From a patient's perspective - how the National Health Service actually works in practice

Introduction

If you aren't from the UK, it might be hard to imagine how the system actually works. Do you just rock up at any doctor or hospital when you feel like it? What are the criteria? What's it like being an NHS patient?

The "patient's perspective" in question is mine - I was born and brought up in London, have parents, sisters, a brother, a partner and a 3 year old son who are all ordinarily resident in the UK and therefore NHS patients.

This article looks at how the National Health Service really works in the United Kingdom - specifically, in England. The NHS is split into four parts, for England, Wales, Scotland, and Northern Ireland. The differences aren't great, but there are some minor variations.

This hub follows on from two others, the first is called, The National Health Service in the UK: who pays, and who is covered, and details how the NHS was founded in 1948, who is covered by the system, and how much it all costs.

The second, What the National Health Service (NHS) in the UK covers, and what costs patients extra is about what patients pay for medical care, dentistry, and optician's treatment, under the NHS.

The NAtional Health Service logo
The NAtional Health Service logo
A baby about to have a developmental check on the NHS
A baby about to have a developmental check on the NHS

Accessing the NHS system - the General Pracitioner

Everyone with a right to National Health Service coverage gets an NHS number. This is allocated to you at birth (if you are born in the UK) or when you take up permanent, lawful residence here, if that comes later.

This number follows you around from doctor to hospital, and keeps your records together. A person is also allocated a National Health Service Card, but these aren't terribly important - I can't remember when I last needed mine, but it can't have been for a while as it's still in my mother's "important documents" file at my parents' home.

The General Practitioner is the gateway to the NHS' medical system. In order to access treatment (other than emergency treatment) you need to be registered with a GP's surgery. There are a lot of them, and they generally cover a small geographic area. An individual patient in a densely-populated area might have the option of registering at several different surgeries.

A GP's surgery is, usually, several doctors practising together. My GP's clinic has 8 GPs based there.

Becoming a GP takes some time - after finishing medical education, a doctor works in a hospital for a number of years before doing GP training.

The National Neurological Hospital, an NHS hospital in Queen's Square, London WC1
The National Neurological Hospital, an NHS hospital in Queen's Square, London WC1

When I see an NHS GP, and making appointments

Most of the time, I'm perfectly healthy when I visit the GP. Sometimes it might be for booster injections for things such a tetanus or polio.

There are also regularly-scheduled screening programmes, such as smear tests (every 3 years), and breast mammograms for older women, for example. Every 3 months, in order to renew a (free) contraceptive prescription, I need to have my blood pressure and weight checked.

With routine appointments such as these, I usually book them a week or two ahead, as then I can choose exactly what time of day will suit me best, and book to see a particular GP if that matters (which it doesn't, to me, but it matters a lot for some people). My GP's surgery has appointments from 8.30am to 7.30pm on weekdays, and on Saturday mornings, for routine matters.

If I am unwell, with (say) an ear infection, or a nasty cough, I obviously don't make an appointment weeks ahead. Instead, I telephone the surgery in the morning, from 8.30am, and a doctor then rings me back to see what is wrong, and if necessary to book an appointment for me that day. With these last-minute appointments, there is much less choice of exact time and which doctors are available.

A National Health Service (NHS) General Practitioner in Holborn, London WC1
A National Health Service (NHS) General Practitioner in Holborn, London WC1

Out of hours GP services

When the surgery is closed, there is a 24 hour, 7 day a week number to contact the on-call GP. Consultations can be made over the phone, and the GP might make an out-of-hours house call, or direct you to go to Accident and Emergency at the hospital (also known as Casualty), or might suggest you go the surgery the following day.

I've only had to ring the out-of-hours number once, when my darling then two-year-old son proved that childproof caps on medicine bottles are not childproof, and took a big swig of Calpol (paracetamol liquid for babies). I rang the GP, who looked up toxicity and doses, then rang me back and told me that the dose wasn't something to worry about.

