Health Services 2.docx

8/21/2019 Health Services 2.docx

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HEALTH SERVICES

1. Introduction

The main objective of this paper is to explain and evaluate how people make use of

health services within the Unite Kingdom. The aim will be to explore certain factors which

may bear an impact on accessing health services, the way people make use of health

services and an examination of factors which could contribute to the incorrect use of these

services.

In terms of general access to health services, research suggests that a variety of

factors can influence accessibility. !eople in poor countries tend to have less access to

health services than those in better"off countries, and within countries, the poor have less

access to health services. #lthough a lack of financial resources or information can create

barriers to accessing services, the causal relationship between access to health services

and poverty also runs in the other direction. $hen health care is needed but is delayed or

not obtained, people%s health worsens, which in turn leads to lost income and higher health

care costs, both of which contribute to poverty& ' #nnals of the (ew )ork #cademy of

*ciences +olume -, Issue )

2. Access to Health Services

/I0U12 . 3onceptual framework for assessing access to health ser vices.

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http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/doi/10.1196/nyas.2008.1136.issue-1/issuetochttp://onlinelibrary.wiley.com/doi/10.1196/nyas.2008.1136.issue-1/issuetochttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632


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/igure illustrates, the 4 main elements that influence our access to healthcare within

the context of the UK 'working from the centre of the framework5. These elements are

categori6ed as geographical, availability, financial and acceptability. 7elow, these elements

are explained with the aid of hypothetical examples centred around a character based on a

farm and how each element would impact him.

8. 0eographical

8.. 9ow long does it take us to get to a service delivery point:

• 2xample;


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8.- /inancial

8.-. $hat is the relationship between the cost of the service and the willingness

and ability of the users to pay for it:

• 2xample;


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be free at the point of delivery, that it be based on clinical need, not ability to pay. These

three principles have guided the development of the (9* over more than = years and

remain at its core.&

'http;GGwww.nhs.ukG(9*2nglandGthenhsGaboutG!agesGnhscoreprinciples.aspx5

2ven though the core principles might be true to all UK H 2U 3iti6ens living within the

UK, the Buality and access may vary hugely. !eople who live in major cities 'ondon,

Janchester, iverpool, and 7irmingham to name but a few5 have more access to services

than people living in rural areas '3herwell, $ealden, (ewark and *herwood and 2ast Devon

to name but a few5. The proximity of the services differs greatly as well as the types of

services available.

$here one resides in the UK is not the only concern regarding access to health care

one%s occupation will also influence one%s access to health care 'the hours one works, the

type of employment, whether or not one is able to take time off from work5, including

language and one%s belief system. #ll these things play a significant role in access to health

care.

/igure A Illustrates The (9* 9ealth and 3are system as of #pril 8=- '*tructure of the

(9* www.nhs.uk5

4

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx


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The people are at the heart of the present (9* 9ealth and 3are system in the UK,

as illustrated in /igure , with a wider range of health care providers that will provide patients

with more choice and value.

The (9* provides all their health care services through organisations known as

Ltrusts%. The following E are the main types of (9* trusts;

• (9* !rimary 3are

• (9* 9ospital Trusts, often referred to acute trusts

• (9* #mbulance *ervices Trust

• (9* Jental 9ealth Trusts

• (9* 3are Trusts

The (9* suggest that one should consider whether one could treat oneself at home,

whether the local pharmacy could assist, if one should see one%s 0!, use a walk"in centre,

call (9* , use a minor injuries unit or dial @@@ in an emergency.

/igure 8 Illustration of primary care and secondary care within the (9*

'http;GGwww.yas.nhs.ukG#boutUsG..imagesGnhsMhowMweMfit.gif5

The difference between primary care and secondary care is where and with whomone receives the service as indicated above in /igure 8. !rimary care is ones local health

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care, the services that most often brings one in contact with the (9* 0!%s, (9* walk"in

centres, dentists, pharmacists and optometrists. These services are provided and managed

by 3linical 3ommissioning 0roups '330%s5 previously known as primary care. $hereas

secondary 'acute5 care is the care one would receive in a hospital. This may be either

unplanned emergency care 'including surgery5 or planned specialist care 'including surgery5.

!lanned care would usually mean that a professional in a primary care setting has referred

you to a specialist, who is a secondary care provider.

