Health

01   NHS Healthcare for the Armed Forces Community

AFF assisted the Department of Health Social Care (DHSC) and NHS England with developing information for the NHS Healthcare for the Armed Forces Healthcare webpage. We hope you find it helpful and welcome your feedback.

02   The NHS Constitution

The NHS Constitution establishes the principles and values of the NHS in England.

AFF consulted on this process and is delighted that the Armed Forces Covenant has been recognised and included in this document. Keep talking to us and let us know if you experience disadvantage as a result of service life.

03   Registering with a GP

All serving personnel are registered at Defence Primary Healthcare (DPHC) Medical Centres. You and your family may be able to register at a DPHC medical centre, depending on where you live.

DPHC medical centres and access to services may differ slightly from NHS GP practices. At a DPHC medical centre, you will receive treatment from a mixture of service and civilian healthcare specialists. You can choose to register at a NHS GP practice if you prefer to.

Top Tips for finding a GP practice right for you

1. Your local HIVE should have information on the local GP practices available in your area and whether you can register with a DPHC medical centre. Or, speak to friends and other people who live locally to see which practice they recommend
2. To find a GP practice near you in England visit the NHS website.
3. To find information on registering with a GP in NI visit NI Direct, Scotland visit NHS Scotland and Wales visit – NHS Direct Wales.

Temporary GP Registration

For children at boarding school in the UK:

Most children who attend boarding school should be registered with a GP practice local to their school, but this will only usually cover them in term time. This is because there is often a significant distance between the child’s school location and home, so the GP practice would not be able to cover emergency visits.

Also, if your child were ill, you wouldn’t necessarily want to travel long distances to visit their GP. If your child requires medical treatment while they are at home in the holidays, they can be registered as a temporary resident at your local GP practice. You can see a temporary GP for up to three months (if you require longer than this you will have to re-register with the practice). The temporary GP will pass on any treatment details to your child’s permanent GP to add to their medical records.

For more information on temporary GP registration visit the NHS website

Visiting from Overseas:

If you are living overseas, you should be able to register as a temporary resident if you need medical treatment whilst in the UK. For more information visit the CAB Advice Guide

For more advice or if you have had problems finding or registering with a GP please contact Karen Ross at additionalneeds@aff.org.uk

04   NHS dentists and orthodontists

AFF understands that some families have experienced or will experience problems with accessing NHS dental care. We are also aware that orthodontic treatment can involve long waiting lists and is subject to local area variations. This can result in disrupted care provision due to frequent moves. Please remember we are here to help.

Dental Provision

You do not have to access a dentist in the area you currently live in, so you can remain with a dental practice you have previously used. However, if you are moving dental practices please inform the practice, so they can give your place to someone else.

To find an NHS dentist please visit: https://www.nhs.uk/Service-Search/Dentists/LocationSearch/3

If you continue to have an issue with finding and NHS dentist for  your family or yourself please contact NHS England’s Customer Care Centre: Telephone: 0300 311 22 33 or Email:         england.contactus@nhs.net

For NHS dentists in the devolved administrations visit:

• NI Direct
• NHS Scotland
• Wales NHS

Dental provision in NI for dependant children

In NI, visiting dependant children are entitled to emergency care under the NHS, provided the Dental Practitioner is willing to take them on under temporary registration. Their UK medical card should suffice as evidence of entitlement or if their parents are registered at the same practice.

Orthodontic provision

Some issues that families have raised with us include:

Waiting list times for orthodontic treatment – some families are experiencing long waiting list times for treatment. There have also been issues with transferring waiting list times on moving.

Continuity of orthodontic treatment – some families have experienced problems with continuing their children’s orthodontic treatment when they move to another area.

AFF has worked with the NHS England Dental Commissioners to provide some specific guidance for families on transferring orthodontic waiting lists and treatment:

• It is recognised that patients receive the best treatment outcome by completing their treatment under the care of one orthodontist.
• NHS Orthodontic treatment can take between 18 months to over 2 years. The average length of time of treatment is 21 months.
• Orthodontists with existing NHS contracts in England can accept a patient who has moved from another part of the country (or from overseas) who is already waiting for or undergoing NHS orthodontic treatment.
• Most orthodontists operate two waiting lists; one for assessment and one for treatment. The assessment appointment will determine NHS eligibility e.g. whether a patient can be treated under the NHS and prioritise clinical need.