St. Thomas' NHS hospital central London
St. Thomas' NHS hospital central London
King's College Hospital, an NHS hosptial in south London
King's College Hospital, an NHS hosptial in south London

Referral to a hospital doctor or clinic

If the GP thinks it is necessary, he can either refer you to a specific specialist doctor at the hospital, or send you to a clinic at the hospital. You can't go directly to a specialist hospital doctor on the National Health Service, the GP has to refer you.

Depending on what type of problem it is, you will either be told to go home and await an appointment letter, or given a letter there and then and sent off to the relevant clinic with it.

My son suffered from horrible reflux as a newborn baby, and when we took him to the GP when he was about 5 weeks old, the GP reckoned he was dehydrated. We were sent to a paediatric clinic at the nearest tertiary-level hospital, where Isaac was seen firstly by a junior doctor, then a consultant (the most senior level) and as a result of those examinations, he was admitted to the paediatric ward for 3 days to be put on a drip and given various ultrasound scans, blood tests, and other nasty procedures.

The children's wards have small rooms attached, so that a parent or guardian can sleep in the hospital overnight and be near the child.

Once referred to a specialist, you might well get further appointments and tests, if necessary, made directly with the hospital. You don't need to be referred each time. So Isaac saw a paediatrician regularly at the hospital until he was over the worst of the reflux, at which point he was discharged back to the GP's care.

Any notes, tests, examinations and so forth are copied to the GP, so your medical file at the GP is a complete health history.

A newborn baby (my son) in a cot in an National Health Service hospital maternity and neo-natal ward
A newborn baby (my son) in a cot in an National Health Service hospital maternity and neo-natal ward
Newborn baby (12 hours old) with his proud grandmother in the same ward
Newborn baby (12 hours old) with his proud grandmother in the same ward

Midwives, ante-natal care and maternity

How this is organised will depend on the Local Health Authority. In a lot of cases, community midwives (those who do routine pre and post pregnancy care) are based at a GP's surgery. In other cases, they hold a separate clinic several days a week.

Pregnancy care is organised through the midwife. It consists of a long (2-3 hour) booking-in appointment early in pregnancy, where health histories of the woman, her partner, and her close family are taken, blood tests organised, height and weight checked, and a care plan devised.

After that, you see a midwife approximately 10 times through the pregnancy, more frequently later on, to check the baby's movement, heart-beat and size, the mother's general health, and to check the mother's blood pressure, sugar and protein levels. At any time, the midwife can refer a woman to the ante-natal unit at the hospital, if she thinks that is necessary.

In addition, in a normal, healthy pregnancy, there are ultrasound scans at about 12 and 20 weeks, and an appointment with the doctor at the ante-natal clinic at about 30 weeks. If the mother has health or pregnancy problems, she will spend a lot more time with the midwife and the ante-natal clinic.

The National Health Service also runs ante-natal classes, and tours of the maternity and neo-natal wards, so that the mother can choose between natural childbirth (midwife-led care) and more medical childbirth (doctor-led care) and which hospital she wants to give birth in.

It's also possible to have an NHS home birth, where two midwives come to the mother's home when she is in labour.

My son and I were discharged from hospital when he was 3 days old. A community midwife visited us at home every day for a week, then every other day for another week.

Great Ormand Street Hospital for Sick Children, a National Health Service hospital in London WC1. This shows the main building.
Great Ormand Street Hospital for Sick Children, a National Health Service hospital in London WC1. This shows the main building.
Great Ormand Street Hospital ambulance entrance
Great Ormand Street Hospital ambulance entrance

Health visitors

Each child is assigned to a Health Visitor, or team of health visitors, from birth.

The first visit at least (and often subsequent ones, it depends on the way the clinic runs) are at the baby's home, when he is a few days old.

Health visitors run clinics, and a mother can attend with her baby or child as often as she wants.

