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The availability of NHS services – ‘getting the care you need’. A key theme in the NHS Plan.

Acute NHS Trusts provide services such as accident and emergency departments, inpatient and outpatient medicine and surgery and in some cases very specialist medical care. They provide secondary care, ranging from relatively small district hospitals to large city teaching hospitals.

The word acute, in health terms, generally refers to physical illnesses and conditions (usually short-term) which require diagnostic tests, treatment and follow-up care. (There is longer-term care provision but most inpatient stays are of a short duration.)

Acute services
Medical and surgical treatment provided mainly in hospitals and minor injury units.

Acute Trust
An NHS organisation providing acute hospital-based services e.g. North Devon District Hospital

When a patient is admitted to hospital.

Ambulatory Care
Services where people do not stay in hospital overnight e.g. outpatients, X-ray, day surgery and medical diagnostics.

Audit Commission
An independent public body responsible for ensuring that public money is spent economically, efficiently, honestly and effectively in the areas of local Government, housing, health, criminal justice and fire and rescue services.


Bed Blocking
The number of beds in a ward or department, which refers to staffed beds used overnight. Where patients, fit to be discharged from hospital, are not discharged due to lack of appropriate facilities in the community. This leads to delayed discharge.
Booked Admissions – is becoming ‘Choose and Book’
The NHS national booked admissions scheme is a style of booking system which enables patients to arrange convenient out-patient and in-patient admission dates, leading to fewer cancelled operations, less bureaucracy and more efficient use of NHS time and resources.


Clinical governance
A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. The Healthcare Commission monitors clinical governance and each Trust has a clinical governance committee.

Clinical team
A clinical team may comprise of doctors, nurses and other health staff who provide services of a particular type, e.g. audiology (hearing services).

A health professional who is directly involved in the care and treatment of patients, for example, nurses, doctors, physiotherapists.

The process by which the needs of the local population are identified, priorities set and appropriate services purchased and evaluated. Primary Care Trusts do not provide all the healthcare services needed for their population. They ‘buy in’ or commission services from other ‘providers’, such as local hospitals, mental health trusts and voluntary organisations. Some General Practices may chose to take on a commissioning role from 2005-06.

Community Care
Care, particularly for older people, people with learning disabilities or a mental illness, which is provided outside a hospital setting.

CCU – Coronary Care Unit
Dedicated unit for specialist (heart) coronary care.

Corporate governance
A framework through which organisations are accountable for standards in conducting corporate business, including meeting statutory financial duties.

Primary Care Trusts (and other Trusts) have Boards, which are responsible for Corporate Governance. Their Boards hold meetings in public and publish an Annual Report.


Day Case Admission
Day case patients are admitted for care or treatment that can be completed in a few hours and does not require a hospital bed overnight.

Delayed Discharge Rate
The proportion of patients occupying a hospital bed who are ready for discharge.

Demographic Trends
Changes in age, sex and size of the population over time.

Department of Health
The Government body responsible for delivering a fast, fair, convenient and high quality health and social care service in England. See website:

DTC – Diagnostic and Treatment Centre
New centres, established in 2004, to increase the number of operations performed in the NHS.


Elective Admission
A patient who is admitted from the waiting list.

Emergency Admission
A patient admitted to hospital at short notice because of clinical need or because alternative care is not available.


Finished Consultant Episode: The point at which a patient is discharged from the care of a particular consultant.


GMS – General Medical Services

GPs – General Practitioners
These are doctors who provide family health services to a local community. They are usually based in a surgery or GP practice and are often the first port of call for most patients with a concern about their health. Most are employed as independent contractors to the NHS. A growing number are salaried.


Healthcare Commission
An independent Government body that carries out reviews of NHS organisations and publishes reports about the quality of health services throughout England and Wales. By 2008 it will have merged with the body carrying out the same role for Social Services. It is also now part of the Complaints system.

Health inequality
The gap in health status and in access to health services, between different social classes and ethnic groups and between populations in different geographical areas.

HOSC – Health Overview & Scrutiny Committee
The County Council has been given The overview and scrutiny of health (Local Government Act 2000) and this is a relatively new area of responsibility for councils.

