Healthcare in Great Britain

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The British healthcare system is universal and of a high standard. Everyone living in Britain must have basic health and accident insurance to receive treatment.

Unlike other European countries, the British healthcare system is not tax-based or financed by employers. Instead, it is paid for by the individual through contributions into British health insurance schemes. Many people top up the basic cover with supplementary private health insurance. Britain has one of the largest private healthcare sectors in the world, with good choice and competition.

## **Improvements**

* NIC (non-injectable arterial connector) which stops doctors and nurses mixing up drips
* Smartphone gadget called AliveCor is attached to the phone and allows it to take an electrocardiogram (ECG) reading in just 30 seconds.
* Create the High Intensity User plan which involves a dedicated staff member meeting troubled patients for coffee and a chat. The scheme also includes patient mentoring, 1-on-1 coaching and a number to call instead of 999 if patients feel in trouble. It led to a reduction of 90% in A&E attendances and 999 calls among the highest frequency users.
* Doctors can look for the protein calprotectin in stool samples – a simpler and less intrusive method. A simple test for stomach problems
* Equip ambulances with tranexamic acid, a substance which helps blood clotting, can reduce the number of people dying from bleeding by up to 30%
* Develop a system to spot sepsis before it takes hold the National Early Warning Score enabling staff to spot deteriorating patients by calculating a score from basic checks including blood pressure, temperature, heart rate and oxygen levels.
* The Beverage Trolley was invented by Sunderland City Hospitals and Quality Hospital Solutions to serve a range of hot drinks to patients at the bedside using a portable boiler system. The machine, being used by 5 NHS hospital trusts, has been linked to patients staying better hydrated as they can get their drink of choice.
* Breathalyser to detect lung cancer
* A “Red Bag” scheme to help care home residents going to hospital. The scheme prevents unnecessary calls, items going missing and delays on discharge, which saves £473,000.
* Apps to check symptoms with GP to prevent unnecessary GP appointments which cost the NHS more than £300 million every year
* Ankle bands to speed up surgery which saves £569 per patient
* Fingerprint-operated medicine cabinets saving around £10,000 per ward
* Cutting out-of-hours strokes deaths with videolink diagnosis which means fewer on-call stroke specialists are needed and could save £150 million a year
* ASSIST Hospital Discharge Scheme saves around 4.5 bed days per patient and is estimated to save up to £1.3 million per year, 5x the cost of running the programme.
* Use UV light to kill superbugs which decontaminates surgical tools and electronic devices in 60 seconds, disrupting the DNA of bacteria, including norovirus and MRSA.
* Video links to 999 calls to help overstretched ambulance services to reduce delays reaching emergency patients.
* ESCAPE-pain programme involves 12 sessions over 6 weeks where patients are taught how to manage pain and to exercise safely. Saves the NHS £5.20 for every £1 spent by improving the wellbeing and quality of life of patients.
* Cutting A&E waiting times through a flexible junior doctors’ rota. The flexibility makes staff happier and more likely to stay in the job, meaning all vacancies are now filled and locums are no longer needed. As a result, waiting times have been significantly cut and patient complaints reduced.
* Secure ‘WhatsApp-style’ messaging service for medical staff to discuss a patient’s care, secure messaging services help them chat without risking data breaches or wasting time on pagers, landlines or fax machines
* Wearable tech to keep an eye on epilepsy patients 80% reduction in the time taken for medical professionals to respond when they suffer a seizure, as well as 30% fewer hospital admissions. The system could help the 500,000 people in the UK who have the condition.
* A software system called Lantum connects locum doctors with surgeries who have gaps in their rotas, avoiding the need for expensive agencies.
* Self-testing kits for HIV
* A Lumify gadget plugs into a phone and uses an app to display the ultrasound image. It means ultrasound scans can now be done at any bedside, in the back of an ambulance or at the site of an emergency incident.
* Episcissors (angled scissors) have been shown to reduce such risks by 43%
* Develop a software which provides a forecast of future inpatient demand days, weeks and months, even years ahead. The reports displayed how many admissions were forecast for each day and what medical/surgical specialty they required. I managed to get a meeting with the head of the NHS at the time who agreed that it should be in every hospital but had no power to make it happen.

