Myths and Truths about the UK National Health System
I am a great believer in countries learning from others. That is why as a Spanish pharmacist, I did my clinical traineeship in the United Kingdom and I came to the United States to study for my PhD. Not surprisingly, I usually find myself explaining to my American colleagues how the US healthcare system could benefit from embracing some of the European policies. Similarly, whenever I interact with healthcare providers in Europe, I wish they learned from American healthcare executives.
In my future posts, I will be addressing cross-national differences in health policy and, in particular, discussing the European policies and programs from which I believe American health insurance providers and managed care organizations could benefit. In this post, I plan to summarize the impressions I got from my clinical traineeship in the UK (I will not discuss well-known matters such as waiting lists or their use of cost-effectiveness analysis, but I will rather focus on my insider impression on some issues of daily clinical practice).
By the time I was finishing my pharmacy degree, I was already interested in health services research and health policy. Because in Europe the UK National Health System (NHS) is considered a reference in this field, I decided to complete my required clinical traineeship in the UK. I did half of my traineeship in the North Middlesex University Hospital and half in a branch of the company Green Light Pharmacy, both in London. Surprisingly, my experience as an insider in the NHS was far different from what I expected. I realized that in terms of micromanagement, the NHS is far from a perfect system; however, some of its primary care–based public health interventions are outstanding.
The impression I got from the NHS during my training in the North Middlesex Hospital was that of a public healthcare system with indiscriminate cost-saving policies, where you would never like to receive care if you got sick. On a daily basis, I would see:
Patients waiting for 3 hours to get their outpatient medications or an outpatient chemotherapy unit requesting drugs 24 hours before they were needed and still not getting them on time.
Medical wards running out of beta-blockers on the weekends and, therefore, dozens of patients missing their dose.
At the end of the financial year, procurement would order as few supplies as possible, which would lead to constant shortages of many drugs, especially off-formulary drugs. Because the formulary was very restrictive and most off-formulary drugs were under stocked and only ordered as needed, patients on common drugs such as mirtazapine or escitalopram would have to miss their doses until the medication was received from the supplier.
However, my training in Green Light Pharmacy gave me the opportunity to get involved in some outstanding health interventions funded by the NHS, such as:
Smoking cessation counseling and needle exchange programs.
New Medicine Service and the Medicines Use Review. The main objectives of these programs, which are completely covered by the NHS and provided by community pharmacies, are to promote the adequate use of medicines, detect side effects at an earlier stage, and promote adherence. I will discuss these 2 programs in more detail in a future post.
Preventive medicine services, such as contraceptive drugs, were completely covered by the NHS. This generous coverage contrasts with the recent controversy in the US on the mandated coverage of contraceptives; abortion rates of the 2 countries contrast, as well.
In summary, I received a very dichotomous impression of the NHS. On the one hand, indiscriminate cost savings at the acute care level would unarguably affect quality of care and push patients toward private care. On the other, NHS is undeniably a referent on preventive medicine and primary care, which are, in my opinion, the “jewels in the crown” of the NHS.
For full disclosure, I will acknowledge that my enthusiasm for these programs is probably biased by the manner in which I got to know them. Green Light Pharmacy is a chain of community pharmacies whose motto is “we care about patients.” With high-standards of care, it is staffed by a group of healthcare professionals sincerely committed to patient well-being and is probably the most patient-centered practice of pharmacy I will ever be involved in. Whenever I see asthmatic patients who cannot distinguish regular from as-needed inhalers, or patients taking statins in the morning, I think of Green Light Pharmacy, because I know no single patient will walk out of these pharmacies with such mistakes.