The diversity and range of health related services provided to local people requires that the Committee works closely with partner organisations, including district councils, the NHS and voluntary sector. The new Patient and Public Involvement Forums (PPIF) also have a key part to play in ensuring that health services are responsive to the issues raised with them by patients and the public.


Integrated Care Pathway
Improving the patient’s route for treatment through different health and social care systems by combining resources and co-ordinating working methods to prevent holdups and jams.

ICRS – Integrated Care Records Service
This is part of the NHS’ national strategic programme for IT and comprises of the Electronic Health Record (lifelong patient health records) and the Electronic Patient Record (updating records at source).

A patient who has been admitted to hospital for treatment and is occupying a hospital bed.

ITU – Intensive Care Treatment Unit or
HDU – High Dependency Unit
Dedicated unit for intensive care of patients. Also known as High Dependency Unit.

Intermediate care
Nursing home, rehabilitation or home care services provided to ease the transition of the patient from hospital to home, from medical dependence to functional independence and to prevent unnecessary hospital admission and effective rehabilitation services closer to home.


Length of Stay
The time from admission to discharge, based on the number of nights in hospital.

LDP – Local Delivery Plan
Commenced in April 2003, this new NHS planning system has been designed to allow Trusts to produce three-year plans, called Local Delivery Plans. They identify milestones for each priority area over the three-year period and will be a ‘live’ document, which will be amended following quarterly and annual review.

Local Health Economy
The NHS organisations including GP practices, and voluntary and independent sector bodies involved in the commissioning, development and provision of health services for particular population groups.

LIG – Local Implementation Group
These groups are set up to work on the National Service Framework standards and guidance and make sure that they happen within a Trust’s area. The LIG membership often includes a cross-section of health, social care, voluntary services and patient, carer and public. Other groups have similar titles and may be countywide i.e. the NSF Mental Health, Local Implementation Team (LIT)

LMC – Local Medical Committee
Statutory representative body for all GPs in a particular area. NHS authorities must consult the LMC on issues ranging from GP terms of service to investigations into professional conduct.


A special X-Ray examination of breast tissue used in the early detection of breast

MIU – Minor Injuries Unit
A Minor Injuries Unit provides special treatment for a wide range of minor injuries and is staffed by specially trained and experienced. Patients with minor injuries do not have to queue behind more seriously ill or injured patients so they are treated more quickly than in an Accident & Emergency department. Nurses in the Minor Injuries Unit can treat adults and children with a wide range of injuries, including: cuts, bruising and grazes, sprains and strains, minor burns and scalds, arm and leg injuries, splinters, minor broken bones, minor bumps to the head, nose injuries, bites and stings. It is advisable to call the hospital before you attend to check opening times.

MDT – Multi Disciplinary Team
This is a team of professionals drawn from various disciplines within the Trust that combine their expertise to the benefit of patients.

MRI Scanner – Magnetic Resonance Imaging Scanner
A scanner that produces images of parts of the body by the use of strong magnetic field and electromagnetic waves.

MRSA – Methicillin-Resistant Staphylococcus Aureus
An infection that is difficult to treat.


NHS – National Health Service
The National Health Service or NHS as it is more commonly known, was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay. The NHS is funded by the taxpayer and managed by the Department of Health, which sets overall policy on health issues. It is the responsibility of the Department of Health to provide health services to the general public through the NHS.

NHS Direct
This is a telephone helpline and website that gives access to a 24-hour nurse advice and health information service, providing confidential information on: what to do if you or your family are feeling ill; particular health conditions; local healthcare services such as doctors, dentists or late-night opening pharmacies, and self-help and support organisations. If you need health information or advice at any time of the day or night, call NHS Direct on 0845 4647.

NHS Number
This is a unique number that will be given to every baby at birth and will be used as a NHS identifier for life.

NHS Trusts
NHS organisations that provide health care.