## **Drugs**

* Make sure patients are not given Pharmaceutical drug until last resort.
* Do not overmedicate people, and over test people for mental health illness or mental disorders.
* Decimalize the possession of drugs
* Reform Policing to understand that drug possession are no longer criminal activities. Continue to apply all other laws with respect to drug related incidents, such as drug dealing, where there is evidence of 'coercion', operating machinery or acting in a responsible position while under the influence, and others.
* Allowing private organisations to enforce drugs bans.
* Allowing use of drugs such as MDMA and LSD for therapeutic purposes.
* All those who commit criminal offences whilst under the influence of drugs or alcohol should be subject to compulsory assessment and if found to be addicted should immediately be taken into such care.
* Addicts with children will be put on the 'at risk' register and custody of children will be dependent on an addict's ability to detoxify. Addicts failing to successfully complete detoxification will not have their children returned to them, the rights of the children must be paramount and either familial custody or foster parents will be sought until detoxification has been completed. The return of children will be conditional on regular detoxification checks.
* Those who commit criminal offences, and who are found to be using drugs, will be expected to prove that they were not funding their drug use by their criminal activity. Those who fail to do so will be placed on a drug's rehabilitation programme and will be detained until they have been free of drug use for 6 months. Upon release, they will be monitored to ensure that they remain drug free and will be re-detained if they fail to do so.

====Benzodiazepine: ====\*Patients should receive proper informed consent prior to starting the drug.

* New prescriptions should be limited to short term (<2–4 weeks).
* Compliant patients already on long-term benzodiazepines should not be forced to stop the drug abruptly or against their will.
* Slow, patient-controlled tapering for those who wish to stop the drug.
* Better prescriber education about benzodiazepines.
* Recognition of severe and protracted withdrawal by the medical community.

Drug Overdose help

Drug Checking help

## **Who can access healthcare?**

Anyone living in Britain can access the healthcare system as long as they have health insurance coverage. Both residents and non-residents will need at least basic health insurance coverage. This covers around 80-90% of healthcare costs. Those not required to take out basic health insurance are:

* Children aged under 18, who are covered by the insurance policy of their parent/guardian;
* Temporary visitors from the EU/EEA/Switzerland, who can receive healthcare coverage through their European Health Insurance Card (EHIC);
* Temporary visitors from outside the EU/EEA/Switzerland, who will need to purchase private health insurance;

Health insurance covers the costs of medical treatment and hospitalization of the insured. However, the insured person pays part of the cost of treatment. This is done (a) by means of an annual deductible (called the franchise), which ranges from £184 to a maximum of £1,500 for an adult as chosen by the insured person (premiums are adjusted accordingly) and (b) by a charge of 10% of the costs over and above the excess up to a stop-loss amount of £400.

## **Basic health insurance**

There are around 60 registered health insurance companies in the UK, each offering the same benefits in their basic health insurance policies, there's a guaranteed issue (nobody could be denied health insurance because of their medical history), community rating (nobody could be charged higher premiums for their health status), and an individual mandate (everyone must carry insurance or pay a penalty).

If you don’t take out British health insurance within 4 months after registering in the UK, you will get a letter from the Department of Health & Social Care, reminding you to take out health care insurance within 3 months. If you fail to do so, you will have to pay a fine. Then you will get another 3 months to take out a health insurance. If you still haven’t done that after this time, you will have to pay a 2nd penalty and the Department of Health & Social Care will arrange a health insurance for you. The insurance premium will be higher than if you had taken out health insurance yourself. Please note that this premium will be automatically deducted from your income during 12 months.

You are free to choose your own insurer and can change company once a year if you give notice. Some of the health insurance companies include:

* Aviva Health
* Allianz Care
* Allied Healthcare (owned by Saga plc)
* AXA PPP Healthcare
* Bupa
* Cigna
* CS Healthcare
* The Exeter
* Freedom Health Insurance
* The PHC
* Vitality Health
* Western Provident Association (WPA)

The basic health insurance policy covers:

* GP visits (fined if it's used in an unnecessary manner)
* Emergency treatment
* Hospital care
* Medicines prescribed by a doctor and on an official list
* Maternity check-ups, tests, ante-natal classes, childbirth and gynecological check-ups
* Vaccinations
* Rehabilitation after operations or illness
* Medical treatment when on short trips outside of Britain
* Services to quit smoking
* Some therapy treatments

Babies are insured from birth, but to continue cover, you must take out health insurance for your child within 3 months of their birth. Children don’t need to be insured by the same company as their parents. Once a child turns 18, they are officially responsible for their own health insurance payments.

