Structure of the NHS

The NHS is the world’s largest publicly funded health service and deals with over one million patients every 36 hours.  It employs more than 1.3 million people and has an annual expenditure of around £105 billion.  The services provided by the NHS can be organised in to the following categories:

These services are provided for by numerous organisations and an overview of the structure of the NHS to explain this further is provided below:

The Secretary of State for Health has overall responsibility for the work of the Department of Health (DH).

The DH is responsible for the strategic leadership and funding of both health and social care in England.  It is a ministerial department supported by external agencies and public bodies.

One of these public, independent, arm’s length bodies is NHS England.  NHS England sets the priorities and direction of the NHS and aims to improve health and care outcomes for people in England.  Its future vision for the NHS is set out in the Five Year Forward View.  NHS England manages around £100 billion of the overall NHS budget.  It allocates some of this budget to clinical commissioning groups (CCGs). 

The NHS is organised locally by CCGs who receive around 60% of the NHS budget.  The CCGs are responsible for the planning and purchasing of primary (in collaboration with NHS England) and secondary healthcare services for their local population.  CCG members include GPs and other clinicians such as nurses and hospital consultants.  CCGs can commission any service provider that meets NHS standards, costs and quality of services taking in to account the assurance provided by the NICE guidelines and Care Quality Commission (CQC) data available for that service provider. 

Vanguards were introduced in 2015 as part of the NHS Five Year Forward View. The 50 chosen vanguards are tasked to develop new care models and potentially redesign the health and care system. It is envisaged that this could lead to better patient care, service access and a more simplified system.

Further information about the NHS in England can be found on the NHS choices website. 

How does the NHS in England work? An alternative guide by The King’s Fund

This complex structure of NHS finance and service can be seen in the flow diagram shown below:

Roles within the NHS

Please click on one of the different multidisciplinary team members to find out more about their roles:

Working for the NHS

Starting work in a new and unfamiliar place can be extremely daunting and starting work in the UK will be no different.  We recognise that there will be significant differences between the way medicine is practised here and the way it may have been practised in your home country.  In order to help assimilate doctors who have moved to the UK, the GMC run a workshop called Welcome to UK Practice.  This workshop provides a great opportunity to meet other doctors, ask questions and learn from real-life experiences of others who have moved to the UK.  The session deals with the role of the GMC, experiences from senior UK doctors in video format, ethical scenarios on issues faced by doctors new to UK practise including consent, confidentiality, raising concerns in 0-18 care and prescribing and creating learning logs and reflections.  The workshop is held in London, Manchester and Newcastle and a place can be booked via the above link or through Health Education England’s course booking system.   

HEE NE also run workshops as part of their regional induction process.  The detail of these workshops and the opportunity to book on to them is available through HEE’s course booking system (use link above).

Familiarising yourself with the hospital setting

360 degree videos of ward, theatre, A+E, resus etc. to be added.  

Appropriate dress

You must at all times maintain an appropriate standard of dress commensurate with your position as a doctor in training. 

You must familiarise yourself and comply with the dress code laid down by each Host Training Trust you attend.  This includes maintaining appropriate standards of appearance, dress and personal hygiene. 

1. All clothes must be clean and presentable and consistent with presenting a professional image.  Jeans are not permitted to be worn in the clinical environment.
2. Hair and beards should be neat and clean; long hair should be tied up and off the shoulder securely.
3. Staff must not wear jewellery except for a plain wedding ring and/or ear studs.
4. No wrist watches should be worn in the clinical environment under any circumstances.
5. Staff must not wear false nails and/or nail varnish as it discourages efficient hand washing and can be sources of contamination.
6. Staff must keep finger nails clean and short.
7. Visible tattoos where present should not be offensive or provocative to others.
8. Staff should not socialise outside the workplace or undertake social activities while wearing an item of clothing that will identify them as NHS employees.  This includes the wearing of stethoscopes outside of the clinical environment.
9. All clinical staff must wear short sleeves or elbow-length in the workplace to enable effective hand washing techniques – ‘bare below the elbows’. 
10. Garments that may interfere with clinical communication and its assessment should be removed at appropriate times. 
11. Footwear should be comfortable and practical for the role undertaken.  Enclosed shoes (toes covered) must be worn by all clinical staff as these offer protection against spillages and injuries.  Trainers are not permitted.

Dialect 

Geordie is the the term used to describe a person from Newcastle, as well as the dialect and is still commonly used in and around the North East.  A few Geordie words that you may come across whilst living and working in the region include:

Other words you may hear include:

1. Mackem – the term used to describe an inhabitant of Sunderland
2. Smoggie – the name given to people from the Middlesbrough and Teeside area
3. Inhabitants of Durham may be referred to as posh Geordies!

Food and drink

As a result of the diverse and multicultural nature of the UK, food and drink is extremely varied with nearly every type of cuisine catered for.  This variety can be found alongside traditional UK food and drink.

The evening meal in the UK is typically the main meal of the day and may be referred to as dinner, tea or supper! Other meals eaten during the day include breakfast, which is eaten in the morning and normally consists of cereal and/or toast with a jam or spread; and lunch, which is eaten around midday and typically consists of a sandwich.  Other terms that may be used in relation to meal times includes brunch, which is a meal eaten between breakfast and lunch; and supper, which may be eaten just before bed and be similar to the foods eaten at breakfast.  However, even within the same region there is inconsistency in the word used to describe a particular meal.  Therefore, if in doubt, ask!

