Healthcare Systems, Policy and Practice in the United Kingdom


Healthcare provision in the United Kingdom is critical for the wellbeing of society. The government has the responsibility of ensuring that people receive adequate care when needed. The goal is achieved through health legislation and general policy enacted and passed by the legislature. The Secretary of State for Health and the Department of Health also have essential input in health policy circles in the country. The Health Act (2006) includes a provision for the Secretary of State to ensure that the people access inclusive health services. The provision contains free care, apart from the already charged services. The NHS Constitution includes comprehensive coverage of the rights of the people covered under the National Health Service (NHS) care (Thorlby & Arora 2016). Some of the rights comprise access to care, devoid of discrimination, and within specific limits for some services, such as planned hospital and emergency care. Although the United Kingdom has a similar model compared to other countries, comprising of the private and public practice, its performance in terms of quality, accessibility, and affordability is adequate; however, improvements are necessary, especially the use HIT, cost containment, and reduction in waiting time.

A Description of the Payment Method

Like other countries, such as the United States and Canada, health care services in the U.K. are covered through the public or private payment models (Fry, Light, & Lawrence, 2018). Hence, various models of care are available in the country.

Publicly Financed Health Care

The UK government ensures that people have adequate access to health care. In 2014, the country used 9.9% of GDP on health care. The NHS’ public expenditure was the budget’s primary consumer, totaling 79.5% of the entire spending on health care (Thorlby & Arora 2016). General taxation provides the majority of funding for healthcare services, while a minority part comes from the national insurance system through payroll taxation. The NHS also earns revenue from co-payments and private patients using NHS services. “Ordinarily residents” in the UK automatically qualify for NHS care. The services are mainly free of charge. A European Health Insurance Card is available to non-residents who receive free care.

Private Health Insurance

Besides publicly-funded health care in the UK, people have access to medical services paid through private insurance. In 2015, it was estimated that 10.5% of the population in the country had private health cover. The nation had about 3.94 million voluntary health policies in early 2015 (Thorlby & Arora 2016). Some people prefer paying for services through health insurance because of the rapid and convenient services. A considerable proportion of services paid using private insurance are elective hospital procedures. However, the cover excludes mental health services, maternity care, general practice, and emergency care. Private insurance information is not freely available. However, the Competition and Markets Authority (2014) estimated that four major insurance companies account for 87.5% of the private insurance sector (Thorlby & Arora 2016). Other small providers share the remaining minor proportion.

Covered Services

The law does not include the actual scope of the NHS, and individuals do not have absolute rights to a specific treatment. Nonetheless, the Secretary for Health is legally responsible for ensuring people have comprehensive coverage. Practically, the body covers for preventive services, such as immunization, vaccination, and screening programs (Fry, Light, & Lawrence 2018) It also pays for inpatient and outpatient hospital care, inpatient and outpatient medications, physician services, mental health care, specific eye services, medically necessary dental care, rehabilitation, and some long-term care.

Cost-sharing and Out-of-Pocket Spending

Besides the cost of care borne by the government, the UK healthcare system also uses a cost-sharing arrangement for services covered by the government. Out-of-pocket payments are usually for limited services, such as primary care in general practice (Fry, Light, & Lawrence 2018). Some of the covered services include when providing certificates for travel or insurance and assessment for employment or insurance purpose.

Outpatient Care

A copayment is a commonly used model for paying outpatient prescription drugs in the UK. However, prescription drugs in NHS hospitals are free of charge. Other services, such as NHS dentistry, use the copayment model for up to GBP233.70 per treatment course. Notably, the Department of Health sets the charges. In 2014, out-of-pocket expenditure by households was 14.8% of the overall spending in the country. Medical goods (such as pharmaceuticals) were the primary source of out-of-pocket disbursement (42.4%) (Thorlby & Arora 2016). Long-term care services were the second at 35.0%.