If you are in Britain for less than 3 months, you may be exempt from the requirement for holding basic health insurance if you have a European Health Insurance Card (EHIC), your own private health insurance policy, travel insurance, or a company healthcare plan but check with your council to make sure.

You can change your health insurance company only once a year and only on 1 January. There is one exception: you can change your health insurance company during the year if you switch from one collective employer’s agreement to another (i.e. if you switch jobs).

You have to cancel your health insurance before 31 December. Your new health insurance company may offer to cancel your old insurance on your behalf. If they don’t offer this, it is best to send an registered letter well in advance.  A health insurance company is obliged to accept you for basic insurance, unless there are some payments overdue/outstanding at the current health insurance company. In such a case, the new company can refuse you basic health insurance.

The new health insurance company is allowed to refuse you for additional health insurance if you don’t meet its requirements. Therefore, it is advisable not to cancel your current additional health insurance until you have received an email or letter that the new company accepts you for additional insurance.

The deductible is the amount you have to pay yourself before you receive a reimbursement from your health insurance company. Everyone over 18 years of age is required to pay a deductible on the basic insurance coverage. The deductible is decided by the government and updated annually. The maximum mandatory deductible has been frozen at £385 per year through 2021.

You can voluntarily raise your deductible; then you will receive a discount on the insurance premium. The higher your voluntary deductible, the lower the premium you will be charged. While this may be attractive for relatively healthy individuals, it may become a risk on the long run. For example, if you get ill or get involved in an accident, the insurance company is able to claim the total of the deductible in one payment. The deductible does not apply to all care from the basic health insurance (see above).

When you are traveling in the EU/EEA (including Switzerland) and carry Dutch health insurance, you are entitled to the same health care as the locals. However, administration and reimbursement for public health care will be easier if you have the European Health Insurance Card (EHIC). You can apply for the EHIC with your health insurance company and you will need to show it if you go to see a doctor or get hospital treatment abroad. Please bear in mind the following:

* EHIC is accepted only by doctors or hospitals under the local public health care system or so-called ‘statutory’ health care system. Therefore, private health care is not covered. If you are unsure, check with your insurance company about where you can go
* Healthcare systems vary from one country to another. Therefore, you may have to pay the care bills directly for treatment and get them reimbursed later on
* Usually only emergency care abroad is covered.
* If you are travelling abroad specifically for medical treatment you will be covered under different rules.

If you work in the UK but reside in another country, you can ask your British health insurance company for an E106 form. With the 106 form, you are entitled to the statutorily insured medical care in your country of residence without having to pay a premium.

## **How to register**

These are the main steps you should take in order to get healthcare in the Britain:

* Register with your local council to get a citizen service number
* Choose and register for the health insurance of your choice (basic package or additional coverage) from the provider of your choice
* Register with a local doctor

Following this, you have 90 days from your arrival to join a British health insurance plan.

* valid ID such as a passport
* visa or residence permit proving your right to be in Britain
* proof of address such as a recent utility bill or rental contract

Once you have registered with a British insurer, you will receive a health insurance card that you will need to present upon receiving any treatment. This proves to your provider that you are entitled to British healthcare.

## **Private healthcare**

You can take out optional supplementary health insurance at an extra cost from the same or separate insurer. Benefits vary from policy to policy but may include:

* orthodontic treatment (dentist)
* spectacles/contact lenses
* choice of doctor when you need treatment in hospitals
* stays in a private or semi-private hospital ward

You can choose the amount of coverage you have with private insurance. The greater the level of coverage, the higher the premium.

## **Going to a doctor**

You are free to register with any doctor you like in the UK as soon as you move and receive your residence permit. However, British doctors can refuse patients if they are full, or if their residence is not in close proximity to the practice. It may be difficult to find a suitable doctor when you are in urgent need, as nearby practices may not be taking new patients. Our advice is to register with a GP practice as soon as possible after your move.

