The NHS was established in 1948 to provide universal healthcare free at the point of use for all British citizens. It aimed to provide medical care based on need rather than ability to pay. The NHS has undergone constant change and reorganization over the decades, moving from an administrative model to a market-based model and now emphasizing primary care and local authorities. Primary Care Trusts (PCTs) manage primary healthcare services in their local areas, including GPs, pharmacies, and walk-in centers. They are also responsible for funding hospitals and making decisions about secondary care services.

1. THE
An overview
Dr. Josep M. Vilaseca
UASP, 27 d’octubre de 2009

2. Founding principles
Tony Delamothe, deputy editor.
BMJ 2008;336:1216-1218 (31 May)
Britain’s National Health Service (NHS) came
into existence on 5 July 1948. It was the
first health system in any Western society
to offer free medical care to the entire
population. It was, furthermore, the first
comprehensive system to be based not on
the insurance principle, with entitlement
following contributions, but on the national
provision of services available to everyone.

3. NHS Organisation
NHS Aims:
• To provide medical care free at point of use
• To rich and poor alike
• in accordance with medical need
2 beliefs:
• Those who need care will come forward
• Those who provide care know what is
required and how to provide it

4. ELS QUATRE (O MÉS?) NHS
• NHS England
• NHS Northern Ireland
• NHS Wales
• NHS Scotland

5. NHS Organisation
Constant change
5 phases:
1948 - 74: Administrative
1974 - 82: Planning
1982 - 90: Managed
1990 - 97: Market
1997 - : The New NHS!!

6. NHS Organisation
The New NHS
Health
Improvement
Programme
Local
Authorities
Primary Care Groups
Health Authorities NHS Trusts
DoH
NHSE
Regional Offices
Secretary of State
Type title here

7. ASPECTES DIFERENCIALS
• Els contractes (p.e. directe NHS – single-handed
GP)
• La competència
• Els tipus d’empreses proveïdores de serveis
sanitaris: persones físiques, beneficència, entitats
sense ànim de lucre, empreses privades
• El càlcul de costos
• Els sistemes d’informació
• Els indicadors en temps real
• L’assegurança, les cobertures

8. What are Primary Care Trusts (PCTs)?
Healthcare in the UK is divided into 'primary' and
'secondary' services.
Primary care services are provided by the people you
normally see first when you have a health problem. It
might be a visit to your doctor or dentist, to your
optician for an eye test, or a trip to your pharmacist.
NHS walk-in centres and the NHS Direct phone
service are also part of primary care.
All of these primary care services are managed by
Primary Care Trusts (PCTs). There are about 152
Primary Care Trusts in England, each one covering
a separate local area.

9. What are Primary Care Trusts (PCTs)?
PCTs are a very important part of the NHS, and they get about
80% of the total NHS budget. PCTs decide what health
services a local community needs, and they are
responsible for providing them. They must ensure that
there are enough services for people within their local area,
and that the services are accessible. These services
include:
GPs, Dentists, Pharmacists, Opticians, NHS Direct, and
NHS walk-in centres.
PCTs make decisions about the type of services that
hospitals provide and are responsible for making sure that
the quality of service is high enough. They also control
funding for hospitals.
As PCTs are local organisations, they are in a good position to
understand the needs of their local community. They make
sure that NHS organisations work effectively with local
authorities, and other agencies that provide local health and
social care services, so that the local community's treatment
needs are met.

10. NHS walk-in centres (WiCs), which first opened
in 2000, offer convenient access to a range of NHS
services. Today WiCs are managed by primary care
trusts (PCTs).There are around 93 NHS WiCs
available in England, dealing with minor illnesses and
injuries. This includes:
• infection and rashes,
• fractures and lacerations,
• emergency contraception and advice,
• stomach upsets,
• cuts and bruises, or
• burns and strains.
NHS WiCs are predominantly nurse-led first-contact
services available to everyone without making an
appointment or requiring patients to register. Most
centres are open 365 days a year and are situated in
convenient locations that give patients access to
services even beyond regular office hours.

