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Mhm. Hello everyone. Um We're, we're gonna start soon but I just want to be sure that can you, can you hear us? Can you hear me? And can you see the screen? If can? So if someone can uh leave a message? That would be great. Yeah, perfect. Thank you. Um So uh we will start in a couple of minutes. Let's just wait for other people to come. Um Meanwhile, I would like to talk about our network UK, New Commerce Network. Um So we, when we first arrived to the UK, we were struggling about the system of the NHS even. We were um we were, we were, we were able to manage the patients even. We have the great, great medical knowledge at the beginning of the, our career in the NHS. Personally, I struggled a lot and all of my friends, we were all talking about the system and about the things that we don't understand in the system. So after that, we decided to um set up a network to help the other people to help the other doctors who wants to come to the UK or who, who has just started to work in the NHS. So we um set up the UK newcomers, uh doctors net, new newcomer Doctors Network. So we been having, we have been having um m weekly, weekly teaching sessions almost every week and it's been going on for, for more than three months I think. And we are so happy to see you guys all joining to us and leaving us feedback. This is all just I helping us to improve more and helping us to think about what we can tell you more. And today, um doctor uh Doctor Cara will be talking about the NHS. Actually, we'll be talking about the understanding the NHS structure of the NHS. And what is the differences of the NHS between our normal practice back in our country mostly and in this, in, in, in the UK. So uh II hope this uh presentation will be very helpful to all of you to understand the system of the NHS, to understand the basics of the NHS. And then um let's, let's, let's leave the stage to uh Doctor Ka. And after that, we will leave the feedbacks and you can ask the questions anytime you will try to answer the questions or we will answer the questions at the end of the presentation. OK. All right. Thank you Yin for introducing the uh lecture today. So I will be presenting, I'm uh doctor, I'm a GP trainee in Cambridge. I started on August. So I'm relatively new to the NHS. And I am just recently, uh I just recently started to learn further about the uh primary and secondary and tertiary care services provided in the NHS and uh the patient pathways and the referral pathways in the NHS. So I just wanted to uh give uh teaching about what NHS is and what is its structure and uh which, what kind of primary and secondary care services are provided within the NHS? And I will specifically uh emphasize the uh community services as it's something that uh is not uh provided back in Turkey and it may not be uh provided as well in other countries. So I, we'll start by, by giving an introduction to the NHS. By the way, it will take roughly half an hour and you can ask any question in between and Yasin will uh try to ask me and, and uh within the uh presentation. So I will start by giving you a brief introduction to the NHS. And I will then talk to you about the structure of the NHS primary services, community services and secondary care. And I will also talk about uh the regulatory bodies that you may have heard of and what are the NHS Trust and what's its functions and some challenges that uh NHS has been facing nowadays. And I will conclude by why, why we should know about the NHS structure. Uh So NHS is established in 1948 and it's funded purely through taxation. So it's free uh at the point of delivery and its values are uh being comprehensive, universal and uh being based on needs rather than ability to pay. And uh its structure is uh it goes through a multi tier system and it integrates different levels of care. So the primary care is the immediate point of entry and secondary care is a referral based from the primary care services. And the tertiary care is an advanced care for complex conditions. So I will start by the primary care services. I am also currently working in a GP practice and we handle around 90 per 90% of the uh patient interactions in the NHS. And we provide uh diagnostic care, preventative care as as we manage long term uh chronic conditions. And we also provide referrals both to private centers and to uh secondary and tertiary centers in the NHS and within the GP practice and also outside of the practice. Uh There are community services and this community services uh composed of the community nurses, midwives, and health care, visitors who deliver care outside of the hospital within the local area. And it also includes the mental health support and drug and alcohol addiction services. Also some physical therapies. Uh pharmacies are also an important part of the primary care. They provide medication vaccinations and they can give some health advice as well. And the urgent, there are urgent care services and they give treatments for immediate but not life threatening uh needs. I will talk to you about the community services in detail because I believe it's something that we don't know much about. So the co they are uh they actually provide care to uh patients who has immobility issues or chronic conditions and those who need treatment at home. Uh So the community services uh provide support to the patients outside of hospital settings and they aim to reduce the hospital admissions. And uh one of the community services is community nursing. So it includes the district nurses and community