Health visitors measure and weigh children and babies, and give advice on breast feeding, bottle feeding, sleeping, tantrums, behaviour, all the rest of it, as and when the mother requests it.

The health visitors' clinic is also where a baby and child has regular developmental checks with a paediatrician, checking all sorts of things from fine motor movement through hearing to speech, as appropriate at different ages.

Isaac was offered developmental checks at 6 weeks, 3, 6, 9, 12, and 18 months, and 2 and 3 years old. He has another upcoming at 4 years old.

Other health professionals

There are lots of other health professionals, often attached to GP's surgeries, who deal with people in the community. They include Community Psychiatric Nurses, who offer support to the mentally ill, and District Nurses, who do home visits for things such as changing dressings.

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45 comments

Teresa McGurk profile image

Teresa McGurk 7 years ago from The Other Bangor

Lovely that you used photos of Isaac! Great overview of the services offered by the NHS.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Well, I didn't see why not. He is an NHS patient, after all (-:


dineane profile image

dineane 7 years ago from North Carolina

"and a doctor then rings me back to see what is wrong"....I haven't even finished reading the hub - just skipped right down here to the comments to say, DAMN! A doctor rings you back????? I've NEVER had that happen. A nurse maybe, but I have never been able to speak to a doctor on the phone...oops...almost lied. My doctor did call me while I was in labor, to tell me not to call again before I came to the hospital the next day unless my contractions increased to more than 5 minutes apart...and even then, I shouldn't call him, just go to the hospital. JERK!


dineane profile image

dineane 7 years ago from North Carolina

Wow. I'm moving to the U.K. Amazing.


dineane profile image

dineane 7 years ago from North Carolina

just thought I should clarify on that first comment, about my labor, that my water had broke, I lived more than 30 minutes away from the hospital. I was calling the emergency number back because I realized I did not understand the instruction from the nurse on my first call - to "leave" for the hospital at 8 am in the morning or the "be there" at 8 am. Yes, it was late, but not after midnight. Obviously the on-call nurse was not clear on the doctor's instruction either, or she would have answered my question instead of having the doctor call me back!


LondonGirl profile image

LondonGirl 7 years ago from London Author

Dineane - they don't ring you back immediately, it depends on gaps between patients, and so forth. The receptionist makes a list, in the order people ring in, and the list is shared out among the doctors.

Last time I had to do this was about 10 days ago - a nasty virus had turned overnight into swollen tonsils and an ear infection in one ear. So I rang at 8.30am, a doctor rang me back at 9.25am, and I saw the doctor who rang me at midday. I got poked and prodded, and given a prescription for amoxicillin, an anti-biotic.

If you rang in the morning, and when the doctor returned your call, you said you'd been stung by a bee 3 days ago, and wanted an appointment, he'd probably not see you at midday (-:

The doctor you spoke to when in labour sounds like a idiot - surely if you deal with childbirth, you have to accept that babies don't come 9am to 5pm, Monday to Friday?


dineane profile image

dineane 7 years ago from North Carolina

LG, it still sounds like a dream to me. A doctor actually eventually returning your call? Even if you got stung by a bee three days ago? Amazing. Then again, I'm told there was a time in this country when docs showed up at your house when you needed them.

As for my in labor doc, I'm sure he was just trying to sleep and thought *I* was being silly...and maybe I was. But he could have at least been nicer on the phone. And he probably didn't give a hoot what time I made it to the hospital - sure that someone would either get him there or take care of me. But the "customer service" part of the equation was definitely missing in one of my most nerve-racking medical situations.


LondonGirl profile image

LondonGirl 7 years ago from London Author

GPs do do house calls, but not often or easily, I think. It's for people who can't get to the surgery easily.

My grandmother had a weekly GP visit at home for the last 6 months of her life (in 2002) because she was suffering from heart failure. The District Nurse visited more often, every other day, I think.