11. WHAT SERVICES DO GPs OFFER?
• Essential Services – All Practices
• Additional Services – Vast Majority of
Practices
– Cervical Screening (Smear Tests)
– Contraceptive Services
– Vaccinations and Immunisations
– Child Health Surveillance
– Maternity Medical Services
– Minor Surgery
• Enhanced Services – Selected Practices

12. ENHANCED SERVICES INCLUDE:
• Childhood immunisations.
• Influenza immunisations.
• Services for violent patients.
• More complex minor surgery.
• Services for alcohol and drug misusers.
• Anti-coagulation monitoring.
• Intra-uterine Contraceptive Device (IUCD) fittings.
• Specialised care of patients with depression.
• Immediate care and first response care.
• Care of the homeless.
• Intrapartum care.
• Minor Injury services.
• Specialised sexual health services.
• Specialised Multiple Sclerosis services.

13. Practice based commissioning: clinicians
in commissioning
Practice based commissioning (PBC) is
about involving GP practices and other
health and primary care professionals in
the commissioning of services.

14. Commissioning
(extract from a letter of David Colin-Thomé, National Director for
Primary Care
By engaging in the commissioning process
through PBC, GPs have the opportunity to
shape the types of care available for patients,
determine how resources are invested to best
effect and buy the services their patients need.
We have a unique and deep knowledge of our
registered patients needs and what happens to
them when they are referred on. We know that
with more influence over the whole clinical
process how much better we can make the
NHS and in the process release resources to
be used in community settings.

15. OUR VISION FOR CLINICAL COMMISSIONING
(extracte del document World Class Commissioning de
l’NHS, març 2009)
PBC recognises the central role of primary care
clinicians – through the hundreds of thousands of
treatment and referral decisions they make each
day – in using NHS resources to deliver high-quality
care for all. PBC gives local clinicians much greater
power and influence, working in partnership with
PCTs, to shape how these resources are invested
so that they deliver better health, better care and
better value for local practice populations and for
taxpayers. Especially in financially challenged
times, clinical empowerment is not a nicety but a
necessity.

16. BBC news Thursday 31 July 2008 (online)
A terminally ill woman who has been fighting
to get a kidney cancer drug has been told her
local health trust has refused to pay for it
once again.
Jean Murphy, 63, from Salford, went to court after
Salford Primary Care Trust refused to pay for the
drug Sutent.
The High Court told the trust to reconsider its
decision, but it has now refused for a third time.
Chief executive of Salford PCT, Dr Mike Burrows,
said the decision had been made after "significant
consideration".
He said in a statement: "A process review panel took
place at the request of Mrs Murphy and her legal
advisers.

17. "After significant consideration the review panel upheld the
decision of the commissioning panel not to fund the drug
Sutent for Mrs Murphy."
Jean Murphy has already taken her case to the High Court.
He added: "We realise this has been a very difficult time for
Mrs Murphy. However the PCT now believes it has examined
in depth all aspects of this case and the conclusion of all
steps of this process support the original decision."
Mrs Murphy's husband Michael, who has Crohn's disease, a
heart condition and diabetes, has now said he will stop
taking his own life-saving medication.

18. His wife is his sole carer, and they believe the drug
Sutent could prolong her life.
The drug is available on the NHS to patients in Cheshire
and Merseyside, but not Greater Manchester as it has
not been approved by the National Institute of Clinical
Excellence (NICE).
People in Greater Manchester can only receive it
through clinical trials - and Mrs Murphy does not fit the
criteria.
When she was first told the trust would not pay for the
drug, Mrs Murphy said: "There's no other thing for me
to have and I'm frightened of dying - really frightened
of dying."