-. !rimary health care

In order for one to understand the access to primary health care, one should

understand the professionals and services covered in !rimary health care.

-.. Traditionally the professionals that make up an !rimary 9ealth 3are Team

'!93T5 are;

• Doctors

o 0eneral !ractitioners '0!5 partners

o 0! assistants

o 0! registrars

o ?ther salaried doctors

• # practise manager

• (urses

o !ractise nurses

o (urse practitioners

o 3ommunity nurses

• *upport staff

o 1eceptionist

o *ecretaries

o 3lerical *taff

• Jidwives

• 9ealth +isitors

-..8 The premises of the ones primary care could also be used for secondary

care services

• 9ospital consultants

• Diagnostic imaging

•

?perating services

-..- #llied 9ealth services may also work closely with !93T

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• !hysiotherapy

• Dietetics

• !odiatry

•

!harmacy• 3ounselling

• *ocial *ervices

• 3omplimentary Therapists

o #cupuncture

o 9omeopathy

-.8 #ccess to 9ealth *ervices

-.8. (9* 0eneral !ractitioner

2very UK resident is entitled to (9* 0! services. ?nce one has decided which

practice to register with 'within your catchment area5, one can access the service. (ew

patients might be refused, if one is outside the catchment area or if the 0! surgery patient

list have reached full capacity, the (9* 3hoices website advises.

Jany practises use different methods to reserve appointments. The favoured

method for an appointment in most practises is to contact the practise telephonically, othersinclude internet appointments and many now also have patient '2JI*5 access. ?ne has to

formally register with the practise by completing the reBuired forms and most practices

reBuire a health assessment upon registering.

In bigger practises, some make use of telephone triage to assess patient needs and

which professional the patient could see. ?nce the appointment is made, the patient have

access to the professional.

Unfortunately due to oversubscribed practises, patients are often told that no

appointments are available and are not advised of alternative service like the nearest walk"in

clinic or to contact the (9* . Due to this, patients often go to #H2, regardless whether it

is an emergency or life threatening, which seBuentially then puts a strain on #H2

accompanied by long waiting periods. #part from this people often make appointments they

don%t keep and essentially hinder others from the service.

-.8.8 (9*

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The (9* is a service that replaced (9* Direct to assists the UK public with

health services when they need a health service fast but not in a life threatening situation.

This service is also accessible to hearing impaired users as well as non"2nglish speakers

that can reBuest a translator.

The (9* is available 84 hours a day, > days a week and is a free call from both

mobile phones and landlines. $hen one calls, the adviser will ask a series of Buestions

and input that data 'answers given by the caller5. # clinical assessment will assist the

adviser with the urgency of the call and advise which service one would need thereafter.

#ccording to (9* *tatistics A *eptember 8=4, There were @@E,EEE calls

offered on the (9* service in *eptember 8=4 eBuivalent to -= thousand per day or

million per year. This was the lowest rate per day since


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The waiting times at a $I3 could be long depending on the amount of people at the

$I3 as it is based on a first come first serve basis. Jost $I3 are also not eBuipped to deal

with certain injuries such as fractures 'even though the (9* specifically informs the public

that this is one of the $I3 services5 as they might not have access to a x"ray.

-.8.4 (9* Dentists

0ood Buality (9* dental services are available for everyone and even though the

(9* website suggests that one should not have to register with and (9* dentist, most (9*

dentists are oversubscribed and have a full patient list which results into lengthy waiting

times to access a dentist or the need to contact another surgery.

The (9* will provide any treatments that you reBuire to keep your teeth and gums

healthy and free of pain, which includes;

• Dentures

• 1oot 3anal

• /illings 'including white fillings5

• !reventative treatments

• 3rowns and bridges

The (9* will not however provide any treatment you would not need, but would like

to have to enhance your appearance like teeth whitening.

(9* Dentistry is not free of charge for every UK resident but rather to specific

groups. The following groups are entitled to free dental care;

• Under F%s

• Under @%s that%s in full time education

•

!regnant woman or if you had a bay in the last 8 months• If your are staying in a hospital and your treatment is being done by the

hospital dentist

?ther groups include people who;

• #re on income support

•


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• If you are named on a valid 938 certificate

There are - bands within the (9* Dental 3harges, ranging from NF.E= to N8@.==

pending on the course of treatment. Due to these fee allot of people do not attend their

appointments due to insufficient funds which in turn is not just time wasted but also the

another patients time that could have been seen but were not able to get an appointment.