NHS Plan
A 10-year plan for investment and reform in the NHS with sustained increases in funding. The purpose of the NHS Plan is to give the people of Britain a health service fit for the 21st century designed around the patient. (Published July 2000)

NICE – National Institute for Clinical Excellence
The body that is responsible for defining what is good for us. Best known as the body that approves (or otherwise) the introduction of new treatments. It is introducing a patient panel, to provide greater public input. Body set up in April 1999 to decide which health treatments and technologies – from drugs to artificial hips – should be available on the NHS.

NPSA – National Patient Safety Agency
The NPSA is a Special Health Authority created in July 2001 to co-ordinate the efforts of the entire country to report, and more importantly to learn from mistakes and problems that affect patient safety. Its aim is to improve the safety and quality of care through reporting, analysing and learning from adverse incidents and ‘near misses’ involving NHS patients.

NSF – National Service Framework
There are a range of NSFs, which establish a set of minimum national standards of clinical quality and access to services in a series of major care areas and disease groups, including mental health, diabetes, older people, coronary heart disease, physical disability & brain acquired injury and long term conditions. The aim is to drive up performance and decrease geographical variations.

Needs Assessment
The process by which a PCT will judge the health status of its population and determine what services should be provided locally to fill in the identified gaps in service provision.

Nursing home
A residential home that has qualified nursing staff available to provide nursing care.


Ordinary Admission
An admission, including one that is an emergency, where the patient is expected to remain in hospital for at least one night.

OOH – Out of Hours
The new contract allows GPs to opt out of 24-hour responsibility for patient care.
(630pm to 8am weekdays plus all weekends and bank holidays)

A patient who attends hospital for treatment, consultation and advice but does not require a stay in hospital.


Palliative care
The care of patients whose disease is no longer curable, eg cancer, HIV/Aids, and motor-neurone disease. It takes into account the physical, psychological, social and spiritual aspects of care of patients, with the aim of providing the best quality of life for them.

PALS – Patient Advice and Liaison Service
This service is available in every NHS Trust and Primary Care Trust and provides advice and support to patients, friends and carers, as well as resolving problems and giving information about the NHS. North Devon PALS can be contacted by phone: 01271 314090 or email:

PEC – Professional Executive Committee
The role of the Primary Care Trust’s PEC is to bring a professional perspective from both health and social care to the decision-making processes of the PCT Board. At present, the membership includes clinical practitioners (dentist, GPs, nurse, allied health professional representative, representative clinician from the acute Trust hospital) Pharmacy representative, PCT executive directors, and a representative from Social Services

PPIF – Patient and Public Involvement Forum
An independent Patients’ Forum, which monitors the work of each NHS Trust and Primary Care Trust; may inspect all premises that NHS patients use; has an open invitation to all PCT Board meetings; and report on the quality of patient services of each Trust. A working agreement is in place between PPIFs and Trusts.

PTS – Patient Transport Service
The PTS transports patients with non-urgent conditions to and from hospitals and day care centres, and carries out non-urgent inter-hospital transfers.

Primary Care
Primary care is usually the first place people go for health advice and treatment, outside of hospital. The service is provided near to or in a person’s home by GPs, nurses, therapists, dentists pharmacists and opticians. This group of health professionals is seen as the ‘gatekeepers’ of the NHS, providing health promotion, care and treatment, and referring to and liaising with hospitals and other care providers. All the professionals working in primary care need to be skilled in their treatment and knowledgeable about the needs of the people they are providing services for. This will ensure that all treatment, advice and support is of the highest quality.

PCT – Primary Care Trust
A NHS body that has responsibility for the planning and securing of health services in a local area. It must ensure the availability and accessibility of GPs, dentist and other health providers, as well as hospital treatment, to all in the community it covers.

Primary Health Care Team
Professional staff working in or attached to general practices to provide a range of health care needs. Includes GPs, community nursing staff, pharmacists, dentists and opticians.


Referral patterns
These describe the number and frequency of patients referred. For example, the number of patients referred to hospital by GPs.

RGN – Registered General Nurse

Risk – Every medical intervention has a risk, however small it may be. It is one of the factors affecting patient choice.

Royal colleges
Statutory organisations that set and monitor professional standards for medical services.


