinic & status

• Family involvement

Differences between the Italian & British

Primary Care Systems – Referrals

• UK GPs deal with a lot of pro le s i house

• E.g. gynecology, contraception

• About 2-3 referrals / day

• Written referral letters needed

• Specific referral guidelines

• 2 week wait referrals for cancer

• Referrals can be refused

• Each referral costs the practice money

Differences between the Italian & British

Primary Care Systems – Other

• Role of trainees

• Research

• Phone calls

• Writing in notes

• Sick notes

• Examinations

Differences between the Italian & British

Primary Care Systems – What the research says…

Differences between the Italian & British

Primary Care Systems – What the research says…

References

• http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overvie

w.aspx

• http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscore

principles.aspx

• http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/how-

nhs-england-now-structured

• http://www.telegraph.co.uk/news/uknews/9155130/NHS-is-

fifth-biggest-employer-in-world.html

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310018/

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1313076/pdf/

9302786.pdf

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088170/