JamaGenee profile image

JamaGenee 7 years ago from Central Oklahoma

You're really a rep for "Move To Britain NOW", aren't you?  ;D  The NHS may not be perfect, but it's certainly wayyy better than in the States.  Calling for an appointment for the same day?  Would have to be a life-threatening emergency, and then you wouldn't call a GP anyway, just go to the ER (Casualty). 

What an impressive series!


Elena. profile image

Elena. 7 years ago from Madrid

LG, I think UK is better off than Spain in some of the patient's "benefits" :-)  For example, I'm not aware of "health visitors" for children here.  Maybe they exist, but I don't know of them. I'm not sure either about getting a call back, except in cases where your condition wouldn’t allow you to leave the house. Still we're pretty much in sync again :-)

I think you may be contacted by the immigration authorities when throngs of Americans start arriving en masse to UK and saying "LG's articles about NHS made me do it!"  Laugh!

Kudos, LG, this is a fantastic series!


LondonGirl profile image

LondonGirl 7 years ago from London Author

Thanks both, glad you found it interesting.

Elena, maybe you've struck on my hidden plan - after all, I'm an immigration barrister LOL!


Kmadhav profile image

Kmadhav 7 years ago from New delhi

New information for me ....it is good to see..........................

http://www.stellarinfo.com


James A Watkins profile image

James A Watkins 7 years ago from Chicago

Another fine Hub explicating the NHS procedures and patient benefits.  Are you familiar with Theodore Dalrymple?  He sure presents a starkly different view of this subject.  He is a physician turned writer from the UK.  Anyway, what matters most is the POV of the consumer and it sounds like a dream!


Amanda Severn profile image

Amanda Severn 7 years ago from UK

Hi LG

A few years ago I was given the opportunity to see the difference between the NHS and private health care in practice. Someone close to me suffered an epileptic seizure for no apparent reason. His company held him in sufficiently high regard to fund a neurology appointment and a brain scan privately, as a priority. Both appointments took place within two weeks of the initial event. Simultaneously, his NHS doctor logged him on to the system and an NHS neurology appointment arrived about three months later. He was told that a scan appointment would have taken a few months more, unless further symptoms presented, in which case the whole process would have been fast-tracked.

I imagine that James's Theodore Dalrymple probably cites such cases as being proof that the NHS is inefficient, and certainly on this particular occassion I was very glad that the matter was dealt with speedily. However, I know that if a tumour had been the suspected cause the NHS would have moved much more swiftly. The beauty of our system is that we can use the NHS with confidence for the vast majority of our requirements, but we can also go privately if we wish for speed and convenience. There's no need to be tied into a prohibitively expensive health insurance for our day-to-day needs.


Peggy W profile image

Peggy W 7 years ago from Houston, Texas

Sounds like a dream in comparison to what we have in the U.S. at the current time! Does England have room for all of us? LOL


LondonGirl profile image

LondonGirl 7 years ago from London Author

James, I've read Dalrymple in the past. He focuses on things which go wrong. But I strongly believe that the system as a whole works very well, and is a good option.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Amanda, I agree - there is always the option to pay privately should you not wish to wait, but the knowledge that you don't have to do so, and will still get proper care. That's an important form of security, I think.

Peggy - sadly, no. LOL!


BrianS profile image

BrianS 7 years ago from Castelnaudary, France

Very good explanation of how the UK national health service works.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Thanks Brian.


robie2 profile image

robie2 7 years ago from Central New Jersey

and this is the " socialized medicine" that some Americans froth at the mouth over-- what a sensible system-- imagine basing healthcare on the needs of the patients --what a novel concept. Nice job LG


Smart Dad profile image

Smart Dad 7 years ago from Northampton

Yep we are lucky In the UK great Hub LG I'll be playing catchup


charanjeet kaur profile image

charanjeet kaur 7 years ago from Delhi

Omg you are a year late to write this hub, i wish i had it in my london stay it would have been easy. London NHS is one so user friendly and much better than to what i had in sweden. I had just landed and my daughter was having high fever, the nhs at basingstoke was so prompt in looking into her and advising the best way possible. I have to say that my stay would not have been possible without a NHS.

