Today we headed back to BCU for another day of learning! We had extra time to grab some coffee, which has nothing to do with our classes today, but it made me happy! We all took some time to review our research presentations, which we will share with BCU staff this afternoon. My group’s project focuses on socioeconomic status’s impact on health care and education access. Wish us luck!
We started the morning by speaking with general nurse Sue and health care assistant Shelly, who work in BSOL training. These programs focus on primary care, or confronting health difficulties upstream before they cause a crisis. They focus on clinical supervision and supporting the NHS workforce. Sue is also the TH lead of clinical supervision. She works to review best practices and provides support for nursing staff. She joked about nurses having a dark sense of humor and how we are happy to discuss gross concepts in everyday conversation. I definitely find this true of myself, much to the dismay of my family when I talk about anatomy at the dinner table. I’ve also found this true of my fellow nursing students, which really confirms my career path, and I’m excited to be entering this community. Shelly shared that she is a healthcare and nurse associated facilitator, and is also passionate about educating and training nurses. Both women talked about how fast paced and stressful healthcare can be, and want to provide nurses support in this difficult profession.
The presenters asked us about the healthcare systems in the US, and wanted to know how people receive primary care. We had a discussion about how our healthcare in the US is typically through an employer. Even with healthcare, essential services like childbirth can have incredibly high out of pocket costs. They asked us how people without insurance receive care. We shared that people without coverage will usually seek care from the ER, the only locations required to take patients regardless of insurance. This was great practice for our presentation because it relates to socioeconomic status.
We also talked about the role of primary care in the NHS, where primary care appointments are free. This is funded by a small national insurance fee from everyone in the United Kingdom. They also shared that their primary care facilities are open 8AM-8PM, which is more flexible than the urgent cares in the US, especially for working parents. Because of this, the urgent cares and primary care practices have very long wait times. If you can afford it, however, you can pay out of pocket for private, much faster care. She said they also focus on recruiting people into nursing. She shared that people often move around to different care facilities for benefits. This does not address the nursing shortage, because nurses are just moving around “like pieces on a chess board”. They also addressed the Primary Care Networks (PCNs), which work with other providers to improve community well being. Examples of this are urology, respiratory, and dermatology services. The distribution of funds to these services is based on the communities need for the service, again focusing on equity over equality. This is evaluated by Quality Outcome Framework (QOF), which finds the number of treatments provided. The most funding is given to primary care networks who care for most patients.
We also talked about prescription charges. In the NHS, prescriptions cap at 9.65 pounds per item. People under 16, college students, people over 65, pregnant, or with chronic illness like diabetes or cancers, are exempt from charges. You can also prepay to cover all medications for a three-month or one-year period (3 month prepay is 31.25 pounds, 1 year prepay is 111.60 pounds). This seems amazing compared to the prescription charges in the US, but this doesn’t just apply to medicine. This can include the price of dressings and other equipment in the hospital, so expenses add up quickly. They also brought up that externalities like healthy eating that can improve outcomes. These external factors can be too expensive for patients Primary care nurses are advocates who help patients to get the best care based on what they can afford.
One of the most moving things we discussed was the role of nurses outside of direct care. In Sue’s experience in primary care, patients often divulge sensitive concerns to nurses and not doctors. She says nursing is about advocating what’s best for the patient, even if that’s against a patient’s wants. She told us never to make promises, especially those we can’t keep, but rather to talk to patients about their concerns and provide resources. A quote they shared was “illness is neither an indulgence for which people have to pay nor an offense for which people should be penalized, but a misfortune that should be shared by a community”. This was said by Aneurin Bevan, father of the NHS. She said people will question if people who are addicted to substances or have behaviors like smoking should be included in this system. A nurse’s job is to look back on why these people are behaving that way, and to provide them the best care no matter what. She also encouraged us not to be ashamed in asking for help. It’s much better to appear inexperienced than perform a skill on a patient incorrectly. Sue said “if you’re not happy, you don’t do it”. These concepts were inspiring to me as a nursing student.
We then got to hear from two general practice nurses, Katy, a respiratory specialist, and LeAnn, a diabetes specialist. They spoke about their student training, and an interesting fact is that nursing students need an additional certification to vaccinate patients, whereas in the US we are allowed to vaccinate as students without outside certification. They are both adult nurses who work with patients from eight weeks to over one hundred years old! They shared that they enjoyed general practice to have more control and more of a management role. They also enjoy working with primary care patients in a preventative role. They also enjoy the hours being more manageable than a hospital role, especially if you have a family to care for.
They shared that they love the free healthcare provided by the NHS, but the main con is long wait times. They shared that they have an on-call doctor for appointments, and open at eight in the morning. They guarantee that by nine in the morning any day, the list will be full. Katy shared that this is hard for them as nurses. They try to fit in as many patients as possible, but there still isn’t enough help. This can lead to conditions progressing and requiring more down the line. Long wait times can also lead to aggressive patients, which makes it hard to provide care. This can also lead to patients disclosing many problems at an appointment for a simple test, simply because they cannot get help anywhere else. There appointment then requires more extensive treatment, increasing waits for other patients. Katy and LeAnn attributed these waits to lack of services and retiring populations. This is why they are very focused on student education in their practice, so they can increase the workforce to accommodate more patients. Katy compared student education to driving a car, you have to learn to pass your test, but once you pass the learning begins again. In other words, you learn a general skill set in university, but more learning continues every day on the job.
One of the most interesting things we discussed was conditions that the NHS does not cover. For example, type I diabetes medication is covered. Type II is considered a “life style” disease, and insulin is charged. In addition, hormones for menopause are charged, even though a woman naturally stops producing these hormones through no fault of her own. In addition, period products are not only paid for out of pocket, they have a luxury tax. It was striking to me that these products are not considered part of health care, as they are a part of women’s health that requires care throughout their lives. This conversation shed some light on the discriminations within NHS coverage.
They ended their presentation by encouraging us to get as much experience as possible. Even in les flattering jobs like bathing, we should try to learn as much as we can. They said to embrace any job because we are all here for the patients no matter what their needs are.
At the end of our session we did an “escape room” activity to test our understanding of the presentation. We then had some time to practice before our presentations, which went very well! I think I learnt a bit more about or topic from the Q&A after, especially in regards to pupil premium and education in the UK. We ended the night by eating Indian Streatery food for dinner, which was delicious. Tomorrow will be our last day at BCU! I can’t believe our trip is coming to a close because we’ve been having so much fun. See you tomorrow!
My research group hyping ourselves up to present
Indian food for dinner