The Organization and Financing of System

Primary Care

General practitioners (GPs) are the leading providers of primary care in the UK. The providers usually gatekeep for secondary care. According to Thorlby and Arora (2016), the country had 34,592 GPs working on a full-time basis in 7,674 practices in 2015. The average number of patients per practice was 7,450, and 1,530 per general practitioner. The country had 43,632 hospital specialists during the same period. In 2014, there were 843 solo practices and 3,589 practices, with more than five general practitioners (Thorlby & Arora 2016). Payment for primary care occurs through a blend of capitation for essential services, optional fee-for-service payment model for extra services, and a voluntary performance-related program.

Outpatient Specialist Care

Most of the specialists in the country have a salary and work in NHS hospitals. CCGs pay outpatient consultations to hospitals. The payment is standardized at the national level. However, in private practice (private hospitals or expressly designated wards in NHS), they are allowed to charge for services. In 2006 (the most recent data on this area) 55% of doctors provided services at a private level (Thorlby & Arora 2016). However, the percentage has been decreasing due to closing the earning gap between private and public practice. Most of the primary care doctors and specialists are paid monthly. The reimbursement package reflects their service delivery based on automatically extracted data from electronic health records in the practices.

Mental Health Care

The healthcare system in the United Kingdom provides mental health services. This aspect of care is provided as a critical element of NHS and covers a variety of services and support. GPs usually treat less-serious illnesses, such as mild depression and anxiety. Mental health or hospital trusts treat those who require specialized mental health services. The government policy has, over the years, focused on improving access to treatments for mild-to-moderate mental illnesses. Outreach and early intervention are some of the mechanisms in place to improve treatment for more severe cases (McGorry, Bates, & Birchwood, 2013). Generally, mental health outcomes are better than in other countries in the world.

Long-Term Care and Social Support

The UK government, through the NHS, supports the provision of long-term care in the country. It pays for several services in this area, such as for individuals needing ongoing medical or skilled nursing. Nevertheless, the government has reduced payment over the years. Local authorities and private facilities provide most of the long-term care in the country. They assess the needs of the target populations and provide necessary care and support (Mossialos, Wenzl, Osborn & Sarnak 2016). However, long term care in the country is not universal. Those eligible for government support use the copayment model, but most individuals pay a more substantial proportion of the budget.

The Level of Performance of Healthcare Services

The Care Quality Commission (CQC) regulates the quality of care in the United Kingdom. The organization is an independent regulator of all the services in the country. Quality care is the extent to which a system’s health care services meet the expected outcomes. CQC plays a vital role in monitoring, inspecting, and regulating healthcare organizations and facilities to attain quality outcomes. To achieve the quality objective, the Commission ensures the registration of all health care providers. The process is critical to meet the desired quality standards in the country. Hospital inspection ensures safeguards are in place to eradicate poor performance (Fry, Light, & Lawrence 2018). The agency conducted a national patient experience survey in 2015 and used the results to create “fundamental standards.”

Another organization that meets the quality standards in the United Kingdom is the National Institute for Health and Care Excellence (NICE). The organization designs national guidance to recommend improvement measures in health and social services. The agency is an executive non-department that the Department of Health and Social Care funds. The standards of care are implemented at the primary, secondary, and social levels. The NHS Choices provide information regarding the level of quality in health and social care in the UK. The public can access inspection results provided by the CQC (Fry, Light, & Lawrence, 2018). The government has achieved positive results through financial incentives to primary care providers and specialists. They award general practice points for keeping relevant data about the services they provide and procedures related to best practice. Hence, the country has one of the highest quality healthcare system in the world.

The UK government focuses on accessibility as a measure of quality in health care. The government enhances availability by freeing health services for a considerable part of the UK population. In the United Kingdom healthcare system, people who meet the “ordinarily resident” criteria have access to universal health coverage. They are entitled to free under the NHS care model at the point of use. The free services extend to other groups, such as non-residents with a European Health Insurance Card. As a result, the country is one with the most accessible healthcare system around the world. Besides access to free services in the public health system, another pointer of accessibility is the amount of waiting time to receive vital services. The waiting time in the UK IS relatively short for essential services, including non-emergency services (Fry, Light, & Lawrence, 2018). However, the system must improve the waiting time for specialist and elective non-emergency surgical services. Minimal changes will improve the system in this performance measure to improve performance further.

