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 – 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
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/