A very well written hub, it is like a guide for all those who are living in london. Forwarding it to all my friends who are visiting london. thumbs up.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Thanks Robie, glad you found it of interest. Most British people will bitch about the NHS until someone (a) foreign criticises it or (b) suggests getting rid of it. Then the someone in question is in big trouble (-:


LondonGirl profile image

LondonGirl 7 years ago from London Author

Smart Dad - I agree, we're very lucky.

CK, I'm glad your experience was postive, and hope your daughter got well fast.


Dolores Monet profile image

Dolores Monet 7 years ago from East Coast, United States

London Girl - what a timely hub especially for those of us in the US. Health Care is a very hot topic and the right wingers are beating the drum against any kind of totally inclusinve health care. The love to rag on about the HORRORS of the health care system in England, you would not believe the things they say. It's so good to hear from someone who actually has experience with this wonderful system.

Here in the US, a new mother is booted out of the hospitol in 24 hours. No nurse comes to visit. And you mentioned house calls? House calls here disappeared sometime in the 1960's - you just get your sick but to the doctor any way you can.


LondonGirl profile image

LondonGirl 7 years ago from London Author

I don't see the horrors, myself. Sure, it's not perfect, but what is? The NHS does mean, however, that no-one is worrying about the cost of breaking an arm, or getting an ear infection. That security is important.

How long you stay in hospital after a baby depends on the health of the mother and child, and how the mother feels. I think it's 24 hours minimum for a normal vaginal delivery, and 3 days for a c-section, but it's extendable if the mother feels she needs the support.

The midwife visiting at home is useful - she checks the cord, weighs the baby daily, checks for dehydration, etc, which is very reassuring.


opinion duck 7 years ago

You really don't know the worst about any system, until you need its help.

The GP in your NHS is the weak link, as is the health insurance companies in the USA.

Putting up your hub is like presenting a paper tiger, it is not the real thing. The real thing is how the patients that have real problems are treated by the system.

NHS probably works for the basics, such as the broken arm, childbirths, cuts and the like. The real test is the non surgical cases, the ones that medicine gropes about in the dark, even today. These maladies escape even the specialists in the field, such as cancer and other immune disease to cite just a few.

Time is of the essence, even outside of contract law, and especially in diagnosing and treating medical conditions. It seems to me that NHS has these problems built into their scheduling and process system.

The NHS is probably as good as any paid system in the USA and it is availabe to all. So my criticism should be directed to the medical community in general, in what I consider non scientific and non professional handling of their patients. Patients are given prescriptions instead of understanding for their medical conitions. Patients should be given the information to understand what they have and how the prescription would enable a remedy for their condition. I believe that the more information given to a patient will result in more successful treatments.

Drugs and surgers have their place, but the best healing machine in the world is the human brain. The body with the brain can cure many things by itself, although it may need assistance at times. Many drugs and treatments just focus on symptoms and not cures.

Anyway, just my view.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Very interesting - thank you.


Lgali profile image

Lgali 7 years ago

Very good explanation about UK national health service good hub.

How are you doing long time you did not visit my hub


LondonGirl profile image

LondonGirl 7 years ago from London Author

I have been reading, Lgali, just not commented recently.


giantsteps profile image

giantsteps 7 years ago

I know a lot of Americans who are afraid of socialized healthcare like the NHS. I've recently moved to the UK from Florida. Before I came here I was worned by friends about the evils of socialized medicine and told that I'd better buy some good health insurance.

Last month I had quite a big medical emergency that required surgery. I have to say that I was pleased by the care I recieved. A hospital is a hospital and none are particularly pleasant to be in, but I got good care while I was there.

Like all healthcare systems the NHS has it's problems. I recently saw a program on the BBC about people with a rare form of cancer that were unable to get a drug they needed approved by the NHS. The arguement given against it was that it costs too much and would only prolong the person's life a couple of months. That's cold, but insurance companies in the States refuse to pay for treatments all the time.