Transferring treatment within the UK

What if I am on a waiting list for orthodontic treatment and I move home within the UK?

If a patient moves and needs to change orthodontists, the current orthodontist should discuss alternative orthodontic providers with the patient and arrange a direct referral to the preferred provider. Under the Armed Forces Covenant service families should retain their relative position on the waiting list, so the referring orthodontist should provide the date of the patient’s acceptance on their list to the new provider to ensure their relative position is retained.

What if I am receiving orthodontic treatment and I move home within the UK?

A patient should remain with their current orthodontist, if possible. If the patient requests a transfer, the treating orthodontist should discuss alternative orthodontic providers with the patient and arrange a direct referral to the preferred provider to continue treatment.

Patients can find information on who currently provides orthodontic treatment on the NHS website. To find an orthodontist practice near you, click here. Patients should contact their preferred dental practice to arrange an initial appointment and discuss a referral to an orthodontist if appropriate.

Transferring treatment from Abroad

Where a patient begins treatment abroad (not just in the EEA) and returns to the UK and is entitled to NHS care, NHS criteria is applicable and not the criteria from the country where they began treatment.  The patient should have been under 18 at the point of referral, have had an Index of Treatment Need (IOTN) of at least 3.6 and have good oral health.

I have moved to the UK and have been on a waiting list for orthodontic treatment abroad. Can I access treatment?

Once referred to an orthodontist and it is ascertained that the patient meets NHS criteria, the orthodontist will agree the appropriate waiting time based on clinical need and the need to retain the patient’s relative position on the waiting list. For the patient’s relative position to be retained, it would be useful for the patient to provide evidence of how long they have been waiting for treatment, e.g. date of patient acceptance on overseas waiting list.

I have moved to the UK and have been receiving orthodontic treatment. How can I continue my treatment?

Follow the general information which provides advice on how to find a local NHS dentist and orthodontist. Patients should arrange for their original patient records including study models, radiographs, photographs and notes to be provided so that an NHS orthodontist can confirm whether they would have met  NHS criteria on their original assessment date (i.e. that they were under 18, an Index of Treatment Need (IOTN) of at least 3.6 and have good oral health).  If the orthodontist feels that the NHS criteria would have been met, a course of treatment within the NHS can continue to be provided.

If the orthodontist does not feel that the NHS criteria would have been met, or original patient records are not provided, a course of NHS treatment will not be provided.

If you have any further queries concerning orthodontic transfers, the NHS England Customer Contact Centre is a useful point of contact for patients requiring information about accessing primary care (GP, dental, optical and pharmacy services). To contact NHS England’s Customer Care Centre: Telephone: 0300 311 22 33 or email england.contactus@nhs.net

The British Orthodontic Society also has some useful information too, visit www.bos.org.uk

Please contact Karen Ross at additionalneeds@aff.org.uk if you are experiencing any issue with NHS dental or orthodontic issues.

05   NHS waiting list times

The Armed Forces Covenant has a commitment that any time waited on an NHS waiting list should be transferred and you should retain your relative position on the waiting list. For more information visit www.armedforcescovenant.gov.uk/support-and-advice/families

AFF is aware that NHS waiting lists in the Devolved Administrations may be longer than those in England, so this may affect the waiting list time. We would really welcome your feedback on any issues you are having with NHS waiting lists, particularly when you are moving from one area, or country, to another.

For information on waiting list times in:

England
NI
Scotland
Wales

06   NHS and DPHC Complaints Procedure – a simple guide on how to complain

NHS Complaints

Try local resolution by talking to your GP or practice manager

• If you are not happy with the outcome or prefer not to raise the issue locally then you can raise it with your local CCG or contact NHS England at england.contactus@nhs.net making sure you put ‘For the attention of the complaints manager’ in the subject line
• For hospital and other NHS services write to NHS England
• The NHS website has more information on the complaints procedure
• The Parliamentary and Health Service Ombudsman can be contacted if you have contacted either your CCG or NHS England but you are still not happy with the outcome of your complaint
• You can also contact the health and additional needs specialist at additionalneeds@aff.org.uk, particularly if you are unsure about making a complaint or if your issues are complex
• To raise a complaint in the devolved administrations visit NI Direct, Scotland and Wales

