An NHS glossary for Americans (consumers amp; entrepreneurs)
I’ve been living in England for over a year now and the entirety of 2017 working in HealthTech. I’ve collected a list of words, terms, abbreviations, and other bits about the NHS. I created this list for my reference. As I talked with more people, mainly from the US, I realized others could use this cultural and business glossary.
For Consumers of NHS Services
GP: The lynchpin of the NHS is the General Practitioner (GP) who is the equivalent of a Primary Care Physician in the US. However, in the UK, these doctors take a lot more responsibility and are the gatekeeper to most services you’ll use.
GP Practice: That’s the clinic where you’ll get to see your GP. You must register with them beforehand to receive services.
GP Registration: Every resident of the UK should register with a GP Practice to receive service. You can only register with one GP Practice, and you usually pick one that’s close to your home or work. GP Practices have well-defined rules of who can register with them, and most of the time it’s based on the distance from where you live/work to their clinic.
A&E: (Accident & Emergency) Same thing as an ER (Emergency Room) in the US.
Surgery: (Gotcha Alert) In the UK, surgery is a clinic (the place) not a surgical operation.
Optometrist: No one says “eye doctor” in the UK.
Bloods: Your blood test.
Results: Your lab results.
NHS Doctor: When you see an “NHS Doctor” in a sign or advertising it means is a free consultation. A doctor can be an NHS doctor and a private doctor at the same time, and even serve a customer from the same clinic, but one consultation could be an NHS consultation (read, “free”) and the other a private one (read, “paid”).
Doctor Visit: This is quite ambiguous, but usually when they say a “Doctor Visit” it means a doctor’s home visit.
999: The same as 911 in the US. Call it for an ambulance, police, or firefighter.
111: There isn’t a national service in the US like this. 111 is used to provide people with a non-emergency line. People can call to ask about symptoms and what to do about them, about prescription refills if the GP Practice is closed, and with a general directory service to find whatever clinic, hospital, pharmacies, or other health-related services. You might have a similar service in the US provided by your Employer or Health Insurance company, like a nurse hotline.
NHS Choices: That’s the NHS website (www.nhs.uk). It’s a combination of WebMD and Yellow Pages for health services.
Flu Jab: The flu shot.
COPD: Not to get medical here but you often hear someone saying “Patients with COPD” which loosely translates to “Patients with Asthma.” COPD is broader than Asthma, though.
Dementia: Most of the time, it means Alzheimer’s disease.
Secondary Care: What you do with a GP is Primary Care. Secondary Care in the US would be what you call a “specialist” (physiotherapist dermatologist, oncologist, etc.)
Free vs. Paid: All consultations with an NHS GP are free. Prescription medication is free for children, the elderly, and a few other cases, otherwise, you pay a small amount (~£8.50). Secondary Care by GP Referral is also free. Dentists, Optometrists, Psychologists, and many other services are usually not free (lots of exceptions and rules at play here).
For HealthTech Entrepreneurs
This part is more oriented toward Entrepreneurs, particularly Americans since I’m contrasting it with how it works in the US. However, I’m always surprised how little most people even in the UK know about this.
The NHS: There is a whole post to write about what is the NHS. I could write a 100-page essay on the topic. As an entrepreneur, the best way I found to think about the NHS is that it’s not an organization in itself, but a collective of many groups. It helps define, but also must abide by the government policies. A common misconception from people coming from the US is to think of the NHS as universal health insurance — it’s not. It’s universal health (no insurance).
NHS England: Well, there is no “The NHS,” there are four NHS. NHS England is the biggest one of them all, and, as you can guess, it manages health services in England. Most of the time someone says “NHS” they mean “NHS England” (NHSE).
CCG: Clinical Commission Groups (CCGs) are organizations that manage the budget for a region of England. IMO, these are the most relevant part of the NHS. The majority of the NHS budget is distributed to the CCGs, which in turn decide what’s best for their population and how to allocate that budget. There are 207 CCGs in England. CCGs have the power to open a new hospital (or close one), decide clinical protocols doctors and nurses must follow, and even which medications are subsidized. There can be significantly different rules, and policies between different CCGs, which makes sense since a CCG in an area where the average age of the population is 29 and near the coast will have very different needs and goals than a CCG where the population is much older and in a rural setting.
CSU: Commissioning Support Units are the IT department (among other things) for the CCGs, Hospitals, and GP Practices. They have the power to decide what can and cannot run inside of a hospital or Practice. They oversee procurement, deployment, implementation, training, and other tasks for the operations of the NHS-associated organizations.