-.8.E (9* !harmacists

!harmacists work all over the country in the community in different premises,

making their service extremely accessible to the UK population. 3ommunity pharmacists not

only prepare and dispense prescription and non"prescribed medicines, but are also able to

give advice on common problems such as colds, aches, pains, healthy eating and stopping

smoking.

)ou don%t reBuire an appointment or the need to register with a pharmacist and can

speak to them in confidence about your most personal symptoms. There are many

pharmacies that are able to provide one with a private consultation without being overheard

by others.

There is a cost on every prescription but there are various ways that you can gethelp with the costs of prescriptions through the (9*.

Unfortunately pharmacies are not able to assist you with all your medical

reBuirements and access is limited to their opening times or the stores opening times.

-.8. (9* ?pticians

(9* eye healthcare professionals are available to everyone and there is no need to

register with a specific one, but an appointment should be made prior to the visit.

It is advised that we visit a ophthalmic every 8 years for an eye test. #n (9* sight

test is free of charge if clinically necessary, unfortunately it is up to your ophthalmic

practitioner to weather the sight test is necessary or not.

#ll children under the age of receive free of charge eye sight tests as well as

some other groups including ow Income *upport and !regnant woman or woman who had

a baby within the last 8 months.

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-.- #ccess to (9* secondary care

-.-. (9* 2mergency and Urgent 3are

?ne should only call @@@ and visit an #H2 for life"threatening emergencies such as;

• oss of consciousness

• /its that are on going

• #cute confused state

• 7reathing difficulties

• 7leeding that can%t be stopped

• #ny life"threatening emergencies

Jajor #H2 departments offer a 84 hours service, -E days a year, however, all

hospitals do not have an #H2. #nyone can access, all one needs to do is find the nearest

#H2 and go there. ?n arrival the staff will assess the severity of the emergency and decide

on further action.

# recent newspaper article in the Jirror reported the following; #n investigation has

revealed >4 trusts are struggling to fill vacancies as staff are sacked or Buit under the strain

of day"to"day life on emergency units& There is a huge amount of stain on #H2 departments

and not enough #H2 doctors to facilitate the demand of patients coming through #H2 doors.

!eople abuse #H2 departments with non"life"threatening cases in many scenarios

due to the lack of knowledge of the amount of pressure, lack of staff, number of people and

that only it should only be used in life"threatening emergencies within #H2 departments.

-.-.8 (9* *ocial 3are

(9* *ocial 3are system provides a service to those who need help and assistance

in everyday life by allowing them their dignity and independence. *ocial care covers adult

services, children services and wheelchair services of which adult services include the

following;

• help in your home with things like cleaning and shopping

• disability eBuipment and adaptations to your home

• day centres to give you or the person who cares for you a break

• day care for your child if either you or they are disabled

• care homes

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• support for carers

• financial support

To access these services one needs to contact ones local adult services within ones

local authority%s social services or be referred to adult services by another professional in

primary care. #dult services are responsible for assessing people%s need for Lcommunity

care% or Lsocial care% services.

?ne of the major concerns of #dult social services is that from the day you contact

adult services they have 8F days before they need to the actual assessment to take place

and then thereafter depending on the need or the eligibility criteria, it could take up to

another months for the decided care plan to be actioned.

-.-.- (9* Jental 9ealth

Jental health services are free of charge to all UK residents on the (9*. )ou will

usually reBuire a referral from your 0! to be able to access them. 9owever there are some

mental health services that will allow people to refer themselves for help. This commonly

includes services for drug and alcohol problems, as well as some psychological therapy

services.

?nes 0! surgery may be able to provide one with these services or one might find

them within, a large local health centre, a specialist mental health clinic, or hospital.

Depending on the treatment reBuired, it might be provided on a one"to"one basis or in a

group with others with similar difficulties, and therapy sometimes also involves partners and

families.

The (9* website advises that if one has concerns about a person%s social

circumstances the correct path to follow would be to contact social services, however if If

you or someone you know experiences an acute emergency, you should call @@@ and ask for

the ambulance service or the police.

!eople often abuse this service in order to be able not to work but claim state

benefits due to the mental illness they supposedly have.