When it comes to sitting down and having a meal with others, there are some informal rules to be aware of:

1. Guests usually wait until everyone at their table has been served before they begin eating.
2. Food is eaten with a knife and fork (with the fork in the left hand and the knife in the right hand) or spoon.
3. It is considered polite to keep your mouth closed whilst eating.
4. Conversation is welcome at the dinner table, although it is considered polite not to talk with your mouthful or eat too loudly.
5. It is important to inform the host or waiter/waitress at a restaurant of any dietary requirements and/or food allergies so that they may accommodate your request.

The North East and north Cumbria is lucky enough to be served by an abundance of local produce, as well as being host to many wonderful pubs, bars and restaurants.  For more information of what is available in the region, please visit the Find Your Place website. 

Queuing

The British have a passion for queuing (or standing in line) and will queue everywhere and for everything!  It is common place to queue when waiting for something, when waiting to be seen by someone, when paying for something and even when waiting to be seated in a restaurant.  If someone decides not to wait in line or pushes in front of someone to get ahead in an already established queue, they are described as having ‘jumped the queue’.  In the UK, ‘jumping the queue’ is considered impolite or even, rude.  It is expected that a person joins the back of a line or queue and waits their turn to be seen or to be seated.   

Tipping

Tipping is not an expectation in the UK, however, if you do, it is typically received with great appreciation.  In restaurants, there is often an opportunity to tip 10% of the total bill for good service.  This may sometimes appear on the end of the bill under ‘service charge’ or ‘optional charge’.  If you do not wish to pay this, simply ask for the charge to be removed.  No other food establishments (e.g. pubs, bars, cafes etc.) expect you to tip.

Small talk

In the UK, small talk is used to describe the short, polite and informal conversations that occur between people meeting or when working together.  It especially occurs between persons who do not know each other very well.  The topic of small talk is usually of little importance and includes questions like ‘how are you?’, ‘did you have a nice evening/weekend/holiday?’ and comments about the weather.  Although engaging in small talk can be daunting at first, the more you do so, the easier it will become.  

Greeting

In the UK, it is customary to greet new people with a handshake.  It is not typical for people to greet each other with a kiss or a hug, unless they are close friends and/or family.  During the handshake, many people will offer a formal greeting such as ‘nice to meet you’.  ‘Hello or hi, how are you?’ is a polite greeting that can be used to initiate further conversation.

‘Please’ and ‘thank you’

In the UK, it is considered polite to use the expressions ‘please’ and ‘thank you’, and it may appear rude if these expressions are not used.  It is much better to overuse them than it is to underuse them!  Typically, if you ask someone to do something for you, you should say ‘please’. If someone does something for you, you should say ‘thank you’.  If you are offered something and you do not want it, you should say ‘no, thank you’.  You should also expect ‘please’ and ‘thank you’ if you are asked to do something for someone, or if you do something for someone.  Sometimes, instead of saying thank you, you may hear someone saying ‘cheers’ or ‘ta’. 

Religion

Although the UK’s official religion is Christianity, the UK is a multi-faith society and welcomes all religions.  Here in the North East, there are many well-established communities representing all major religions.  There are also plenty of places in which to practise your faith, including churches, mosques, temples and synagogues.  Prayer rooms are available in most hospitals.  The UK is committed to religious freedom and supports a person’s expression of faith, including dress and symbols, which are welcomed as a sign of diversity within the society.

If your religion has any specific practice requirements, it would be worthwhile discussing these with your employer in advance of starting work. 

Public and ‘other’ holidays

There are 8 public holidays in England and Wales.  These include:

There are also an additional 2 bank holidays in Scotland (St. Andrew’s day on 30^th November and a further bank holiday on 2^nd January; Easter Monday is not a bank holiday) as well as in Northern Ireland (St. Patrick’s Day on 17^th March and Orangemen’s Day on 12^th July). 

When bank holidays fall on a weekend, it is customary for the following Monday to be a ‘substitute’ holiday.

Other special occasions that are celebrated in the UK (but are not public bank holidays) include:

1. Halloween – celebrated on the 31^st October by dressing up in ‘scary’ costumes and going ‘trick-or-treating’.  Some people also hold Halloween parties or gather together to watch horror films, either at home or at the cinema.
2. Bonfire Night – also known as Guy Fawkes night and celebrated on the 5^th November.  Typically, those participating in the event do so by making bonfires, setting off fireworks and burning effigies of Guy Fawkes.  Many local areas run bonfire night parties for the wider community and have stalls selling food and drink in addition to a bonfire and firework display.  There is usually a small monetary charge attached to attending such an event.
3. Remembrance Day – this marks the eleventh hour on the eleventh day of the eleventh month in 1918 signifying the end of the Great War (World War 1/WW1).  In commemoration of that moment, a two-minute silence is held at 11am on the 11^th November across the UK.  Felt or paper poppies, which are a symbol of Remembrance Day, are often pinned to people’s coats in the lead up to the day.    

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