Chafford Hundred Medical Centre is a statutory care sector. Statutory services are clearly defined by legal statute and would normally be delivered by, for example, the NHS. An example of this is the A&E department in a hospital. Statutory services are available to all client groups ranging from infants (0-3 years) to the elderly (65+ years).
The surgery is run by the government and is part of the NHS. It is free healthcare for the public and is provided by hospitals as well as surgeries.
The NHS is now the largest organisation in Europe. It is recognised as one of the best health services in the world by the World Health Organisation. This has brought about some fundamental changes in the way the NHS is structured and the way in which the different organisations within the NHS relate to each other. The following is a diagram which illustrates how the NHS works. I obtained it from the NHS website.
The NHS, which the surgery is part of, is run on a national level. This includes key government departments divided into various other departments. Each of these departments then have a different responsibility within the NHS.
Next in the hierarchy is the Secretary of State for health in England. The Secretary of State for Health, Alan Milburn MP has the responsibility for continuing the reduction in waiting times and delivering modernisation in the National Health Service.
Sir Liam Donaldson, is the UK Government’s principal medical adviser and the professional head of all medical staff in England. The Chief Medical Officer provides advice to the Secretary of State for Health, the Prime Minister, health ministers and ministers of other government departments.
The department for health in Britain is responsible for many things regarding health and social care. The Department of Health works to improve the quality and convenience of care provided by the NHS and social services. Its work includes setting national standards, shaping the direction of health and social care services and promoting healthier living. It has overall responsibility for
setting the direction of health and social care services in England, setting and monitoring standards for health and social care services, ensuring NHS and social care organisations have the resources they need and ensuring patients and the public can make choices about the health and social care services they use.
The Department does not run the NHS or social services. It works with health and social care organisations, arm’s length bodies and other public and private sector organisations to deliver health and social care. The deparetement for health also:
* makes policies in realtion to health and social care and issuing guidelines
* monitors the performance of health authorities and social service departments, ensuring the quality of care
* allocates resources for the provision of health and social care
The Surgery is a Primary Care Trust. Primary Care is the care provided by people normally seen when someone first has a health problem. In this case the doctor in the local area. It can also be something like a pharmasict to obtain medication. A PCT will work with local authorities and other agencies that provide health and social care locally to make sure that the local community’s needs are being met. PCTs are now at the centre of the NHS and get 75% of the NHS budget. As they are local organisations, they will understand the needs of their community, so they can make sure that the organisations providing health and social care services are working effectively.
Finally, Chafford Hundred Medical Center is run by the GP in charge. Mr T. Abela. There are also partners within the surgery who each have a number of patients they see each day. The work is shared out equally between all the partners and the Surgery is organised by Mr. Abela, as he is the chief GP.
Chafford Hundred Medical Centre is funded by the NHS (government) because it is free for people to use. The money comes from taxation and this is how the NHS in itself can operate. The funds are distributed such that 70% of the funds go to the care workers in the form of salaries. This includes cleaners and part time staff. The remaining 30% goes to the general maintenance of the sugery including domestic bills, such as electricty, maintenance of computer equipment, photocopiers etc. and any other expenses that need to be paid.
The way GP surgeries are funded is changing according to new laws. A new way of allocating money to GP practices has been designed to give more freedom to GPs to work with other practice staff to design services to meet local patient needs. This will expand the roles of other primary care staff and promote new ways of working.
If accepted by family doctors the new contract will:
* Enable primary care trusts and practices to design services to suit local needs, for example by enabling them to set up new services for managing coronary heart disease or diabetes
* Create new roles for nurses and other healthcare services by encouraging greater team work and diversifying skills
* Improve the attractiveness of family medicine as a career choice for doctors and encourage those who are already GPs to stay in the profession
* Improve the quality of primary care services through a new quality incentives framework and reward GP practices for better quality care
* Allocate primary care resources more fairly by using a new formula to distribute funding based on the needs of each practice’s patients
* Trigger a major overhaul and modernisation of GP premises and greater investment in IT.
Roles of the people who work in the Surgery
Main Care Workers- General Practitioners
The Surgery’s main care workers are the General Practitioners and there are six qualified GPs on site. They are directly involved with patients and patients’ confidentiality is respected by each doctor. Each day, the care workers have a list of patients’ appointments, which are equally shared out between all the doctors. A GP could see anything between 20 and 50 patients a day, depending on the time of year and the general health of patients. The clients each get at least a 10-minute consultation with their GP every time they visit the surgery. This means they can ask any questions as well as share their worries with the doctor. If there were something seriously wrong with a patient, the GP would have to refer that patient to the hospital. The patient would be made fully aware of what was wrong and would know the measures to be taken in order to improve their health. A GP may also be required to carry out home visits sometimes, for example, if someone feels too unwell to visit the Surgery or if they are elderly or disabled.