-.-.4 (9* #mbulance *ervices

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The (9* #mbulance services range from urgent care, planned health care to and

can include transport service.

ife"threatening care can be accessed through dialling @@@ and asking for the

ambulance services. #ccording to the (9* website, once the @@@ call is received they are

divided into 8 categories to provide the best service for the situation;

• Immediately life threatening Alife"threatening calls will receive an

ambulance capable of transporting the patient safely within @ minutes of

the reBuest for transport being made.

• #ll other calls A /or conditions that are not life threatening, response

targets are set locally

Unfortunately the above times are not realistic numbers due to allot of (9*

Trusts closing down hospitals and #H2 that are only available at certain hospitals. #part

from longer traveling times, road works and traffic has a huge impact on the route and

time an ambulance will take to reach the intended person.

@@@ calls are also not always life"threatening which diverts the service from serious

injured and ill patients.

-.4 (9* vs !rivate

There are various discussion one could consider when comparing the (9* services and

those of !rivate 9ealth care, unfortunately there will always be pro%s and con%s in every

discussion. ?ne however need to look at the comparison of a patient%s journey for different

perspectives to comprehend the differences.

3igna, a private medical provider of private health care have done just that

the following diagram 'https;GGwww.cigna.co.ukGdownloadsGmedicalGarticlesG2xperience

C8=theC8=differenceC8="C8=diagram.pdf 5 below shows the patient journey from three

perspectives;

• (9* !atient

• !rivate !atient

• 3igna private !atient&

This highlights the five main steps in the patient journey and compares these across

the - and through reforms it has made many efficiency improvements in recent years. 7ut

13

https://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdf


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there are still limits in the (9* in terms of access to care and patient choice. #s an example,

an (9* patient may be referred to a private hospital for a consultation but theyOll have to

attend a group clinic where they are unlikely to be seen by a consultant. Then theyOll have to

meet stringent criteria to have access to some surgical procedures and must then wait a

minimum of 4 weeks to have the treatment.

?nce in hospital the different experience for an (9* and private patient continues.

!rivate patients often have their own private room and services. !rivate healthcare also

means more personal care. 3onsultations are based on individual appointments rather than

clinics. /ollow up care is one to one. #nd members of 3ignaOs medical plans enjoy an even

better experience. ?ur nurses can provide advice and support throughout the patient

journey. They can help patients get the information they need from their consultant, provide

additional support through the 3are 3o"ordination !rogramme and continue to support the

patient and their family in their recovery after treatment is completed.&

'https;GGwww.cigna.co.ukGmediaGproduct"newsGexperience"the"differenceGindex.html5

$ith the above one can argue that 3igna used this as a marketing tool to sell their

product and have not disclosed the cons to (9* vs !rivate 9ealth care.

!amela 7rooks, a health journalist edited a base document written by


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proviso that some policies restrict treatment

to set lists of hospitals

offering !JI, itOs worth talking to an

independent financial adviser, who can help

you see the differences between the

policies. #dvisers at insurance companies

can only discuss their own policies and

canOt give you advice on how it compares

with others.

Private room; you donOt have to worry

about being on a mixed"gender ward.

Depending on your policy, you may have an

ensuite bathroom.

$ou %et !hat #ou pa# for ; the more cover

you want, the higher your premium will be.

• &nrestricted visitin% hours. Premium costs are risin% above the level

of inflation; medical treatment costs arerising by = per cent each year, according

to group health intermediary Jercer. $hen

insurersO costs rise, premiums tend to rise in

line with the costs

Personal care; a retinue of medical

students wonOt accompany your

appointment with the consultant, you wonOt

be kept waiting for hours to see them andyou will have more time to discuss your

symptoms.

'(pertise; private hospitals might not have

the same depth of expertise found in teams

within the (9* or all departments on one

site. *o if you have a problem with yourmouth, it might not be easy to coordinate

treatment between a dental department and

the 2(T 'ear, nose and throat5 unit.

pecialist claim team; your insurer may

have a team that deals specifically with a

certain type of condition, such as cancer,

who can help advise you.

)ime constraints; if your consultant also

works in the (9*, your treatment will need

to be given in the time he or she has free

from the (9*.