health nurses and they uh provide at home care for the patients with chronic conditions, especially for the ones that are risk to discharge from hospital uh with community support. So they can discharge the patients early uh with the help of community nurses that will provide care in the uh local setting. They also provide wound care and palliative care. Uh They can uh even prescribe medication for those patients. And uh they provide regular checkups to elderly and disabled patients and give the them treatments at home and they do re uh regular visits to the ones in need. And health visitors are uh general, they focus on the preventative care and it's for families, Children and newborns and they provide support to new parents and they do developmental checks of the newborn and they check their immunization schedules, nutrition and their health and like the uh developmental check is done in uh six months in the uh GP setting in setting. However, the health visitors uh provide continuous care to the uh newborn uh parents. And it's especially important for the vulnerable families who don't uh have access to uh care as much as the others. And the midwife services. They provide prenatal and postnatal care to uh pregnant babies. And uh they provide the care outside of the hospital settings and closer to the uh patient's houses. They generally come to uh GP practices uh once, twice a week and uh provide regular ans check ups and postnatal check ups. They monitor, monitor the fetal house and prepared the parents for the childbirth. And they even sometimes provide home visits and they have to identify the complications or do. And so for pregnant uh female patients, if they uh have an acute uh disease or a new uh complaint, they come to GP directly. But for the antenatal uh checkups, they uh take appointment from midwives and they uh provide the uh regular checkup for the uh prenatal care and the mental health support. There are community mental health teams they that assess patients and they provide ongoing support for the mental health patients and they can go see the patients at their houses and uh they also provide care at the local, local settings. So there are mental health uh health trust that provide community services and they see the patients in their neighborhood. And uh it includes the psychiatric nurses, social workers and therapists. And they can support uh people suffering from depression, anxiety and uh other mental illnesses. And they also uh provide crisis intervention. Uh So there is a hotline uh one on one and their GPS also can uh refer patients to crisis intervention. So patients that need to be seen urgently by the mental health team within like 24 hours are seen by the mental come to mental health teams and there are rehabilitation services in community. Uh then they offer physical and occupational therapy, also speech and language therapy. They also support the patients uh who recently discharged or who are recovering from a fracture surgery and they have the patients to regain their mobility and independence and they aim to uh uh uh regain to patients to, to the their functionality. And uh the these uh occupational therapists also assess the patient's houses and see whether the house is appropriate for this patient to keep the uh her or his functionality. And they recommend changes if needed. Uh For instance, if a patient has uh has a fracture and cannot uh go upstairs and he he or she doesn't have uh enough facilities in the uh first floor, they can uh provide an or give a recommendation about changes at the house to uh be a to for patients to be able to uh have all her or his needs at the uh house, I think and the pharmacies or they also provide medication and uh they do do give some advice about uh health care and there is a recent uh change in the pathway uh that's provided by the pharmacies. I will talk about this soon. And so they dispense medication and uh educate patients about how to use the medication properly. And they also provide over the counter services for uh many issues like colds, headache, digestive problems, some uh tread worms and et cetera. And if they feel like the patients need to go see a doctor, they provide advice on that. And they also provide vaccination services especially during the peak se seasons on spring and autumn. And they also provide some health screenings like uh ambulatory BP monitoring. And if uh they feel like it's needed, they refer the patients to GPS with the results and they also provide contra contraceptive advice and emer emergency contraceptive advice uh within the pharmacies. They also offer some, some, some of the pharmacies offer smoking cessation programs as well. So there is a new pathway that's launched in uh on a on this January. So it enables the pharmacist to uh prescribe the medication for seven common conditions in uh particular ages. So for otitis media, impetigo and infected insect bites, shingles, sinusitis, sore throat and uncomplicated UTI S patients are actually recommended to go see the pharmacy first pharmacist first. And if and they can provide the medication right away without uh needing to see the GP and urgent care services. They address like nine nonlife threatening conditions, but the ones that required uh urgent attention. So it's uh it helps to uh avoid long waiting times in the A&E S by handling minor injuries like sprains, fractures, burns and cuts. And uh they also, they are also available for like minor eye injuries, uh eye issues and skin issues. And it's accessible through calling 111 or they can, the patients can be directed