Medical Receptionists and Secretaries Handbook 1st Edition
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Contents
Preface ix
Contributors x
Acknowledgements xi
1 The National Health Service 1
History 1
Structure of the NHS 6
The NHS Plan 12
Resource allocation in the NHS 22
Delivering care 25
Mental health services 32
Public health 34
The NHS, the regions and devolution 36
Summary 40
References 42
Useful websites 43
2 Patient (customer) care 45
The medical receptionist and secretary 45
Putting patients first 46
Complaints within the health service 51
The complaints procedure 53
Developing your personal effectiveness 61
Patients’ rights 65
Access to healthcare 66
Total quality in medical practice 74
Customer care: involving patients and the public 75
Summary 76
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3 Communication 77
Introduction 77
Listening 78
Use of questions in communicating 79
Methods of communication 80
Barriers to communication 88
Confidentiality 90
4 Law, ethics and medicine 91
Introduction 91
History of ethics and etiquette 91
Medical ethics and etiquette 92
Doctors’ duties 96
Patients’ rights 97
The regulatory bodies and their role 101
Summary of medical ethics and etiquette 103
Legal aspects 104
Employment rights 113
Certification 118
Health and safety at work 120
Summary of legal aspects 129
Useful websites 129
5 Health and safety in a clinical environment 131
Introduction 131
First aid at work 132
Hazardous substances in the workplace 132
Hepatitis and AIDS 134
The NHS National Patient Safety Agency (NPSA) 136
Fire Precautions Act 1971 136
Clinical risk management 137
Coping with aggression and violence 138
Summary 142
Useful websites 142
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Contents v
6 Practical reception skills in general practice 143
Introduction 143
Record keeping and general administration 146
Information technology (IT) 151
Summary 163
7 The hospital service 165
The patient’s route through the hospital 165
Outpatient appointments 167
Admissions from the waiting-list 169
Accident and Emergency admissions 169
Home from hospital support 170
Day cases and ward attendees 170
The hospital team 171
Clinical audit 174
Star ratings 174
What is a medical record? 175
Case notes 175
Master index 178
Filing room/medical records library 178
Medical records procedures for departments 179
Retention of records 181
Destruction of medical records 181
What’s new in medical records? 181
NHS Care Records Service 182
The role of the secretary in hospital 182
8 Private medicine 185
Introduction 185
Changes in the relationship between the NHS
and the private sector 185
Private clinic or hospital 186
The secretary in private practice 191
Summary 193
9 Forms, fees and finances in general practice 195
Introduction 195
Contracting 195
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Finance 197
Quality and Outcomes Framework 198
Practice income 199
Scotland 201
Wales 203
Northern Ireland 204
10 Using information technology 207
What’s in the box: basic terminology 207
How a computer works 208
Computers in general practice 210
Electronic medicine 214
Computers in hospitals 216
Information, management and technology 217
Getting the best from the computer 223
The barrier created by the computer 223
Maintaining security 223
Computers and the law 225
Useful websites and references 226
11 Medical terminology and clinical aspects 227
Introduction 227
Pathology and X-ray examinations 228
Prescribing and drugs 228
Nurse prescribing 234
New developments in pharmacy 235
12 Primary healthcare services and social
services 237
Introduction 237
Trusts and fundholding 239
Primary care trusts 239
The patient and the receptionist 242
The primary healthcare team 243
Care trusts 250
Health promotion 253
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Local authority social services 254
Summary 259
Useful websites 259
13 Audit, health economics and ensuring quality
for the medical receptionist and secretary 261
Introduction 261
Audit 262
Health economics and cost-effective medicine 263
Private Finance Initiative 264
Clinical governance 265
National Institute for Clinical Excellence (NICE) 265
National Clinical Assessment Service (NCAS) 266
National Service Frameworks (NSFs) 266
Patient surveys 266
Summary 267
Conclusion 268
14 Training and development 269
Introduction 269
Why train? 270
Training strategies 270
Self-development 271
The NHS Plan 271
National Vocational Qualifications (NVQs) 272
The NHS University (NHSU) 273
Summary 273
15 Complementary medicine 275
Introduction 275
Acupuncture 275
Alexander technique 276
Aromatherapy 276
Chiropractic 276
Homeopathy 277
Hydrotherapy 277
Hypnotherapy 277
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Osteopathy 278
Reflexology 278
Summary 279
Appendix 1 Further reading and reference
books 281
Appendix 2 Hippocratic Oath 285
Appendix 3 Training programmes 287
Appendix 4 Medical terminology 289
Appendix 5 Immunisation schedules 303
Appendix 6 Incubation periods of some
infectious diseases 305
Appendix 7 Abbreviations of qualifying degrees
and further qualifications 307
Appendix 8 Useful addresses 313
Appendix 9 Statutory organisations 317
Appendix 10 Information and support groups 321
Appendix 11 Measurements in medicine 333
Appendix 12 International organisations 335
Appendix 13 Professional organisations relating
to complementary medicine 337
Appendix 14 The Wanless Report 339
Index 341
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Contents ix
Preface
Once again, I am delighted to have the opportunity to revise the Medical
Receptionists and Secretaries Handbook in readiness for the publication of
its fourth edition.