CQC: Care Quality Commissions are the auditors of the NHS. A hospital, HealthTech startup, or GP getting a call from the CQC is like the IRS telling you they’d like to review some of your finances. Their job is to make sure businesses are operating within the law and delivering the right level of clinical safety to their patients. A bad score from the CQC is not the end of your business, but it’s a very public spotlight that tarnishes the business’s reputation and requires immediate changes to improve quality. In extreme cases, the CQC can shut down an organization. On the other hand, getting an “Outstanding” rating from the CQC is like a seal of approval by Consumer Reports.
GP Practice: This is probably the biggest misconception about the NHS, both by patients and by startups. GP Practices are private for-profit businesses! Stop the presses. GP Practices are small businesses, usually owned by a group of 3 to 7 doctors in a partnership format. They employ nurses, receptionists, and even salaried part-time or full-time doctors. The CCGs have a system of paying these Practices based on the number of patients (“the list”) they are overseeing at any given year. Yes, doctors don’t get paid by the number of consultations they hold, but by the number of patients they manage.
GP Registration (The List): When an individual registers with a GP Practice, besides the clinical aspect of it, there is a financial impact. GPs get paid by the number of patients registered with them. There is a not so simple formula that calculates how much a GP will get paid on an annual basis depending on someone’s age, gender, and conditions. If a person goes to the GP once a year or ten times a year, it makes no difference to how much that GP got paid. If you understand actuarial risk or the US health insurance system, you’ll see that the risks have been pushed down to the lowest layer of the whole NHS system. There are enormous implications in the alignment of incentives (clinical and financial) — See QOF points.
Locum GP: A doctor can be a partner at a GP Practice, in which case they share the profits at the end of the year, they can be a full-time or part-time employee of a GP Practice and be on a fixed salary, or they can be a Locum Doctor. Think of Locum Doctors as on-demand doctors that can come in for a few hours, days, or weeks to help manage demand from patients. It could be because a GP was sick or had to go on a last-minute trip, or because of unexpected high demands from the population (e.g., a bad flu season).
STP: Sustainability and transformation partnerships (STPs) are groups of CCGs that joined forces to share processes, tools, vendors, procurement, etc. There are 44 STPs in England. Usually, you don’t sell a product to a single CCG; you sell to a group of CCGs that belong to the same STP group. STPs are more of a roundtable council than an organization.
Pharmacies: A pharmacy is a pharmacy right? You wish! Nothing in England is that simple (neither is it in the US). A GP Practice can have its own pharmacy, and 20% of them do. This bit is so complicated and full of regulation primarily to prevent misaligned incentives (if the doctor also owns the pharmacy she would be incentivized to get more people on medication that she sells in her pharmacy). I’m not qualified to talk even superficially about this.
Hospitals: There are NHS Hospitals and Private Hospitals in the UK. NHS Hospitals are independent non-profit organizations managed by NHS Trusts. I have little expertise on this topic to give more details.
NICE: The National Institute for Health and Care Excellence defines processes and protocols for operations of healthcare organizations and treatments (Care Pathways) of medical conditions. In my opinion, NICE doesn’t get enough credit in the eyes of the population. NICE is to UK Healthcare what FAA is to US Aviation and more. NICE is a global reference for medical protocols. If you ask any doctor in any country around the world if they heard what the UK NICE is, they would say “of course”.
111: A significant portion of the healthcare questions by patients has shifted to the 111 system. It started about four years ago and this year (2018) is likely to provide 20M+ calls in England. This service is commissioned by CCGs (STPs, actually) and it’s the collaboration of many players in the UK healthcare industry: call-center providers, the clinical providers, the clinical queuing system, etc.
GP Providers: These are the companies that provide back-office solutions for GP Practices, so they can manage all the patient records, appointment booking, prescriptions, and everything that a GP Practice needs to operate as a GP business. There are only four providers of such services in England. Due to the incredibly complex regulation and accreditation process, new competitors are shunned from playing this game.
QOF Points: The Quality and Outcomes Framework is an incentive program to make sure GPs are proactive in the care of their patients. A GP Practice might make an additional £100,000 a year from the NHS if it gets all the QOF points it can. As an example, GP Practices can earn a certain amount of QOF points depending on the percentage of their patients who have come for a blood test, flu shot, or blood pressure measurement.
N3: The N3 is a network used by all clinical services inside of the NHS. In layman’s terms, it’s an NHS Internet. It’s quite hard to integrate with the NHS system because of the N3. Software must run on datacenters within this network. The rules for gateway/proxy into the N3 are complex and not only require the technical complexity to be solved but it’s also driven by regulation. If you try to connect to the N3 today, it might be 6–9 months before you are accredited to do so. For startups, this is though. The minute you decide to “pivot” you’ll have to apply again.
Did I miss anything I should add to this list?
Follow me on Twitter: @calbucci
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