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Healthcare in the United Kingdom is mainly provided by four publicly-funded health care systems to all UK permanent residents that is free at the point of need and paid for from general taxation in the United Kingdom. Healthcare is a devolved matter and so England, Northern Ireland, Scotland and Wales each has its own system with different policies and priorities though the degree of co-operation usually conceals the difference from cross-border users of the services. Although commonly referred to as the "National Health Service" ("NHS") across the UK, the National Health Service covers England with NHS Scotland covering Scotland, NHS Wales covering Wales and the Department of Health, Social Services and Public Safety providing healthcare in Northern Ireland in the guise of Health and Social Care in Northern Ireland.

In addition to the public NHS systems (which dominate healthcare in the UK), private healthcare and a wide variety of alternative and complementary treatments are available.

Services common to the whole of the United Kingdom

General practitioners

Each NHS system uses General Practitioners (GPs) to provide primary healthcare for patients and to make referrals to services as necessary, whether for tests or treatments. GPs are qualified doctors, typically working in business practices that deal exclusively with NHS patients and receive fees based on the number of patients and the different services provided by the practice under the GP contract. Doctors are not allowed to charge for services provided as part of the contract, which almost all care is. All people are eligible for registration with a GP, usually of the patient's choosing, though the GP must be local to the area in which the person lives. GPs can only reject patients in exceptional circumstances.

There are no fees payable for the services of a general practitioner.

Health Centres and Clinics

Health Centres close to residential areas are provided as part of the free public health service. They typically provide care that is considered more routine and less invasive than the type of surgeries and procedures that take place in the hospital. Ophthalmology, dentistry, wound dressings re-dressing, infant check-ups and vaccinations, are typical areas of practice to be found in such places. Medical services are typically provided by nurse practitioners and visiting specialist doctors.

Health centres do not make a charge for their services.

Hospitals

Hospitals have specialist diagnostic equipment that is not generally available in GP surgeries or in health centres. They also perform surgical procedures. Mental hospitals care for those with psychiatric illnesses although many general hospitals may merely have separate psychiatric units. Access to hospital services is via referral from a general practitioner. Some hospitals have Accident and Emergency departments providing trauma care and no referral is needed to access A&E services.

All services in UK hospitals are free of charge to the patient.

Advice services

Each NHS system runs 24 hour confidential advisory services: NHS Direct provides a telephone-based service for England, NHS Direct Wales/Galw Iechyd Cymru provides a similar service in Wales while Scotland has NHS24.

Ambulance services

Each public healthcare system provides free ambulance services for patients facing life-threatening emergencies or if ordered by hospitals or GPs when patients need the specialist transport only available from ambulance crews or are not fit to be sent home by car or public transport. In some areas these services are supplemented when necessary by the voluntary ambulance services (British Red Cross, St John Ambulance and the St Andrews Ambulance Association). Where needed, patient transport services by air are provided by the Scottish Ambulance Service, various ambulance trusts in England and Wales (some jointly operated with police helicopter services) with emergency air transport also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion; on more than one occasion this has led to new-born babies needing special care being flown long distances in Hercules transport aircraft or similar.

Cost recovery in exceptional circumstances

In general, the cost of NHS health care is met from taxation and the NHS does not bill for its services. Each NHS system, however, reserves the right to claim compensation for treatment required as a result of the negligence of others. For example, when compensation is received from motor insurance companies through the Injury Costs Recovery Scheme following the determination of fault in motor accidents. Foreign visitors to the UK are not charged for emergency NHS treatment to stabilize a health problem that has started in the UK during their visit but cannot receive any other NHS services. If it becomes clear that a patient has received services who was not in fact eligible to receive free treatment, the NHS will recover costs from the patient.

Dentistry

Each NHS system provides dental services through private dental practises and dentists can only charge NHS patients at set rates (though the rates vary between countries). Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists comes from work sub-contracted from the NHS. Not all dentists choose to do NHS work and there is a trend of movement from the NHS to private dentistry.

Services which differ between the countries of the United Kingdom

Pharmacies & Prescription charges

Each NHS system uses pharmacies to supply prescription drugs. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service

In England, patients under 16 years old (19 years if still in full-time education) or over 59 years will get the drug for free. There are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £7.10 is payable per item.

