Other NHS secondary care

Secondary care means treatment provided in a hospital, generally for health conditions requiring specialist medical knowledge. (HIV treatment is part of secondary care.)

Nonetheless, what is provided by primary care and secondary care varies not only between areas, but also between GP practices in the same area. Secondary care does not cover ‘social care’ (see below). The distinction between the two is often difficult to define, for example when caring for the elderly or those with dementia.

In England, secondary care is currently paid for (or commissioned by) primary care trusts (PCTs) and provided by NHS trusts (including acute trusts, hospital trusts and foundation trusts). The Conservative/Liberal Government plans to replace PCTs with GP commissioning consortia.

In Scotland and Wales secondary care is both paid for and provided by Health Boards. In Northern Ireland care is commissioned by the Health and Social Care Board and provided by Health and Social Care Trusts.

Yes. Most NHS secondary care clinics do not have the open-access policy of HIV and sexual health clinics. For almost all secondary NHS care you need a referral, but this can be from a GP, other primary care worker or another NHS professional. Staff at an HIV clinic can refer patients direct to other NHS clinics. In some parts of England clinics may request that patients ask their GPs to refer them, as the place the referral comes from can affect the funding. The person making a referral should offer a choice of appropriate services.

Yes, generally, but this is not always strictly enforced. Some highly specialist services are only provided by a few hospitals and will have patients from around the country. In England, patients will usually be given referrals to hospitals in the area of the local primary care trust, but sometimes also to foundation trust hospitals, which could be anywhere in the country.

For people with entitlement to NHS care, there is no charge for hospital treatment. While people staying in hospital do not have to pay prescription charges, most outpatients pay the same charges as in primary care (see below for details).

The rules are the same as for HIV medical care, as described above and in the chapter on access to healthcare. In addition, a number of services should be provided free of charge to all, regardless of immigration status:

• treatment for a long list of infectious diseases, including tuberculosis, viral hepatitis, pandemic influenza, cholera, smallpox and typhoid

• family-planning services

• diagnosis and treatment of sexually transmitted infections

• treatment provided in an Accident & Emergency or casualty department

• treatment provided to those detained under the Mental Health Act 1983.

People on a low income, regardless of immigration status, may be entitled to free prescriptions and help with other health costs.

Under the NHS Act 2006, the Secretary of State for Health has a duty to provide a comprehensive health service, but this will involve making ‘reasonable’ decisions about the best use of limited resources. Similar legislation exists for the other countries of the UK.

The NHS constitution includes a number of ‘rights’ for people entitled to NHS care which also apply to secondary care. This includes targets for the waiting time for appointments, but the Conservative/Liberal Government is likely to abolish many of these. The length of the waiting time varies between the four countries of the UK. Patients have the right to drugs and treatments that have been recommended by NICE (National Institute for Health and Clinical Excellence), if their doctor says the treatment is clinically appropriate.

Methods of patient involvement and complaints are the same as for HIV medical care (see above).