The continued escalation of changes in the National Health Service
since 2001 has given me the challenge of a continually changing situation!
However, I have endeavoured to ensure that the information contained in
this edition is as up to date as possible.
More and more reforms, quality issues and advances in information
technology mean that health service managers as well as healthcare pro-
fessionals rely on the support of receptionists and secretaries working as a
team in healthcare provision to give an efficient, high-quality service to
both patients and the public.
These are times of continuing change for all involved in the provision
and delivery of healthcare, based on identified patient needs, whether
working in the NHS, social care or the private sector. It is therefore vital
that they have a knowledge and understanding of what these changes
involve.
I cannot over-emphasise the important role of the medical receptionist
and secretary in providing the vital link between patients and healthcare
professionals in the NHS and private sectors.
Mari Robbins
January 2006
ix
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Contributors
Sally Storey
Director of Human Resources and Organisational Development
Queen Elizabeth Hospital NHS Trust
Woolwich
London
Roy Lilley
Former Trust Chairman
Writer and broadcaster on NHS Issues
x
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Contents xi
Acknowledgements
My acknowledgements go to Ivan Chu (Health and Safety Adviser,
Bournewood Community and Mental Health Trust), Sue Dunlop
(Secretary to Professor J Cobb and Mr G Etherington, Harley Street,
London), Marjorie Lear (Practice Manager, Oxshott Medical Centre,
Surrey) and Barbara Stewart (Pharmacist, West Sussex).
In revising material for this edition, I have found both the NHS and
the Department of Health websites an invaluable source of current
information.
xi
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1
The National Health
Service
History
Prior to the National Health Service Act of 1946, healthcare in the UK had
developed in an ad hoc manner.
The medical profession had, since the latter part of the nineteenth
century, gradually acquired social respectability, legal status and
economic strength. The concept of public responsibility for the health of
individuals can be traced back to 1834, when the Poor Law Amendment
Act was passed, which established that parish workhouses should provide
sick wards where the able-bodied inhabitants could be treated when they
became unwell. However, as the health of the community had been
severely neglected, it became necessary for the workhouses to admit the
sick paupers from the parish to their wards – people who had hitherto
been left to die as they were unable to obtain medical care themselves. By
1848 the demand for institutional care was such that the sick wards of the
workhouses had become entirely devoted to sick paupers. The Public
Health Act of that year acknowledged for the first time the State’s
responsibility for institutional care.
The quality of medical care available improved as scientists made
important discoveries. Florence Nightingale, in her contribution to both
nurse training and hospital planning, revolutionised the standards of
institutional care. Largely due to the philanthropy of the well-to-do and
the moral obligations of the charitable and religious bodies, the end of the
nineteenth century heralded the opening of many voluntary and private
hospitals. Voluntary hospitals were financed through subscriptions and
donations, and attracted the services of skilled doctors, some of whom,
acting on their social conscience, often treated patients without payment.
The beginning of the twentieth century saw the advent of insurance
schemes which enabled individuals to protect themselves against sickness
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2 Medical receptionists and secretaries handbook
and injuries which might involve them in expensive medical care or affect
their capacity to work.
However, despite the progress that was being made, the standard of
medical and nursing care emerging throughout the country was
inconsistent in both quality and availability.
At the end of the First World War, the first Ministry of Health was
established, which together with various reforms provided the stimulus
for a nationally organised health service. The Second World War brought
about further reforms and the publishing of the Beveridge Report in 1942
with its recommendations that formed the basis for the post-war system
of social welfare services, and the provision of a comprehensive system
of healthcare. Sir William Beveridge recommended that the term
‘comprehensive’ meant that medical treatment should be available for
every citizen, both in the home and in hospital, and provided by general
practitioners, specialist physicians and surgeons, dentists, opticians,
nurses and midwives. He also advocated the provision of surgical
appliances and rehabilitation services.
Thus the National Health Service (NHS) became effective in 1948,
with the aim of improving the health of the people, providing healthcare
through a system of public finance and public provision and, by eradicat-
ing disease, reducing the demand for free healthcare services. The NHS
took over all hospitals, convalescent homes and rehabilitation units,
offering consultants contracts as full-time salaried employees. General
medical practitioners providing family doctor services were encouraged to
sign contracts to provide family practitioner services for patients in their
area, and were permitted to remain self-employed but paid by the health
service on a fee basis.
Medical services fell into the following three functional areas:
• those concerned with the sick person in the community
• those concerned with the sick person in an institution
• those concerned with preventive medical services.