General Practice is an essential part of medical care in all countries. The general practitioner is the first point of contact for most medical services. The bulk of the work is carried out during consultations in the surgery and during home visits. GPs provide a complete spectrum of care within the local community: dealing with problems that often combine physical, psychological and social components. They increasingly work in teams with other professions, helping patients to take responsibility for their own health .GPs call on an extensive knowledge of medical conditions to be able to assess a problem and decide on the appropriate course of action.
They know how and when to intervene, through treatment, prevention and education, to promote the health of their patients and families. The wide mix of General Practice is one of the major attractions. There can be huge variation in the needs of individual patients during a single surgery. No other specialty offers such a wide remit of treating everything from pregnant women to babies and from mental illness to sports medicine. Individual doctors may develop special interests in diverse areas. General Practice gives the opportunity to prevent illness and not just treat it.
Learning to become a doctor, such as a General Practitioner is a long and expensive course of study. It can take a minimum of 9 years to train as a general practitioner and 12 years before a doctor is suitably qualified to apply for a post as a hospital consultant. As postgraduate training progresses, it becomes increasingly difficult to change direction. It is essential that anyone considering medicine is totally sure that that this is what he or she wants to do before embarking on the first step of applying to a medical school. After completing medical school, a medical degree is received. This will enable an individual to work in a hospital or other health setting and be qualified for their job.
There are no alternative routes to becoming a doctor. Working through different levels without a full medical education is impossible. It is therefore vital for someone to be 100% sure about their decision to be a doctor as it does require a lot of expensive education.
Personal qualities of a GP should include:
* Ability to care about patients and their relatives
* A commitment to providing high quality care
* Awareness of ones own limitations
* Ability to seek help when appropriate
* Commitment to keeping up to date and improving quality of ones own performance
* Appreciation of the value of team work
* Clinical competence
* Organisational ability
A typical day for a doctor may involve a series of jobs and clerical work that must be carried out. The following is an outline for what a GP might do in the course of a normal working day:
* Upon arrival at the Surgery, the GP would go to their appropriate consultation room and be ready to see the patients they have on their list for that day (patients are usually shared out between the doctors).
* The doctor would then pick up the patient notes for the first few patients. This is required so that the doctor can enter relevant information into the patient record. This is also done on a computer.
* The patients would then come in one by one. Each consultation is around 10 minutes long based on a client’s needs. The doctor provides medical provision as well as advice about conditions and health. In special cases, for example, the elderly or disabled, a doctor may have to carry out a home visit as the client cannot get to the surgery by themselves.
* The doctor would then follow up and referrals etc. by contacting the right people. The doctor may then look up any information they think the patient may require at a later date.
* The doctor would then update the patient notes as required and leave the surgery.
A typical day at the surgery would start at around 8.30am. The doctor would then carry out the morning session and see patients until around 12pm when they would have a lunch break of around 2 hours. At 2.30pm, the doctor would then come in for the afternoon session, which would end at around 5.30pm. This obviously varies if staff are working part time etc, but this is an outline based on a doctor who is working full time.
Other Care Workers
It takes a lot more than just the doctors in order to run the surgery. Many care workers, some with indirect contact to the patients, help to maintain the level of care required by the patients. Below are a list of the staff on site and a brief description of their day-to-day work:
1. Nurse- Nursing and Midwifery is a major part of healthcare. Very few professions today offer such a range of specialties, varied career paths and promotional opportunities. Nursing requires the desire to help people. One needs to be a practical individual and know how to manage time, as often there is a tight schedule, which must be met. Effective communication skills and the ability to work in a team are also developed as well as learning how to lead.
2. Health visitor- A Health Visitor is a qualified and registered nurse or midwife who has undertaken further (post registration) training in order to be able to work as a member of the primary healthcare team. The role of the Health Visitor is about the promotion of health and the prevention of illness in all age groups. Health visitors carry out a range of different work. For example, working with mothers of young babies – advising on such areas as feeding, safety, physical and emotional development or working with people of any age who suffer from a chronic illness or live with a disability.
3. Administration- This is a key part of the health care system and is essential, in order to ensure things run smoothly. Collecting and handling information is an important function of these staff. Information is increasingly stored on computer systems, using sophisticated methods to collate and interpret it. Some of this information will be about patients including personal and financial issues.
Meeting the care needs of individuals
The Surgery strives to meet the care needs of individuals and it provides advice as well as medical treatment. It is important that the service provides advice for their patients as well as medical treatment as advice can strengthen the relationships between clients and care workers as well as making the clients feel more at ease.
