The National Health Service (NHS) of Great Britain has been found over 50 years ago. At its foundation, the principle of equal treatment was a defining element. Every citizen of Great Britain was supposed to have equal access to all necessary medical services –regardless of their financial status. Therefore, basic medical services are guaranteed to all residents of the UK. Medical treatment by a doctor is for free, and there is no such thing as practice fees or co-payments/out-of-pocket-expenses?. Usually, people have to pay parts of the medicine costs themselves, although there is an easy way to get exemptions of the payments (eg. Children and old-age pensioners). This way, not even half of all invalid people have to take a share of the costs. Additionally, extra payments will be charged for dental treatment as well as glasses.

On the other hand, citizens of Great Britain are free to choose private insurance. In 2003, already 15% of the British possessed complementary insurances, tendencies rising. It is also possible, to take a full private insurance. Although these insurants do not use the services of the NHS, they do not receive tax reduction in return.

General Practicioner System
The first examination ist normally conducted by a general pracitioner, called GP. The area code of the resident decides, which GP they have to attend. In cities, there is usually more GPs for each district. The options to choose are relatively poor though. Very different from Germany, the GP is also in charge of cancer check ups for women and the treatment of children with chickenpox. If necessary, the GP refers the patient to a specialist or a hospital. GPs often work in joint practices or Medical Centres. Mostly, there is also other services provided, like foot care, physiotherapy, or dental services.
The GPs are paid by a per-capita-lump sum Which is based on the lists of patients. Additionally, each service exceeding the primary healthcare package, but conducted by a GP (not by a specialist), can be charged as additional service, the so called “fee-for-service”.

Financing
More than 70% of the financing is paid by tax receipts. Approximately 20% of these receipts come from Social Security Contributions, and about 5% from different sorts of fees. This way, the British Health System is by and large a tax-funded and state-run system. Unfortunately, it is getting more and more evident, that this way of financing is not working sufficiently. There has been a financial deficit of 750 million Euros in the year 2005/2006. Now, reforms, cancelations and the involvement of private companies are supposed to help, to financially come to grips with the health system again. By the way, most of the British are content with their health system. According to a survey in November 2005 from the CWF (Commonwealth Fund), lead by the german institute for quality and efficiency in the health system, only 13% of the people thought, that the System needed dramatic changes.

Organisation of the NHS
The following Institutions and facilities exist within the NHS: (vielleicht eher überblick oder Auswahl der wichtigsten Institution und facilities?)

The function of the Department of Health is to control the administration units listed below, especially concerning the spending as well as the delivery or non-delivery of services. It is also responsible for the administration of resources and finances. The Department of Health does not run the NHS alone but works tightly together with the Strategic Health Authorities. They again work together with the Primary and Secondary Care Trusts and monitor the configuration of the health services.

The Modernisation Agency is responsable for Innovationes and Modernisations. This unit of the NHS has been established only recently.

The NICE is responsible for the development of Standards in order to guarantee the best clinic procedure possible. They keep an eye on the benefit-cost analysis.

The Special Health Authorities a special position within the Hierarchy of the health care units. They are set below the Department of Health, but above the Trusts.

The Primary Care Trusts (PCTs) are responsable for the planing of the health care services. This care focuses on the treatment of routine injuries and illnesses as well as preventive care (ergänzt im englischen) Additionally, they regulate the transfer by the GPs and take care of the improvement of the Health level of the British people. The unit is separated in single sections. The way the PCTs exist today, was created in the year 2000. Concerning the funcioning of the NHS, the PCTs are very important and therefore use 75% of the NHS-Budget. Additionally, their work is directly monitored by the Strategic Health Authorities.

Secondary Care Trusts offer „secondary care“, such as

Care Trusts: they offer a combination of health and social care. People depending on their social services often suffer from the barriers, that stringently arise as a result from the parallel structure of the health and social care system. Normally, the social provision is regulated by „local councils“ and the Health services of the NHS.

NHS/Hospital Trusts: these trusts usually represent Hospitals, which are self- organisazed.

Foundation Trusts: These are hospitals, but with a different way of administration. They are paid eg. According to their performance, as to wich they get more money if they treat more patients. They receive greater freedom, financially as well as concerning operations. Foundation Trusts don’t exist for a long time. The first ones had been found in the middle of 2004. NHS Trusts can be transformed into Foundation Trust, if they show a certain performance level. (Patients, who have to go to a hospital can choose between four different hospitals, one of which may be conducted privately. So called "Independent Sector Treatment Center“, operation centers run by private companies, do carry out smaller operations for the NHS patients against payments.

NHS direct is a telefonservice. Nurses give advice and instructions for selftreatment or, if necessary, they guide the calling person to the adequate service. NHS direct is supposed to relieve the GPs. GPs, however, repeatedly say, that this is not functioning well. The NHS website direct (http://www.nhsdirect.nhs.uk) attends more than 200.000 visitors each month.

In Walk-in Centres, nurses are taking care treating simple illnesses and injuries

The Family health service is in charge to take care of the basic medical service, conducted by the GPs, dentists, Ophtalmologists and pharamcies. It is split in different provision sections. Primary care stands for the service within a district, secondary care refers to the treatment through specialists. Sometimes, people even speak about tertiary care, which means treatment by special high-class medicine. Thus, patients in Great Britain do only get direct access to primary care.

Actual attempts for reform – the NHS Plan
The health system is underfinanced and the enduring waiting periods for patients attending specialists or for in-patient-areas can not be taken any longer. Because of this, an enormous Reformprogramm called „The NHS Plan – A Plan for Investment. A Plan for Reform“ is running since Juli 2000, which is aimed at fulfilling many changes within the NHS until the year 2010. Some of the core points of the reform programms are:

Investments in NHS-Facilities (e.g. increased supply of beds in hospitals, improvement of boarding and hygiene) as well as in staff of the NHS (eg. hiring more senior consultants and GPs, more money for training, additional jobs for nurses)

All in all can be stated, by implementing the NHS plan, the Labour-government has been trying to increase quality as well as efficiency by staying closer to the structures of the market.

„Practice Nurse“ – it is not only the doctor who makes prescriptions
In Great Britain, in case she has the adequate special qualification, a nurse may prescribe medicine according to given guidelines. A “Practice Nurse” works in a GP-practice and knows how to treat chronic deseases and to deal with the reception of new patients. This massive enlargement of competence was mainly due to a massive lack of doctors. Surveys had made clear, that normal and routine check ups in accordance to the guidelines could be done just as well by the nurses as by doctors. The treatment for patients, who had a coronal by-pass operation, for example, are mainly done by “practice nurses” now. Of course, it is also an attempt, to lower the costs of the health care system. Therefore, nurses are supposed to take over ambulant care more and more. A realised project in Glasgow had shown, that by directed treatment of patients suffering from cardiac insufficiency, the numbers of patients who actually were sent to hospital was reduced by half. Since this special group of patients has long phases of confinement to bed, another enormous potential of reducing costs comes into play here. These examples show, that nurses are used very specifically within the Health system of Great Britain.