Workforce, training and education
East Midlands

Please note this page is currently under development 

Settling into the NHS 
 
Structure of the NHS
 
 
Structure of the NHS 

The NHS is the world’s largest publicly funded health service and deals with over one million patients every 36 hours. It employs more than 1.3 million people and has an annual expenditure of around £105 billion. The services provided by the NHS can be organised into the following categories:

Primary care includes community services such as general practice, general dentistry, pharmacies, walk-in clinics, the NHS 111 telephone service and community optometry. It is generally the first point of contact for patients and often the way to access secondary care services.

Secondary care – Secondary care is healthcare generally provided in hospitals. It includes accident and emergency departments, inpatient wards, outpatient departments, antenatal services, mental health hospitals, genitourinary medicine and sexual health clinics

Tertiary Care - Care for people needing complex treatments. People may be referred for tertiary care (for example, a specialist stroke unit) from either primary care or secondary care.

These services are provided for by numerous organisations and an overview of the structure of the NHS to explain this further is provided below:

The Department of Health & Social Care (DHSC) is responsible for the strategic leadership and funding of both health and social care in England. It is a ministerial department supported by external agencies and public bodies. The Secretary of State for Health & Social Care has overall responsibility for the work of the DHSC.

One of these public, independent, arm’s length bodies is NHS England, which since 2019 has joined with NHS Improvement, working together as a new single organisation to better support the NHS to deliver improved care for patients. There is a new single operating model which has been designed to support delivery of the NHS Long Term Plan.

Local health systems are supported by seven integrated regional teams who play a major leadership role in the geographies they manage. They make decisions about how best to support and assure performance in their region, as well as supporting system transformation and the development of sustainability and transformation partnerships (STPs) and integrated care systems (ICS).

The NHS is organised more locally by Integrated Care Systems (ICSs) who work with partnerships of organisations that come together to plan and pay for health and care services to improve the lives of people who live and work in their area.


 

Roles within the NHS
Working in the NHS exposes you to many different roles and professions and together, these multidisciplinary teams work to provide safe and effective patient care.
 

Doctors

  • Undergraduate medical students: in the UK, medical students typically study for five to six years. Much of this study will take place in one of our many teaching hospitals and you may be asked, in your capacity as a fully qualified doctor, to contribute to their education and training.
  • Foundation doctors: doctors who have just graduated from medical school are called Foundation doctors and are required to complete a 2-year training programme called the Foundation Programme. This programme provides experience in a range of different areas of medicine and surgery. Doctors on this programme are responsible for caring for patients but under the supervision of more experienced doctors and healthcare professionals. For the first year of the programme (called F1), doctors are provisionally registered with the GMC. In the second year (called F2), doctors are fully registered with the GMC and begin to take on more responsibility for patient care.
  • Core training doctors: Some specialties require doctors to have undertaken a more generic programme of training before entering specialty training. Examples include Core Surgical training, Acute Care Common Stem (ACCS) and Internal Medicine Training (IMT). Following completion of these training programmes doctors can apply for higher specialty training in a specific specialty area.
  • Specialty training doctors: these are doctors that are training in a particular area of medicine or surgery including general practice. Depending on the area of training, they may have to complete between 3 and 8 years of specialty training. As these doctors progress through their training and gain in experience, the supervision they require will reduce. Doctors in specialty training are referred to as ST doctors. They may have previously completed a core training programme before entering higher specialist training, or for some specialties they will have applied directly into specialty training, which is often referred to as ‘run-through’ training.
  • Consultants and GPs: Upon completing their specialty training and exit examinations, doctors are awarded a Certificate of Completion Training (CCT), which allows them to apply to the specialty or GP register and apply for a consultant or general practitioner post.
  • Specialty Doctors and Associate Specialists: The term 'SAS doctor' includes staff grade, associate specialist and specialty doctors with at least four years of postgraduate training, two of which are in a relevant specialty. SAS doctors are a diverse group with a wide range of skills, experience and specialties. They are an essential part of the medical workforce
  • Locally Employed Doctors: There will also be doctors working in non-training roles, directly employed by local trusts or practices to fill local service needs. These posts have some similarities to SAS doctor roles but may not have the same entry criteria or terms and conditions of service. These posts include job titles such as trust grade, trust doctor, clinical fellow and senior clinical fellow.
  • Medical Careers: There are many career pathways and specialties doctors can work in in the UK. To find out more about career options for doctors available in the UK go to https://www.healthcareers.nhs.uk/explore-roles/doctors

 

Nurses

There are four key areas of nursing that nurses will qualify into:

  • Adult: Adult nursing specialize in caring for people aged 18 and above. Adult nurses may work managing one health condition or a variety.

  • Child: A child nurse aims to minimise the effects of illness on children, ensuring they develop into healthy and happy adults.

  • Learning Disabilities: These nurses work with adults and children who have a range of learning disabilities. Their work aims to improve and maintain their patient’s health and encourage independent living.

  • Mental Health: Support people with a range of mental health conditions, this might involve long-term care or more short-term support

  • District nurses: play a crucial role in the primary healthcare team. They visit people in their own homes or in residential care homes, providing increasingly complex care for patients and supporting family members.