Most doctors allow you to register online or in person at the clinic. You will need to have a valid ID, your citizen service number (BSN) and your health insurance details.

Upon registration, you will likely have an initial consultation appointment with the doctor to review your medical history. You should bring along your medical records, along with a list of medications you are using.

The doctor can treat you and refer you on to specialist treatment. Unless your insurance policy specifies otherwise, you may also consult specialists without a referral from your doctor and have this covered by your insurance.

You will need to book your appointment beforehand (online or over the phone) and give 24 hours notice if you need to cancel, otherwise you can be charged. Take your British health insurance card when you visit the doctor.

* The doctor invoices your insurance provider directly, in which case you don’t have to worry about any payment
* He sends the bill to you, to forward on to your insurer
* He charges you the full costs, which you then need to reclaim from the insurer. You will need an invoice or receipt if this is the case.

If you are not satisfied with the medical services you receive in the UK, you should first address your concerns directly with your doctor. Again, they are a direct people and will be able to hear your dissatisfaction. If that does not resolve the issue, you can submit a complaint in writing with the clinic’s complaints officer. The complaints officer can help you with the drafting of the letter and serve as a mediator between you and your doctor.

Clinics can take up to 6 weeks to respond to your formal complaint. If you are still not satisfied with the response, you can refer your complaint to the independent dispute resolution board your clinic is affiliated with. You will not need a lawyer for this procedure but their decision is binding, and they will generally charge you a fee for the service. You always have the right to change doctors in the UK if you are not satisfied with the care you have received.

## **Women’s healthcare**

You can access a gynecologist in British through basic health insurance. The basic insurance package will also cover you for:

* maternity care including check-ups, ultrasounds, ante-natal, and post-natal care
* cervical cancer screenings
* breast examinations
* regular check-ups including urine and blood tests, and blood pressure check

If you are pregnant in Britain, you can see your GP, gynecologist, or midwife. Births take place in hospitals, birthing centers, or at home. You can search for gynecologists on the website.

Contraception is easily available, including emergency contraception. However, basic insurance does not cover some medication such as the pill and the intra-uterine device (IUD). The basic health insurance covers several vaccinations.

## **Children’s healthcare**

Children are insured through the policy of their parents/guardians, including dental care up until the age of 18. You can register your child with the family doctor in the UK. Doctors can offer pediatric care or can refer to specialist pediatricians or children’s hospitals if necessary.

You can choose your own pediatrician, and they should be a member of the Royal College of Paediatrics and Child Health. The RCPCH runs a preventative health program in Britain, which is delivered at local level through schools. This focuses on sexual health, physical activity, and early detection of health conditions.

There are no compulsory vaccinations for children in UK, however, basic health insurance covers several vaccinations, including:

* Whooping cough
* Diphtheria
* Tetanus
* Hepatitis B
* Measles, mumps, and rubella (MMR)

## **Visiting the dentist**

A British dentist may work in either a private dental practice or public dental clinic. The basic health insurance does not cover most dental care, unless you have private insurance coverage.

Adults must pay for their own dental check-ups and treatment. However, the basic British health insurance covers treatment for problems caused by serious, unavoidable illness and children’s check-ups and treatment are free of charge.

Once registered with a dentist, you will usually be invited for check-ups every 6 months. Your dentist may delegate certain routine tasks to dental hygienists, dental assistants, and prevention assistants. If necessary, they may also refer you to specialized orthodontists and oral surgeons, who are usually based in hospitals. To find a dentist out of hours, call the surgery and a voice mail will direct you to an emergency service.

You may have to take out additional insurance to cover the cost of dental treatment (check what your policy offers); under 18’s have coverage under the basic health insurance package.

## **Hospitals**

There are different types of hospital. Unsurprisingly, those attached to universities, which carry out medical research, have the most advanced medical equipment and treatments, and can offer the most specialized care. Teaching hospitals, training medics, and nurses also offer some specialized treatments. General hospitals deal with more routine conditions. Look for a sign with a white ‘H’ on a red background. Unless it’s an emergency, you need to have a doctor’s referral to a British hospital. You will need to show proof of your health insurance coverage.