by the GP or they can also self refer to urgent care. And uh after the the urgent care service, they generally uh referred the patient back to their GPS for their follow up. The second care, secondary care services are provided in the hospitals in general and emergency departments. And the uh except the emergency department, they all require a GP referral and uh the in the hospitals they provide in the secondary care hospitals, they provide like uh surgeries, inpatient and outpatient treatments. And the second uh they also uh many specific have these like diabetes, asthma and heart disease and there are like uh cons and these uh multidisciplinary teams include both nurses, therapists and consultants. So patients can be seen by an asthma nurse instead of consultant when you refer the patient to the secondary care service. Uh if the triaging team decides that the patient doesn't actually need a consultant and uh they are also, they also provide rehabilitation services like physical therapy and occupational therapy, speech therapy for the patients that are recovering from uh surgeries and illnesses. And the second tertiary care services are highly specialized and complex services that uh is the dedicated, the specific uh topic. So they there are a couple of types of tertiary care uh can such as cancer care, neurosurgery and cardiac surgery, uh facilitations, transplant services, and pediatric tertiary care services. And uh the pediatric tertiary care services are specific for severe conditions in Children. And they like to the of these genetic diseases. I have even seen a uh specialist center for uh le disease in the hospital and they generally require a secondary referral. And NHS include uh uh what is NHS include? And what is, it's strong. It's uh it's uh a service that uh provides budget for the healthcare services and it coordinates with clinical commissioning groups uh which are organizations that are responsible for planning uh healthcare services in the local population. So NHS uh coordinates those commissions and regulates the healthcare services. And uh there are some regulatory bodies as well that uh inspects and regulates the healthcare and sets the standards. So there is scar called the commission commissions which inspects and regulates healthcare providers in general. And you might have heard of mice uh which develops uh clinical guidelines for treatments and based on their also the cost effectiveness. And it's an evidence based guideline that you can reach from across the UK and uh Public Health England also provides public health services and pandemic response and I will discuss those in detail. So nice, provides evidence based guidelines basically that uh every trust U uh uses for their own guidelines. And it's um it provides the most effective treatments for specific conditions. And uh public health England is now known as UK health security agents. They are responsible for protecting the public from health threats like COVID and they uh provide prevention from uh emer emergency uh emergencies and outbreaks in the population and they uh give response to the uh infectious diseases and environmental HAZ hazard. And uh they also provide health improvement programs like smoking cessation program, mental health supporting programs and alcohol reduction programs and health education England, which we uh hear while applying for the training. So it's uh responsible for regulating the training and education of the health care force. And uh they recruit enough amount of healthcare professionals uh to uh to provide the need of the NHS in general and it sets the standards of the education and training in the whole country. Uh So it ensures that the uh quality of the training in across the UK is the uh same in everywhere and they also provide uh support for continuing professional development. So CPD uh is that uh so for CPD, they provide actually uh some uh learning opportunities like digital ones through N HSE AE LF hub that you can uh if you are working in the NHS at the moment, you can reach NHS H and uh you can uh reach some free CPD uh trainings that you can do online. And NHS Trust are uh organize organizations that are responsible from delivering health care services. So they include uh hospitals, mental health facilities, and community services. So they operate in specific regions and uh they ensure that the local standards meet the uh national standards. There are a couple of times of types of NHS trust. Uh The first of all, first of all, this and the first one is uh acute trusts. They provide general inpatient and outpatient care, uh emergency services, outpatient and inpatient services. And they uh work closely with GPS and uh they get the referrals from the GPS and there are mental health trust that are specialized in mental health services. And uh they also provide community based care and inpatient care. So they uh they have even specialized units such as like child and adolescent unit, prenatal mental health unit and crisis teams. They also work with GPS and they take referral from the GPS and they are coming to Health Trust that manage the district, nurses, community nurses, health visitors, and they uh regulate the long term support for patients in the community. And they also provide rehabilitation cirrhosis like occupational and physiotherapy. And their ambulance trusts are specifically uh that specifically provides emergency ambulance services. They uh work through 999 responses and they dispatches um ambulances and paramedics and for severe conditions like heart attacks, stroke accidents and severe