They were identified with the following services:
• general practitioner services
• hospital services
• services provided by the local authority (excluding school health
services).
The hospital service was administered by regional hospital boards, which
absorbed all of the public and voluntary hospitals in the country. The
national planning of hospital requirements was established.
Teaching hospitals in England and Wales remained relatively indepen-
dent with their boards of governors who were responsible directly to the
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The National Health Service 3
Secretary of State, but they were linked only to the regional hospital
boards in that there was one teaching hospital in each region.
General practitioner services were organised through executive
councils, which administered the family doctors’ contracts and dental,
pharmaceutical and ophthalmic services. The local health authorities
administered the preventive services, ambulance services, etc.
The main advantage of the NHS was that it had brought together
services which had previously been under the control of independent
organisations. However, administration of this tripartite arrangement was
far from satisfactory, and in an attempt to improve the co-ordination of
healthcare between hospital boards, local executive councils and the type
of care provided by local authorities, the 1974 National Health Service
Reorganisation Act came into force.
Reorganising the NHS
The 1974 reorganisation brought about major changes in the way in
which the NHS was organised and structured.
The changes introduced to the NHS the concept of planning and
improvement in personnel and manpower controls.
One issue that arose from this reorganisation and which remains today
was the creation of the Health Service Commissioner role.
Health Service Commissioner (Ombudsman)
The Health Service Commissioner (Ombudsman) undertakes independent
investigation into complaints about the NHS, as well as Government
departments and other public bodies. It is completely independent of the
NHS and the Government. In the NHS the Ombudsman investigates com-
plaints that a hardship or injustice has been caused by its failure to
provide a service either as a result of a failure in service or due to mis-
administration. The Ombudsman also looks into complaints against
private health providers, but only if the treatment was funded by the NHS.
Complainants can only refer their cases to the Ombudsman after failing
to achieve a resolution with the organisation or practitioner they are com-
plaining against – for example, because of delays in dealing with a com-
plaint locally or failure to obtain a satisfactory answer to a complaint. The
Ombudsman can consider complaints from a patient, a close member of
the family, or a partner or representative if the patient is unable to act for
him- or herself, or from someone who has suffered injustice or hardship
as a result of the actions of the NHS. A complaint will normally only be
considered within a year of the events which gave rise to it.
The Ombudsman publishes detailed reports of investigations which
identify common themes in complaints. The reports are intended to be
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4 Medical receptionists and secretaries handbook
used as training tools to improve services, and chief executives are asked
to ensure that all clinical directors and complaints managers are made
aware of them. They are also considered by the House of Commons public
administration committee.
Further information can be found at www.ombudsman.org.uk
The 1982 reorganisation
The 1982 reorganisation aimed to simplify the health service and deliver
greater efficiency and accountability of the service to Parliament. It also
aimed to strengthen local-level management.
The NHS
The NHS is now the largest organisation in Europe, and is recognised as
one of the best health services in the world by the World Health
Organization, but there need to be improvements to cope with the
demands of the twenty-first century.
The NHS is mainly financed through taxation, and therefore relies on
Parliament for funding, and is accountable to Parliament through the
Secretary of State for Health. Parliamentary procedures ensure that the
Government has to publicly explain and defend its policies for the NHS.
The NHS is changing the way in which it works in order to ensure that
patients always come first. Figure 1.2 indicates how the new structure
works in England, and details of the health service in other parts of the
UK can be found at www.nhsuk/Wales(Scotland/NorthernIreland:)
Department of Health (DH)
This is the department that supports the Government in improving the
health and well-being of the population. It is responsible for:
• the NHS
• social services
• public health.
The DH negotiates levels of NHS funding with the Treasury and allocates
resources to the health service.
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The National Health Service 5
Health and Social Care Health and Social Care
Standards and Quality Strategy and Business Development Services Delivery
Health Protection, Corporate Management
Communications Access
International and Development
Health and Scientific
Development
Finance and Investment
Research and
Development
Workforce
Health Improvement
International Systems
Quality and Standards User Experience and Strategy and National
Involvement
Programme Delivery
Care Services
Programmes and
Performance
Regional Public Health
Group Business Team Group Business Team
Figure 1.1 Structure of the Department of Health.
It can be seen from Figure 1.1, which demonstrates the present struc-
ture of the DH, that it is divided into three groups:
• health and social care standards and quality
• strategy and business development
• delivery of health and social care.
The DH is currently involved in an 18-month programme of change
that will reduce (or transfer) its staff by nearly 40%. Some posts will be
abolished and others will be transferred to other national bodies. This
demonstrates the Government’s policy of shifting power from Whitehall
to frontline healthcare personnel. The new role of the DH will be to
provide strategic leadership to NHS and social care organisations by, for
example:
• setting the overall direction
• ensuring that national standards are set
• securing resources
• making major investment decisions
• driving choice for patients and users.