2patricias profile image

2patricias 7 years ago from Sussex by the Sea

We are both supporters of the NHS. Of course there are a lot of complaints, because people are treated according to their perceived needs, and on the basis of knowledge about outcomes.

There will always be those who perceive their own needs as being of the highest priority when the 'system' makes them wait. However, my guess is that this would also happen with an insurance based system.

We have both had cases in our families where the NHS has provided highly specialised care quickly.

When Pat's daughter was born (over 20 years ago), Pat had some health issues after being discharged from hospital. She was visited at home by a midwife every day - even Sundays - until all the matters had been successfully resolved.


dineane profile image

dineane 7 years ago from North Carolina

I keep coming back to this hub, LG...have given you lots of links on facebook, for what it's worth :-)


LondonGirl profile image

LondonGirl 7 years ago from London Author

Giant, sorry to hear you were ill. I agree, being in hospital anywhere, any time isn't a fun experience! The NHS is pretty good, on the whole, I reckon.

Dineane, thanks! Glad you've found it interesting, and thanks for linking!


LondonGirl profile image

LondonGirl 7 years ago from London Author

Pat, I agree. Not perfect, but pretty damn good. When I had my son 4 years ago, I was visited by a midwife every day for the first week or so, then every other day until the health visitor took over. Seemed good to me.


Leta S 7 years ago

I just wanted to come by and say thank you, LondonGirl, for writing this so people in the US, with all the debate going on over health care, can get a better grasp on "socialized medicine." Of course, you know I'm already sold and believe health care to be a human right. :)


Leta S 7 years ago

And btw....this was recently sent to me:

"In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed."

Can you verify if this is true, or if it is propaganda as I think it is?...thanks!


Shubhadevi profile image

Shubhadevi 7 years ago

very good information sharing on UK national health service has been made in this hub..


Liz 7 years ago

Dear Lita

My father is in his mid-70s and in the past 18 months has undergone major bowel surgery and had a heart valve replaced on the NHS. Loads of aftercare and regular blood tests.


ryankett 7 years ago

Lita Sorenson, that is most definitely propoganda, I know a 63 year old male that has just had a TRIPLE bypass!


nicomp profile image

nicomp 7 years ago from Ohio, USA

"Here in the US, a new mother is booted out of the hospitol in 24 hours. No nurse comes to visit. And you mentioned house calls? House calls here disappeared sometime in the 1960's - you just get your sick but to the doctor any way you can."

Who knows better, the hospital or the new mother?

If you want a nurse to come visit, pay for one.

How can anyone imagine that letting government bureaucrats will change this situation?


lxxy profile image

lxxy 7 years ago from Beneath, Between, Beyond

Thanks for providing this true look into the health care system across the pond.

Great pictures, and cute baby. =)


Moon Daisy profile image

Moon Daisy 6 years ago from London

LondonGirl, that's a great summary of the NHS. I feel ever so lucky to live in the UK. I particularly appreciated the midwife and health visitor visits after I had my daughter, as well as all the developmental checks.

It's interesting that you get a doctor phoning you back when you want to make a same-day appointment. At our surgery you just phone early in the morning and they give out the available appointments on a first-come-first-served basis. I suppose the way that they do things at your practice is fairer. Although I'm pretty certain that if somebody had a real emergency our doctors would still manage to fit them in, even if it meant bumping a patient with a less urgent problem.

Great hub, thumbs up!


E M Smith profile image

E M Smith 6 years ago from Kingston-Upon-Hull

I have both the patient's and employees perspective. The NHS has many things not right but on the whole it is a wonderful thing. I hope the planned shake up does not deccimate its services.

It is a bit of a postcode lottery for some things and our GP practice leaves a lot to be desired.


WestOcean profile image

WestOcean 6 years ago from Great Britain

A very useful hub with lots of practical info.

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