  • General practice nurses: These are nurses working in a primary care setting. General practice nurses work in GP surgeries as part of the primary healthcare team, which might include doctors, pharmacists and dietitians. In larger practices, they might be one of several practice nurses sharing duties and responsibilities. In others, they might be working on their own, taking on many roles.

  • Neonatal Nurse: Neonatal nurses care for newborn babies who are born premature or sick. A newborn baby can suffer from a range conditions requiring treatment.

  • Theatre nurse: Theatre nurses work with patients of all ages and are involved in each phase of a person’s operation. They provide high standards of skilled care and support during each phase of a patient’s perioperative care.

  • Nursing Associates: Nursing associates are a relatively new role within the nursing team. Nursing associates work with healthcare support workers and registered nurses to deliver care for patients and the public.

  • Clinical Nurse Specialist: These are nurses who have undertaken further training and/or qualifications to develop a particular specialism in a specific area of nursing, for example a clinical nurse specialist in diabetes care. They may have developed additional skills to help deliver care in their particular specialism.

  • Advanced Nurse practitioners: registered nurses with additional education and training who can diagnose and treat certain medical conditions without the direct supervision of a doctor.

Midwives:

Midwives provide care and support to women and their families while pregnant, throughout labour and during the period after a baby’s birth. They mainly deal with pregnant women requiring professional support and advice. Midwives are likely to be the lead health professional and contact for pregnant women. They are an expert on childbirth and have diverse responsibilities. They provide full antenatal care, including parenting classes, clinical examinations and screening. Midwives help identify high-risk pregnancies that may require obstetric or neonatal input. Midwives will monitor women and support them during labour and the birthing process. Midwives teach new and expectant mothers how to feed and care for their babies.

Some midwives may develop a specialist area of practice such as Bereavement or safeguarding.

Allied Health Professionals

  • Pharmacists: experts in medicines and their use. They also offer health advice to patients on issues such as sexual health and giving up smoking.
  • Pharmacy assistants: help pharmacists prepare and dispense medicines.
  • Pharmacy technicians: manage the supply of medicines in a community pharmacy and assist pharmacists with advisory services. In hospitals, they do more specialised work such as manufacturing or preparing complex medicines.
  • Physiotherapists and physiotherapy assistants: work with people to help with a range of problems which affect movement using exercise, massage and other techniques.
  • Occupational therapists: help people of all ages to carry out everyday activities which are essential for health and wellbeing.
  • Speech and Language Therapists: provide life-changing treatment, support and care for children and adults who have difficulties with communication, or with eating, drinking and swallowing.
  • Health visitors: are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness. They work with families to give pre-school-age children the best possible start in life.
  • Radiographers: use imaging to aid with the diagnosis and treatment of pathology.

 

Wider Health care team

  • Health Care Assistants: work in hospital or community settings, such as GP surgeries, under the guidance of a qualified healthcare professional to deliver basic care to patients.
  • Phlebotomists: collect blood samples from patients to help diagnose illness.
  • Ward clerks: do administrative work to support professionals in hospitals and health centres.
  • Domestics: keep hospitals, health centres, offices and other areas clean and hygienic.
  • Porters: move people and items around a hospital site.

 

This is not an exhaustive list and you are likely to meet many more healthcare professionals in numerous roles throughout your career in medicine. For further information on the other roles in health see the Health careers website.


 

Appropriate workplace clothing

When at work there will be a dress code that you must familiarise yourself with and comply with. This includes maintaining appropriate standards of appearance, dress and personal hygiene.

Common themes around appropriate dress at work for doctors in training include:

  • All clothes must be clean and presentable and consistent with presenting a professional image. Jeans are usually not permitted to be worn in the clinical environment.

  • Hair and beards should be neat and clean; long hair should be tied up and off the shoulder securely.

  • Staff must not wear jewellery except for a plain wedding ring and/or ear studs.

  • No wrist watches should be worn in the clinical environment under any circumstances.

  • Staff must not wear false nails and/or nail varnish as it discourages efficient hand washing and can be sources of contamination.

  • Staff must keep fingernails clean and short.

  • Visible tattoos where present should not be offensive or provocative to others.

  • Staff should not socialise outside the workplace or undertake social activities while wearing an item of clothing that will identify them as NHS employees.

  • All clinical staff must wear short sleeves or elbow-length in the workplace to enable effective hand washing techniques – this is referred to as being ‘bare below the elbows’.

  • Garments that may interfere with clinical communication and its assessment should be removed at appropriate times.

  • Footwear should be comfortable and practical for the role undertaken. Enclosed shoes (toes covered) must be worn by all clinical staff as these offer protection against spillages and injuries.


 

Useful resources 

NHS Induction Programme for International Medical Graduates 

How does the NHS in England work and how it is changing?

The A to Z of NHS health professionals

Practical guide on being an international doctor in the NHS and what you can expect from your first weeks (BMA guidance)

Working and Training in the NHS: a guide for international medical and dental graduates thinking about working or training in the UK

 

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