Global research reveals that the United Kingdom healthcare system is the most efficient in the world. A recent study of seven industrialised countries confirmed the results regarding the efficiency of the country’s health care system. The Commonwealth Fund report investigated various aspects of performance, including efficiency, quality, accessibility, equity, and quality of life. They included findings from Australia, Germany, Canada, the Netherlands, and New Zealand. However, the results indicated room for improvement in the country’s health care system because the UK came second after the Netherlands (Fry, Light, & Lawrence, 2018). However, the United Kingdom performed well in terms of accessibility and quality of care. Generally, compared to other healthcare systems in the industrialised world, the performance of the UK system is better. Nonetheless, through the Ministry of Health, the government can implement some recommendations to improve its performance.

Recommendations to Improve the Level of Performance

The government in the United Kingdom can implement some effective measures to improve quality and performance. From the discussion, the government has integrated information technology as part of the quality initiatives in health care. However, it should undertake more quality improvement initiatives through information technologies to reduce cost while improving healthcare outcomes. Therefore, one crucial step is to enhance innovation in the country’s health care. Information technology in health care includes extensive use of data and informatics to improve the quality of services to patients (Waterson 2014). The initiatives should be implemented in the private and public health practices. Such efforts will improve performance throughout the continuum of care and for various patient populations through enhanced service delivery.

In a healthcare system where people do not wait for a long time to receive treatment, quality of care is almost guaranteed. Therefore, the UK government can achieve better quality by reducing the waiting time further. The government should ensure complete changes in the private and public practice to reduce the amount of time an individual has to wait to receive critical treatment. Better quality outcomes can be achieved if the waiting time for emergency and urgent services is reduced considerably. Among other things, improvement in health information technology will enhance the outcome in this area (Fry, Light, & Lawrence 2018). For instance, nursing and other providers will collect and record patient information in real-time. Such measures will also reduce mortality and morbidity in the country among different patient groups, such as the aged and children.     

Another critical area that the government should improve is the cost of health care. Although the UK rates better compared to other countries, such as the US and Australia, in terms of the cost of care, the government should implement further cost-containment measures. Some of the mechanisms include patient cost-sharing to guarantee an adequate budget for medical services (Thorlby & Arora 2016). The process will improve care by ensuring that funds are available for critical health care services, such as the preventive and treatment of chronic conditions. The government should also strive to allocate more funds to essential sectors, such as public health, to improve performance.


The United Kingdom has an efficient healthcare system, especially compared to other systems around the world, such as the US healthcare system. The country’s private and public health sectors are running efficiently through effective government policies to extend care to a large proportion of the country’s population. In terms of performance measures, such as accessibility, affordability, and quality, the country’s performance remains impressive. However, the government can improve the system further through information technology, cost containment, and reducing waiting time. The measures will ensure a better system with improved performance.



Fry J, Light DW & Lawrence RM 2018, Reviving primary care: a US-UK comparison. CRC Press.

McGorry P, Bates T, & Birchwood, M 2013, ‘Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK’, The British Journal of Psychiatry, vol. 202, (s54), s30-s35.

Mossialos E, Wenzl M, Osborn R & Sarnak, D, 2016, 2015 International profiles of health care systems. Canadian Agency for Drugs and Technologies in Health.

Thorlby R, & Arora S, 2016, International Health Care System Profiles: The English Health Care System, The Commonwealth Fund.

Waterson P 2014, ‘Health information technology and sociotechnical systems: A progress report on recent developments within the UK National Health Service (NHS)’, Applied Ergonomics, vol. 45, no. 2, pp. 150-161.

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