Today’s the big day! We all woke up very nervous, but excited for the long day at BCU and our presentations. We walked to BCU and stopped for our morning Starbucks. As soon as we walked into the room we all began practicing our presentation to ease the nerves.
Our first lecture of the day we spoke to Sue who’s been a nurse practitioner for 13 years, she has also worked in hospitals, social care, community nursing, and 111. She also does a lot of wound care education. Also Shelly spoke who is a district nurse, school core, and GP for 17 years. Her specialist is Anticoagulation and has a clinic in Birmingham.
We learned about their BSOL (Birmingham & Solihull) training hub which plays a key role in delivering the NHS primary care workforce of the future. They are very dedicated to ensuring patients receive quality care from competent and appropriately-trained healthcare professionals. They really promote primary care and supporting long term conditions in the community. Both of these women offer support and guidance to students and qualified nurses who wish to enter general practice or continue their career in this area. Shelly works closely with the higher educational institutes across BSOL promoting nurses apprenticeships and student nurse placements. Their emphasis is on promoting primary care, which is free, unlike the United States where primary care is very expensive.
As we have learned the NHS is primarily funded by the government from taxes. Working people in England pay a national insurance contribution where a small amount of this helps to fund the NHS. We learned that general practice surgeries are an independently owned business. Sue mentioned her brother had to wait a month for a scan for cancer, but if he paid privately he could get it that afternoon. General practice is contracted by the NHS, but not funded by it, so the employees are paid by their general practice not the NHS funding. In general practice you have to negotiate your own wage, sick days, and holidays. Unlike the NHS where you work your way up with wage and get paid more as your band increases. General practices used to be 9-5 but now extended to start earlier and finish later. It depends on locality and some practices stay open for longer and get referral from practices that don’t. The employees in general practice do not get maternity or sick pay unless they have a generally good GP practice. The NHS hospital nurses will get their regular salary for 9 months, then it drops to standard salary for 3 months. For general practice it depends on who you work for. For example Shelly said she got 6 months with a half of her start salary which is not much money. Because of all these terms and conditions many nurses who want to have more children will switch back to hospital nursing instead of GP. As well as, a GP nurses are expected to do a lot more.
We learned a lot about Primary care networks (PCN) which is a network of practices working with other providers to improve health, and wellbeing of patients in their locality with shared funding for community services. For example respiratory services, wound care services, urology services, and dermatology services. So this results in certain services that have more need getting more funding. They have an Integrated Car system (CCGs) that are partnerships between organizations that meet health and care needs across an area. Another program is Quality Outcomes Framework (QOF) which is clinical domains that relate to long term or enduring medical conditions. Practices have to have benchmarks and have to meet specific targets related to their management. CQC comes and checks the practice to make sure everything is safe, up to date, and working well and can actually close the practice if they are under pare.
“Communication is the biggest part of health care,” Shelly said. They really emphasize communication between all practices and professions. While the USA is more within only one system, like the hospitals and doctors offices work well with communication, but the communication between schools, social work, and hospitals cohesively is lacking.
In England, certain groups are able to access free NHS prescriptions, but working age adults have to pay their prescriptions. Over the age of 65 and pregnant women get free prescriptions. Anyone under the age of 16 or in college does not have to pay for prescriptions. Those with some long term conditions are medically exempt from paying prescription charges (diabetes, thyroid, cancer, etc.). Social determinants of health are also prominent in UK along with the USA. The cost of living can lead to people not able to afford certain prescriptions, therefore they deny the treatment. It is 9.63 pounds for all items like prescriptions, inhalers, etc. So if there are many different items needed, then they cannot afford it. As well as, menstrual products are not part of the NHS free healthcare, therefore women must pay for these products like the USA.
NHS waiting times for GP appointments are booked on a priority basis. Most GPs, since the pandemic, will be able to see you in 2 weeks for a routine appointment, but for urgent needs you will need to call or attend an urgent care center. They have a new initiative called pharmacy first, where patients should present to their local pharmacy for minor illnesses (ear infection, sore throat, UTIs) so they can agree on health issues before they get worse, so again that emphasis on preventive care is very important in the UK. This is something I believe the USA should look into implementing better because normally you need to get an urgent care appointment to get that prescription which involves a lot of waiting.
One thing I found really interesting was that many patients prefer a nurse or nurse practitioner for their assessment. They said the doctors sometimes do not even read the chart and ask a lot about their past illnesses or why they are there, while the nurse tends to be more willing to read the chart and learn all the information before assessing the patient. The nurses said they teach their students that you cannot blame the patient for their illness or promise to solve the patient’s issues, but recognize you will try your best to solve their problems. “Do not ever make premises you cannot keep,” Sue said. A major debate is should alcoholics, drug addicts, etc. have free healthcare? Well what has their trauma been, what has happened in their life that could lead to this, or what could have been done to prevent this. I believe this is very important to recognize because we tend to blame people for these illnesses, but there are many underlying issues that lead to turning to drugs/alcohol that they cannot control.
We then talked to Katie and LeAnn, who are qualified nurses in the general practice today, and alumni of BCU. They are not just specialized, but have lots of skills involved. They work in a big team of 10 nurses, with over 17,000 patients. They have similar issues we have talked about before with waiting times, and waiting weeks to see a doctor. They also mentioned that they do not get the best pay for maternity, sick days or holidays. At their practice they get maternity full salary for only 6 weeks then it goes to half their salary, but they can negotiate more if they are on good terms with the practice. Since patients have a hard time getting appointments they tend to ask for even extra examinations or procedures because they want to make the most of the one appointment they have.
The nurses told us lots of horror and humorous stories they have experienced with patients or with each other, which was really funny and interesting to hear. It is nice to know even with all the bad and sad stories within the healthcare system you can still find humor and fun with patients and coworkers. Some advice they gave was to get as much experience as possible, have a strong stomach, never be afraid to ask questions, and of course enjoy your job.
After the lecture we went to lunch and then we did an escape room based on what we learned from our guest lecturers. It was a tool to work on teamwork and leadership, as well as it was a fun way to learn. We finished up the day with our big presentations. Although we were nervous they went really well, and everyone was so interested to hear what we learned and research. They asked many great questions and also gave some insights from their experience. When we left it was actually raining which was the first rain we have had in England so far, surprisingly.
Finally we got dinner at this Indian restaurant which was delicious. Birmingham is actually known for their curry. Today went really well and I am excited for the nursing home tomorrow.
My amazing presentation group
First England Rain
Indian Restaurant