injuries. The paramedics uh go and assess the patients and if they feel like the patient doesn't need an ambulance, they uh may refer the patient to G their GP or they can uh send the patient uh via an urgent uh ambulance rather than an emergency one. And uh they also provide non emergency services for the transport of the patients from a hospital to another one or uh by the patient is when the patient is immobile, they can provide uh service to take the patients to their appointments. And like there are few challenges that are, that's NHS is facing at the moment. So the first one is the funding pressure because the uh there's an increased demand for the services and the costs are rising. So the budget is it there are budget constraints at the moment that's impacting the service and stuff shortage is an issue. But the workforces especially the healthcare provide professionals uh has been undergoing burnout and after the COVID-19 pandemic and it's causing the uh stuff shortage uh in the hospital settings and they are the waiting times are long at the moment for the for a special secondary and tertiary care services. And even for the GPS, people may sometimes need to wait for a month or longer to get an appointment and the population is aging and uh they have more complex health needs. So they also, they need long term support and, and it just is struggling to meet the needs of the elderly population. And uh the challenges that may face the NHS may face is like uh there is a need to integrate the technology with the uh hospitals but even some hospitals are still uh using a paper based approach uh for their data because of privacy and data, uh security concerns. And uh there are emerging infections, disease and potential pandemics. Uh For instance, like uh around August, there was a uh emerging uh whooping cough uh epidemic within uh east of England. And there is a financial sustainability problem because of the economic uncertainties. And uh the the population has been getting older. So it's harder to uh provide the uh financial support for the NHS. And also there is an increased demand for the mental health support because of the pandemics effects on the people. So it's is also another challenge that the NHS has been facing at the moment. So in conclusion, this uh important for a junior doctor to know uh which, what type of services does the NHS uh provide as uh its posters to uh go through a better teamwork approach. And it helps you to identify which sources you need to manage your patients particularly. And it's important to know like which career options you may have in the future if you by knowing the whole structure. Oh, if you have any questions I'm happy to answer. It was a relatively shorter presentation today, but thank you for uh listening and your attention. OK. Uh Thank you, Basha. Thank you for giving us overall idea about I uh N NHS. Um I'm just quickly checking, is there any questions? If not, I can leave the feedback, feedback forms and um there is uh one question. Yeah. Um Could you repeat the part where we can get additional CPD avoiding free courses? Uh Yes, sure. If you are working in the NHS uh E LF hub, you can see in the screen in the lower part. Uh If you enroll in the website with your uh NHS email, you can find like uh many uh teachings, online teachings in the website. OK. It is provided by the Health Education England. Um And also you can collect CPD points from, from any of the, most of the teaching sessions. Um It also gives CPD points and also you can collect from uh from, from a courses you, you buy um for BM BMG courses or OX or teaching courses. Uh And also BMG, for example, when you get the, when you get the BMA uh P BMA papers, B BMA articles, then you can collect some one or two points from uh from each, for each of the uh articles in, for the readings that you did. Uh you can claim CPD points uh by on what you learned from that reading where you read it and et cetera. So it shouldn't be, it's not necessarily uh a program that provides uh uh CPD points like uh you can claim pretty much anything you do for your development as a CPD point when you are doing your portfolio. See, um I'm just trying to um share the feedback forms with you. OK. Here, is there any other questions? Is there any other questions then you can ask? Meanwhile, let's see. I think now you must be able to see the feedback form. Uh Just share it with everyone. And also we will send you a email. You can, you can uh you can access to the link with the email as well and you can share the feedbacks, uh your feedbacks with us. Thank you. Um Have you got anything to say by shock or? And no? Thank you for listening. And uh if you have any uh questions later on, just leave it to the feedback and I will try to mention the upcoming sessions, I will be providing uh other teaching sessions in the upcoming weeks. So if you just uh leave it um a note in the feedback about what you want to hear about specifically like GP or other testing. If you just write it down, I will try to uh provide the teaching sessions on them. Yeah. Also if you want, you can leave a um you leave a noting in our threat in our network in the middle. So if you go to the network and there are like threat sessions, then you can choose, um or you can leave, you can start a comment about it and we will be able to see uh what do you would, what, what do you want us to tell you in the future sessions? Um Thank you so much, Misha. Thank you so much, Jin. Thank you everyone for joining us today. I'm hoping to see you um in the next sessions. Yes. Thank you. Thank you.