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An Overview of Scotland’s
National Health Service
Aziz Sheikh
Professor of Primary Care Research & Development and Co-Director,
Centre for Population Health Sciences, The University of Edinburgh
Harkness Fellow in Health Care Policy and Practice, Division of General
Internal Medicine and Primary Care, Brigham & Women’s
Hospital/Harvard Medical School
PNHP Annual Meeting, November 2, 2013
Location and population size
Political, financial and structural
 Health is devolved from the UK government to the Scottish
 Publicly funded healthcare system with funds raised from general
taxation – overall taxation contribution is on a sliding scale ranging
from 0 – 45% (was 50% until April 2013)
 Annual budget of £12 billion (approx. $19 billion)/year – 9.6% of GDP
 Care essentially free at the point of delivery for all, including
prescriptions (co-pay for adult dentistry and optometry)
 Delivered through:
 14 regional health boards
 And a variety of specialist health boards e.g. NHS24, NHS Health
Scotland (Public health), Health Improvement Scotland, Scottish
Ambulance Service, NHS Education for Scotland etc.
Primary health care
 General practitioners and allied health professionals (e.g. dentists,
opticians and community pharmacists) are employed as
independent contractors and are responsible for primary care
provision: approx 12,000)
 General practitioners operate as family physicians and are the
main co-ordinators or “gatekeepers” to care
 90% of all health care interactions take place in primary care
 Paid through a combination of:
 Capitation fees
 Service fees
 Pay for performance (Quality Outcomes Framework)
 Out-of-hours care provided through NHS24 (telephone helpline)
and out-of-hours consortia
Secondary and tertiary care provision
 Overwhelming majority of specialist care is provided
by consultants and their teams from NHS hospitals
 These consultants and their supporting teams are
employed directly by NHS Scotland
Key demographic challenge
Our ‘2020 Vision’
Our vision is that by 2020 everyone is able to live longer healthier lives at home, or
in a homely setting.
We will have a healthcare system where we have integrated health and social care,
a focus on prevention, anticipation and supported self management. When hospital
treatment is required, and cannot be provided in a community setting, day case
treatment will be the norm. Whatever the setting, care will be provided to the highest
standards of quality and safety, with the person at the centre of all decisions. There
will be a focus on ensuring that people get back into their home or community
environment as soon as appropriate, with minimal risk of re-admission.
Route map for 2020 vision:
12 priority areas for action
Improving quality of care through a focus on:
Increasing the role of primary care
Integrating health and social care
Improving safety in all healthcare environments
Improving deliver of emergency and unscheduled care
People powered health and care services
Improving support and treatment of those with
chronic disorders
Route map for 2020 vision:
12 priority areas for action
Improving population health through a focus on:
7. Early years
8. Reducing health inequalities
9. Preventive measures on alcohol, tobacco, dental
health, physical activity and early detection of cancer
Route map for 2020 vision:
12 priority areas for action
Securing the value and financial sustainability of health
and care services:
10. Establish a vision for health and social care workforce
11. Increasing investment in new innovations which
improve quality, reduce costs and provide growth to
the Scottish economy
12. Increase efficiency and productivity through more
effective use of unified approaches coupled with local
solutions and decision making
Scotland’s linkable databases
Dental SMR13
Neonatal Record SMR11
Outpatients SMR00
Child health surveillance
Community care SMR50
Hospital Admissions SMR01
GP consultations
Mental Health SMR04
Cancer Registry
Cancer registrations SMR06
Example: Effectiveness of H1N1
vaccine for pandemic influenza
Preparing for the next pandemic…
Core funding in place and release of
additional funds at first signs of
pandemic influenza
This has enabled:
Creation of data structures to
permit real-time evaluations
Permissions and approvals for
data linkage and analysis
Development of detailed analysis
and reporting plans
Further details: [email protected]