The hospital will usually be in your local area. There are 3 types of wards: general (2 to 4 patients), semi-private (two patients), or private for 1 patient only. Beds usually have private televisions and phones, although you will be charged to use these. Patients need to bring their own nightwear, toiletries and other personal requirements.

All hospitals have children’s wards and there are also special children’s hospitals, which provide more facilities to keep children entertained while in hospital or to help them with school work during their stay.

Some children’s hospitals and wards are able to accommodate parents overnight. Please note, visiting hours vary between hospitals and are usually strictly enforced.

## **Health centres and clinics**

Many GPs have their own practices, although some work in multi-disciplinary primary care centers or health centers alongside therapists, nurses, midwives, and other health professionals. Alongside hospitals, there are a number of outpatient clinics that provide secondary care.

## **Pharmacies**

Pharmacies clearly marked with a green cross, are good places to get health advice as well as medicines. You will need to pay a small, one-off fee the first time you get prescription medicines from a pharmacy. This is to open a patient file in which the pharmacy will record all your medications. If you go to another pharmacy you will have to do the same there, therefore it makes sense to try to go to the same pharmacy each time. There is always a pharmacy open 24 hours somewhere in the area. To **find the closest out-of-hours pharmacy**, you can also:

* check the list displayed in the pharmacy window
* Call **111** free of charge. The person you speak to will be able to look up an out-of-hours pharmacy or another service in your area.
* look under medical assistance in one of the free local newspapers
* visit this online list of pharmacies (enter your postcode to find the nearest one).

If you have a consultation with a GP, you can sometimes collect your medicine right away from the pharmacy as they are often connected electronically. You won’t have to pay for your prescription. However, if it is non-prescripted, you must pay. Your insurance company may also specify which types or brands your policy covers, and which it doesn’t. If it doesn’t cover your medicine, it might be worth looking for a cheaper generic brand.

## **Mental healthcare**

The first point of call for anyone in Britain experiencing mental health problems is the GP. They will assess and prescribe any necessary medication or further specialist treatment. Care is available through hospitals, medical centres, and clinics. Basic insurance covers some services such as day treatment programs and visits from mental health nurses.

There is plenty of private treatment available, including private counselling and health spa facilities. Psychotherapy is also available through basic insurance packages. You will have to pay around 10% of costs, up to the first £100.

## **In an emergency**

The basic health insurance covers emergency treatment and you can consult with any doctor or hospital directly in an emergency, even if you have restricted choice. They may ask you for your health insurance details, even in an emergency, so keep these with you at all times.

For urgent medical treatment, go to the A&E or ER of the nearest hospital; most public hospitals have 24-hour A&E departments.

For an **ambulance**, call **999**, free of charge from any phone. You will be charged £500 if there is no immediate danger to life, otherwise you will not be charged. Therefore, you might want to take the patient to hospital by car or public transport if they are well enough to travel this way. All ambulances are provided by St John Ambulance.

Other useful numbers, free of charge, from any payphone is:

1. General emergency number: 112
2. Police: 000
3. Crime stoppers: 0800 555 111
4. Fire brigade: 998
5. Coastguard: 997
6. Mountain rescue: 996
7. Gas emergency: 0800 111 999
8. Missing person: 0800 234 6034
9. Electrical emergency: 995
10. Water emergency: 994
11. Poison control: 993
12. Child abuse and family violence: 992
13. Mental health crisis, emergency or breakdown: 116 123
14. Anti-bullying hotline: 0845 22 55 787
15. Homeless advice: 0808 800 4444
16. Road help: 0800 88 77 66
17. Blood needs: 0300 123 23 23
18. Non-emergency police: 101

Fire Hydrant sign

## **Other forms of healthcare**

Complementary and alternative therapies are available, with many treatments covered by British health insurance. According to the World Health Organization (WHO), the most popular treatments in Britain are:

* homeopathy (used by 63% of patients with insurance coverage);
* alternative massage therapies (41%);
* phytotherapy (27%);
* nutrition therapy (22%);
* acupuncture (18%)

Basic health insurance will cover treatments prescribed by your doctor/GP. Otherwise, you can get coverage through many private insurers.