Midwives who care for women throughout pregnancy, birth and for 28 days after the baby is born. Some are based in hospital and some go out into the community.

Health visitors who promote health for families and are responsible for preventative action. They aim to identify the health needs of the local population and work closely with other NHS colleagues.

District nurses who care for people in their homes or elsewhere outside the hospital setting. Like health visitors, they offer advice in health promotion and education.

How primary care is developing

The 1997 NHS Primary Care Act introduced greater flexibility in the delivery of primary health care services for patients. The new law allows GPs, dentists, NHS trusts and NHS staff to develop, with health authorities and health boards, new ways of delivering their primary care services.

From October 1998 pilot schemes began in areas with high levels of illness and where it is often difficult to recruit GPs. There are two types of scheme:

• one which will enable NHS trusts or GP practices to employ GPs on a salary (instead of a self-employed basis), with the aim of giving patients who live in areas of high health risk access to a flexible family doctor service;

• one to create primary health care 'one-stop shops' where GPs, community nurses and other professionals work as a single team in the community offering a range of services from eye tests to counselling.

The new Primary Care Groups - local partnerships between family doctors and community nurses - will be expected to play an increasing role in taking decisions about services for patients.

Secondary care

While Primary Care Groups may be the first point of call, secondary care, managed by NHS Trusts, deal with any further treatment or care someone may need. This can range from health advice to some of the most sophisticated treatment in the world.

There are around 300 district general hospitals in England, found in many large towns and cities. They provide a range of services from the care of the elderly to maternity services, supported by services such as anaesthetics, pathology and radiology. Almost all district hospitals have accident and emergency departments for emergency admissions.

Patients either attend as day cases, in-patients for a longer stay or out-patients. There are also patients who attend wards for treatments such as dialysis. The advent of new treatments has meant the trend has been towards more patients treated as day care and fewer long-stay wards.

Tertiary care

Some hospitals provide specialist services such as heart and liver transplants, treatments for rare cancers and craniofacial services. These specialist services cover patients over more than one district or region.

There are also specialist hospitals of international renown such as the Hospital for Sick Children at Great Ormond Street, Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery. As well as offering highly specialised treatments, these hospitals are also centres for teaching and international research.

Date: 2016-01-03; view: 662