19. She has undergone several unsuccessful treatments to
slow the cancer's progress and her consultant said
she would be an ideal candidate for Sutent.
Mr Murphy said he now has "no option" but to refuse his
own treatment.
"I love and care for my wife, and I'll do anything for her,"
he said.
"I've helped her through the years, and we've been
married 25 years, and for them not to help, well I don't
want any help from them."
The couple's daughter, Cathy Ostasz, said the PCT
were sending her mother to an early grave.
"This family will fall apart without my mum," she said.
"This is all because of Salford PCT and I think they're
disgraceful. They are sending my mother to a
premature death."

20. Cancer patient wins drug battle
Amanda Crook
October 22, 2008 - Manchester Evening News (online)
A TERMINALLY ill grandmother has won a landmark
battle to force health chiefs to pay for a life extending
cancer drug - by proving it works.
An anonymous donor stepped in giving Jean Murphy,
62, £10,000 to pay for pioneering drug Sutent to tackle
her kidney cancer after Salford primary care trust
refused to fund it four times.
Mrs Murphy says she felt better within days of taking the
drug and now scans have confirmed she has
responded 'exceptionally' well to the treatment -
prompting PCT bosses to change their minds.

21. Mrs Murphy was told she had 18 months to live in April but
since starting treatment says she has stopped using a
wheelchair, oxygen supply and stair-lift. Before taking the
drug she was virtually housebound but now she is shopping
for the family and socialising again.
She hopes her six month battle, which took her to the High
Court, will pave the way for other patients to be offered a two-
month 'taster' of the drug on the NHS to see if it works for
them. She said: "I am overwhelmed, I cannot believe it, even
though I have had it in writing I have to keep looking at it
again and again because we have had such a long fight and
they refused me for so long.

22. "I really hope that what I have been through will change things
for other people, so that no one else has to go through what my
family has done. I think everyone who doctors think would
benefit from Sutent should get to try it for two months - anyone
can accept not having a drug that doesn't work for them.
"I knew straight away that the drug was working, I am a different
person now, but it was great to have my doctor confirm it, saying
my tumours have shrunk dramatically.
"We want to thank everyone at the hospital, my solicitor and all
the people who have contacted us, supporting us and most of all
the donor who has made this possible."
Benefit

23. On average Sutent patients can expect to live an extra six
months. The government's health watchdog issued draft
guidelines a few months ago saying Sutent is effective but
too expensive to be provided on the NHS. Mrs Murphy and
doctors at The Christie hospital in Withington have written
asking them to reconsider before publishing their final
decision.
Salford PCT chief executive Dr Mike Burrows said the PCT
had agreed to fund Mrs Murphy's treatment because she
was one of a 'minority' for whom it was effective. He said:
"We hope the treatment continues to be effective for Mrs
Murphy in line with the initial indications.

24. "NICE guidance states that patients currently receiving
Sutent should have the option to continue therapy until the
patient and their clinician consider it appropriate to stop.
"The funding of new high cost drugs, particularly for cancer
treatments, will continue to be an emotive and challenging
issue for PCTs to manage, given our responsibility as the
local leader for health, and the need to work within the
financial resources available to us.
"The PCT has to act in a way that ensures we have high
quality, convenient and timely health services and
treatments available to everyone in Salford."
Funding

25. Prof Robert Hawkins, Mrs Murphy's consultant at the
Christie said: "I am delighted Jean is doing so well and has
responded so positively to Sutent. I'm also delighted that
she be able to have her treatment funded on the NHS as
this will take away a lot of anxiety for her and her family.
We are so grateful to the anonymous donor who has made
this all possible."
He says around half of patients respond well to Sutent but
around 10 per cent - including Mrs Murphy - have an
exceptional response to it.

26. Last summer broadcaster Tony Wilson, who
later died of a heart attack, had to rely on
showbiz friends to pay for the drug because
health bosses wouldn't approve the treatment.
Mrs Murphy's solicitor Mark McGhee said:
"Obviously Jean is grateful that the PCT has
finally done the right thing. We now hope this
sets a precedent for all kidney cancer patient
sufferers in Salford."

27. DEBAT
Moltes gràcies!
Josep M. Vilaseca