Secondary care
Specialist care typically provided in a hospital setting or following referral from a primary or community health professional. Hospitals are also sometimes referred to as ‘Acute Trusts’ or ‘DGHs’, meaning District General Hospital.

SLA – Service level agreements
Agreement (contract) between organisations and/or agencies setting out how
services must be provided, what their standards will be and how monitoring will take place.

An individual who uses, requests, applies for, or benefits from health or local authority services. They may also be referred to as a client, patient or consumer.

SAP – Single Assessment Process
The purpose of SAP is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs, and that professional resources are used effectively. In pursuit of these aims, SAP should ensure that:

Individuals are placed at the heart of assessment and care planning, and these processes are timely and in proportion to individuals’ needs.
Professionals are willing, able and confident to use their judgement.
Care plans or statements of service delivery are routinely produced and service users receive a copy.

Professionals contribute to assessments in the most effective way, and care co-ordinators are agreed in individual cases when necessary.

Information is collected, stored and shared as effectively as possible and subject to consent.

o Professionals and agencies do not duplicate each other’s assessments.
Special Health Authorities
The National Institute for Clinical Excellence, the National Patient Safety Agency, the National Blood Authority etc.

People who have an interest in an organisation, its activities and its achievements, including customers, partners, employees, shareholders, owners, government and regulators. Modern consultation is usually ‘stakeholder-focused’.

Statutory Organisations
Organisations with powers to fund or provide services, such as local authorities, NHS Trusts and PCTs.

SHA – Strategic Health Authority
In April 2001, 28 new authorities were created from the 95 existing health authorities to provide strategic management support for primary care trusts and hospitals in improving NHS performance. The local SHA is the Southwest Peninsula SHA, based in Saltash near Plymouth.


Tertiary Care
Care of a highly specialist nature typically provided in regional centres

Therapy services
These are provided by ‘allied health professionals’ who include dieticians, hearing therapists, occupational therapists, physiotherapists, podiatrists (chiropodists) and speech & language therapists.


Unitary authority (council)
A new type of local authority that delivers the full range of local government services itself. In the traditional set-up, still widely used, the functions are split between county councils (including social services and education) and district/borough/city councils (including housing and planning).


Walk-in Centres
NHS Walk-in Centres offer fast and convenient access to a range of NHS services, including health information, advice and treatment for a range of minor illnesses (coughs, colds, infections) and minor injuries (strains, sprains, cuts) self-help advice and information on the NHS, social services and other local healthcare organisations.

Whole Systems Approach
Term for a strategic, integrated approach to planning and delivering services. A local whole system of care covers all local health and social service provision and any other service that impacts upon health and social care.

Types of Staffing Grades


Consultant Qualified and registered with a specialist interest.

House Officer (HO) Doctor in Training. Just qualified, not registered.

Junior Doctor, not yet sure of speciality.

Specialist Registrar (SpR) Grade below Consultant.


Nursing Grades go from A to I, I being the highest. Unqualified Nursing staff are typically at A and B grade, and qualified staff are anything above D grade.

Nurse Consultant: The Nursing equivalent of a medical Consultant Grade. Nurse Consultant’s spend a minimum of 50% of their time working directly with patients. The rest of the time is devoted to managing and developing the nursing workforce. Nurse consultants are responsible for developing personal practice, being involved in research and evaluation and contributing to education, training and development.

Nurse Practitioner: The Royal College of Nursing describes the Nurse Practitioner as an individual who can diagnose and treat a broad spectrum of illness. What differentiates a Nurse Practitioner from any other qualified nurse is the ability, and authority, to diagnose and then treat.

Nurse Specialist: A Clinical Nurse Specialist can be defined as ‘a recognised, accountable expert and staff resource who can be called upon to lead or be consulted, because of her in-depth nursing knowledge and skill in a particular specialist field of clinical nursing practice’ Castledine (1992). An example might be in one of the areas of Chronic Disease Management, i.e. Asthma, CHD (Coronary Heart Disease) Diabetes or Epilepsy.

Last updated: October 3, 2017