#ll the information above is available at http;GGwww.netdoctor.co.ukGfocusGpmiGadvantages.htm

-.E 3onclusion

There are a huge number of factors that influence how people in the UK access

health care. $ith all services, regardless whether or not in health care, there will always be

pros, cons and misuse. It seems that one of the biggest hurdles within the (9* is trying to

educate a nation the use of the right service for the right need.

15

http://www.netdoctor.co.uk/focus/pmi/advantages.htmhttp://www.netdoctor.co.uk/focus/pmi/advantages.htm


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HEALTH SERVICES

$ith a growing population and people living longer because of this improved and

expanded services, the strain on the (9* will grow bigger year by year and people will make

more and more misuse of services in order to fill their individual needs.

1eferences

0! *ervices at 7reaking !oint with longer waiting times #vailable at

http;GGwww.independent.co.ukGnewsGukGhome"newsGgp"services"at"breaking"point"with"

longer"waiting"times"on"the"way"claims"survey"F>>8-.html #ccessed on 8> (ovember

8=4

Transforming !rimary care available at

https;GGwww.gov.ukGgovernmentGuploadsGsystemGuploadsGattachmentMdataGfileG-=4-@GTransf

ormingMprimaryMcare.pdf #ccessed on 8> (ovember 8=4

Inclusive !ractise #vailable at

https;GGwww.gov.ukGgovernmentGuploadsGsystemGuploadsGattachmentMdataGfileG-=E@8GInclusi

veM!ractice.pdf #ccessed on 8F (ovember 8=4

(9* 0eneral !ractitioners '0!%s5 available at

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGdoctorsG!agesG(9*0!s.aspx accessed

on 8F (ovember 8=4

(9* #vailable on

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG2mergencyandurgentcareservicesG!age

sG(9*".aspx #ccessed on 8@ (ovember 8=4

(9* *ervices explained available onhttp;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG!agesG(9*services.aspx #ccessed on

8@ (ovember 8=4

# guide to mental health services in 2ngland available on

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGmental"health"services"

explainedG!agesGaccessingC8=services.aspx #ccessed on - December 8=4

16

http://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttp://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttp://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspx


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HEALTH SERVICES

2mergency and Urgent care available on

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG2mergencyandurgentcareservicesG!age

sG#2.aspx accessed on - December 8=4

(9* hospital *ervices available on

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG(9*hospitalsG!agesG9ospitals*ummary.

aspx accessed on - December 8=4

(9* healthcare available at

http;GGwww.theguardian.comGsocietyG8=4GjunG>Gnhs"health accessed 8@ (ovember 8=4

?pticians. #vailable at

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGopticiansG!agesG(9*opticians.as

accessed -= (ovember 8=4

(9* !harmacy #vailable at

http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGpharmacistsG!agesGpharmacistsandche

mists.aspx #ccessed -= (ovember 8=4.

!rivate medical insurance #vailable on http;GGwww.netdoctor.co.ukGfocusGpmiGadvantages.htm

#ccessed - December 8=4

17
http://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/AE.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/AE.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/NHShospitals/Pages/HospitalsSummary.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/NHShospitals/Pages/HospitalsSummary.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/NHShospitals/Pages/HospitalsSummary.aspxhttp://www.theguardian.com/society/2014/jun/17/nhs-health%20accessed%2029%20November%202014http://www.theguardian.com/society/2014/jun/17/nhs-health%20accessed%2029%20November%202014http://www.nhs.uk/NHSEngland/AboutNHSservices/opticians/Pages/NHSopticians.ashttp://www.nhs.uk/NHSEngland/AboutNHSservices/opticians/Pages/NHSopticians.ashttp://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/pharmacistsandchemists.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/pharmacistsandchemists.aspxhttp://www.netdoctor.co.uk/focus/pmi/advantages.htmhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/AE.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/AE.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/NHShospitals/Pages/HospitalsSummary.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/NHShospitals/Pages/HospitalsSummary.aspxhttp://www.theguardian.com/society/2014/jun/17/nhs-health%20accessed%2029%20November%202014http://www.nhs.uk/NHSEngland/AboutNHSservices/opticians/Pages/NHSopticians.ashttp://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/pharmacistsandchemists.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/pharmacists/Pages/pharmacistsandchemists.aspxhttp://www.netdoctor.co.uk/focus/pmi/advantages.htm

Documents

Health Services 2.docx