This means that the surgery provides medical care for their patients in the form of referrals to hospitals, medicine, and things like permission for sick leave from work. Medical care is vital to the clients, as they require some form of assistance as well as a professional opinion. If a problem is serious, it is important that it is identified before it becomes worse. The main care worker-the GP- decides based on professional training, how serious a condition may be. This means that some patients may only need medicinal treatment, as their conditions may not be as serious as they had thought.
A professional opinion is very important to a client who is not well. Advice is a vital part of the client-carer relationship and gives a more emotional relationship a chance to develop. It also means the patient will receive help with vital decision-making. Doctors will also provide advice regarding personal problems, should the client choose to discuss them. It is important for the client and doctor t develop a close relationship because the patient needs to be comfortable with their doctor in order to be able to share problems without feeling embarrassed or uncomfortable.
The care needs of each individual fall into the PIES. These are physical, intellectual, emotional and social factors that can affect a client in different ways. I have summarised each of the PIES below and explained how each can affect a patient.
There are many physical needs a client may have when coming to use a service, such as a GP surgery. Clients who have physical disabilities will certainly have more physical needs. These clients will need the service to meet more specific health needs, as they will require further assistance than people who do not suffer from disabilities. In order to meet the care needs of these individuals, the Surgery has wheelchair access, which is very important to people with physical disabilities, as then they can easily enter and exit the building as they wish.
There is also a domiciliary service available for people who are unable to visit the surgery themselves. For example, elderly people who cannot leave their homes will require a GP to visit them at home. Also, in the case of terminally ill patients who are confined to their homes and cannot leave, a home visit would be necessary. Physical disability can also be very hard to deal with emotionally; therefore it falls under more than one category of patient needs. Other physical needs may include the need for constant medication in order to help with physical health as well as advice about things like quitting smoking or losing weight in order to improve health.
A client’s most important intellectual need is being educated about their condition as well as how to maintain good health. It is vital that the doctor informs the client about whatever their condition may be or gives them information that they may not have previously known. A client will then feel more at ease, as they will understand their own problem and how it can be treated. Health awareness is very important in order for patients to be able to understand their rights and the type of service that will be provided for them. Promotion of good health is another important factor for clients as they must be intellectually educated about the benefits of things like eating well and regular exercise. Doctors within the surgery strive to educate patients about maintaining good health, as this is not only physically excellent but also intellectually stimulating. In addition, it can help social and emotional aspects of a patient’s life, for example, by increasing their self-esteem.
Sometimes, there may be patients from different backgrounds, who may not understand English. Therefore, the surgery has a professional translator available should there be such a client. This is important in order for the patient to be able to communicate their ideas successfully to their doctor.
Emotional needs of a client can be very specific and sometimes be difficult for a doctor to provide. Clients may suffer depression or emotional distress. Often clients will need to share personal problems with their doctor, in order to be able to explain the problems they are having. A doctor will provide as much advice and help as they can but sometimes, if it is felt that a client has deep emotional troubles, they may be referred to a counsellor or in very serious conditions, a psychiatrist. A client requires their doctor to be open minded and understanding about anything they choose to share.
Client confidentiality is another very important aspect in the client-carer relationship, as the client needs to know they can trust their doctor with any information they may wish to share. In addition, the doctor should approach problems in a professional manner, by offering advice or perhaps medical provision. The final decision should be left up to the client. Sometimes, clients will just require someone they can talk to and a doctor must be understanding and helpful in any way he or she can. If a patient is referred to a psychiatrist, the doctor may still have consultations with the patient in order to ask about how they are coping or whether they are feeling any better.
The main social need of a client relating to this particular care setting, is a good relationship with their doctor. This social interaction is very important because a client needs to feel at ease with their doctor. Good social relationships also mean the doctor will be able to discuss their clients’ personal problems without any embarrassment or unease. This will mean the patient will feel they have someone to turn to, who will not only provide medical provision but also advice and help about in depth problems.
In some cases, communication between the patient and doctor can be difficult, for example, if the patient is from a foreign background and does not understand English. For this purpose, the surgery has a translator as well as a language line for anyone who contacts the surgery but doesn’t understand English. Communication is vital, which is why the surgery strives to work past any barriers that may get in the way of successful communication between client and carer.
I created the following pie chart in order to show how much the four PIES are dealt with in this care setting. I chose the percentages based on how much I think each aspect of the PIES is dealt with. I drew these conclusions based on my questionnaire as well as additional information I obtained by speaking to one of the doctors who works at my care setting.