The United Kingdom's health service is split into two tiers: primary and secondary care. Primary care refers to the care a person might receive from her general practitioner, who is the patient's first port of call. Secondary care refers to the care a patient receives in hospital, as either an in-patient or an outpatient.
The UK health care system dates to the foundation of National Health Service in 1948. According to Geoffrey Rivett, although both primary and secondary health care was available, it was the National Health Service Act of 1977 that clarified the distinction. Primary care was defined as family health services (e.g., family doctors, opticians, dentists, chemists) while secondary care was defined as community health services (e.g., midwives, clinics, treatment in hospitals).
The benefits of the UK National Health System, were for years, unparalleled. Health care remains free at the point of delivery, although now most people pay for dental care and general eye care, but this was not so in the beginning. People in the UK do not pay for care from their general practitioner, nor for their stay in hospital. But they might if they want to avoid long waits for some surgical procedures. Many people have long relationships with their family doctor and will normally trust the primary health care providers over secondary health care.
Features of Primary Care
The primary care that is undertaken by general practitioners has changed over the years and they are not as involved in maternity cases as before. That duty has been undertaken by district midwives or in hospitals. Most general practitioners now have more help and there are more group practices than in the past. Paperwork and records are now managed on computers. Most people now fund their own optical and dental care, unless they are on benefits, in which case they are expected to make a contribution to the cost.
Features of Secondary Care
Most people who attend or are admitted to a hospital are there because of a referral from their general practitioner or through accident and emergency departments or from a telephone and Internet-based help system, NHS Direct. Hospitals have developed, and continue to develop, based on government planning for health care needs. Since the NHS changes of 1991, hospitals are managed by health care trusts that not only provide hospital and mental health care services, but also deal with ambulances and special services.
At the top of the hierarchical structure of the NHS is the government, which is responsible for legislating on both primary and secondary health care. A cabinet minister, known as the secretary of state for health, is responsible for the NHS and the implementation of government objectives. The Department of Health works alongside the government in the interest of national health. Below these are the Strategic Health Authorities, which manage health services over a designated area. Below all that are Primary Care Trusts, which are the chief funding source of both primary and secondary health care in the UK.