In Northern Ireland, prescription charges will be abolished by April 2010. At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £6.85 is payable per item.

In Scotland, prescription charges will be abolished before 2011. At present, patients under 16 years old (19 years if still in full-time education) or over 59 years get free prescriptions and there are also exemptions for people with certain medical conditions, and those on low incomes. Prescribed contraception is also issued free of charge (e.g. contraceptive pills). Otherwise, as of April 2008, a fixed charge of £5 is payable per item.

In Wales, prescription charges were abolished in 2007 and all prescription drugs are now dispensed without charge.

Parking charges

Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals) but continue in England.

Polyclinics

Polyclinics are being trialled in London and in other suburban areas and, if successful, may be rolled out across England.

Role of private sector in public healthcare

Whereas the UK government is expanding the role of the private sector within the NHS in England, the current Scottish government is moving in the opposite direction, actively reducing the role of the private sector within public healthcare in Scotland and planning legislation to prevent the possibility of private companies running GP practices in future.

Cost control

Each constituent part of the NHS (e.g. a trust or GP practice) is responsible for overall control of costs within its area of operation.

The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland .

In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, the Scottish Medicines Consortium performs a similar function. However, the Scottish system makes some new drugs available for prescription more quickly than in the rest of the UK which has led to complaints.

Private health care

The United Kingdom also has private health care which is mainly paid for by insurance or funding as part of an employer funded health care scheme. It is considerably smaller than the public NHS sector given the comprehensive nature of NHS healthcare and the fact that NHS care is mostly free of charge at the point of use.

There are many treatments that the private sector does not provide. For example, one of the largest health care providers in the UK is BUPA and it excludes many treatments from its insurance plans , nearly all which are available as NHS treatments. The list contains many forms of treatment and care that most people will need during their lifetime. The BUPA exclusion list includes

• ageing, menopause and puberty
• AIDS/HIV†
• allergies or allergic disorders
• birth control, conception, sexual problems and sex changes†
• chronic conditions†
• complications from excluded or restricted conditions/ treatment
• convalescence, rehabilitation and general nursing care†
• cosmetic, reconstructive or weight loss treatment†
• deafness
• dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc)†
• dialysis†
• drugs and dressings for out-patient or take-home use†
• experimental drugs and treatment†
• eyesight†
• HRT and bone densitometry†
• learning difficulties, behavioural and developmental problems
• overseas treatment and repatriation
• physical aids and devices†
• pre-existing or special conditions
• pregnancy and childbirth†
• screening and preventive treatment
• sleep problems and disorders
• speech disorders†
• temporary relief of symptoms†
• treatment in a hospital that is not a Bupa Heartbeat hospital

† (except in exceptional circumstances)

See also

• Emergency medical services in England
• Emergency medical services in Northern Ireland
• Emergency medical services in Scotland
• Emergency medical services in Wales

References

1. 'Huge contrasts' in devolved NHS BBC News, 28 August 2008
2. NHS now four different systems BBC 2 January 2008
3. Health and Social Care in Northern Ireland
4. NHS Direct (England)
5. NHS Direct Wales/Galw Iechyd Cymru
6. NHS 24 (Scotland)
7. Wiltshire Air Ambulance
8. BBC News-RAF flight 'saved couple's baby'
9. "Call for dentists' NHS-work quota". {{cite web}}: Text "BBC" ignored (help)
10. NI to scrap prescription charges BBC News, 29 September, 2008
11. Vow to scrap prescription charges BBC News, 22 October 2008
12. NHS car parking charges abolished BBC News, 2 September 2008
13. Private firm to carry out surgery BBC News, 5 August 2007
14. £64bn NHS privatisation plan revealed guardian.co.uk, 30 June 2006
15. Plans to end private cash for NHS BBC News, 21 June 2007
16. Sturgeon to end privatisation of GP practices Sunday Herald, 8 June 2008
17. NAO report (HC 129-I 2007-08): Report on the NHS Summarised Accounts 2006-07: Achieving Financial Balance
18. Call for quicker drug decisions BBC News, 10 January 2008
19. http://www.bupa.co.uk/heartbeat/html/not_covered.html BUPA exclusions

• Healthcare in the United Kingdom