DPHC Complaints

• Every DPHC medical centre should have a local medical complaints policy and a medical complaints manager (MCM)
• You can make a verbal (or informal complaint) to the MCM to see if there can be a local resolution
• Or you can make a formal written complaint if local resolution isn’t possible. Include the names of the people involved and any witnesses to the event. Also state you desired outcome
• You should receive acknowledgement within 2 working days and a full response within 10 working days
• If you are still not happy with the outcome your complaint can then be sent to the Regional Clinical Director who has a further 30 days to investigate
• If it still cannot be resolved it will then be forwarded to HQ Defence Primary Healthcare for further consideration

07   Health and social care provision in Northern Ireland (NI)

AFF has received a number of enquiries regarding healthcare provision and NHS waiting list times in Northern Ireland. As a result of these enquiries, we have complied some specific information about health and social care provision in Northern Ireland.

Prepare for your assignment to NI

1. It is important to register your family member’s specific health or additional needs requirements (including acute and chronic illness, mental health and any specific medication being taken) to ensure the chain of command is aware of the support or provision your family member may need. This can be done by:

• Reading AGAI 108 and completing Annex A – Career Management Notification Proforma
• It is also important for the serving person to include this information on their Assignment Preference Proforma (APP), so that any specific information is available to the chain of command before an assignment is offered or agreed.

2. It is important to research the health and social care available in NI (see the information below) ahead of requesting or accepting an assignment. Although NI has an NHS, some healthcare provision isn’t available, including some drugs for cancer treatment. For other healthcare provision, there may be longer waiting lists than you are currently experiencing.

3. When transferring ongoing care or treatment it is advisable to:

• Speak to your current healthcare professionals for referral across to equivalent care or provision
• Ensure you have copies of your current patient records
• Ensure you have enough medication to tide you over until you have registered with your new GP

Who provides health and social care in Northern Ireland?

HSC Trusts

Belfast Trust is one of five Health and Social Care (HSC) Trusts that provide health and social services across NI. While the board commissions services, it’s the Trusts that provide them ‘on the ground’. Each Trust manages their own staff and services and controls its own budget. The other four Trusts in Northern Ireland are:

• Northern Trust
• South Eastern Trust
• Southern Trust
• Western Trust

Ambulance services in NI are provided by the NI Ambulance Trust. For more information, visit www.niamb.co.uk

Access to information

• Belfast Health and Social Care Trust
• Click here to find an NHS GP in NI. The HIVEs in NI can also give advice on GP practices and how to register
• You may also be eligible to register with a doctor at the Defence Primary Healthcare medical centre in Aldergrove
• If you have an issue with finding a GP practice, or wish to make a complaint about NHS healthcare provision, click here
• Patient and Client Council

Awareness

Some procedures may be offered to be performed in the Republic of Ireland as this is an EU country and therefore funding has, in the past, been available to reduce waiting lists in NI. If this were offered, advice would be given through 38 (Irish) Brigade Central Risk Assessment Cell (CRAC) team reference personal security.

Healthcare provision that is not available in Northern Ireland

Termination of pregnancy

The law in NI is different from that of Great Britain. In NI, it is lawful to perform a termination of pregnancy only if:

• it is necessary to preserve the life of the woman, or
• there is a risk of real and serious adverse effect on her physical or mental health, which is either long term or permanent.

It is for a medical practitioner to assess, on a case-by-case basis, using their professional judgement as to whether the individual woman’s clinical circumstances meet the grounds for a termination of pregnancy in NI. Termination can be made available for serving personnel through the medical centre who will refer to the MPAC system; however, it does require travel to England and on advice only given by MPAC for non- serving personnel.

Enhanced Screening for Pregnancy is not available due to the Abortion law. If this is required, it may result in the individual returning to England to access this procedure.

Bariatric surgery (gastric band surgery)

Bariatric surgery is not available in NI. Again, it would be advisable to discuss your options with your GP or consultant in England before planning a move to NI.

Cancer drugs

Certain cancer drugs are not available in NI. Advice would be to discuss with your oncologist, before leaving your current location, availability of your treatment plan in NI.

For more information on what you can do if cancer drugs are not available, click here.

NHS waiting list times

NHS waiting list times vary in NI to those in your current location. The advice would be to discuss options and seek advice with your current GP before leaving your current location.

Different healthcare provision

Assisted conception and In Vitro Fertilisation (IVF)

This is available in NI for both heterosexual and same sex couples. One cycle of IVF is available on the NHS in NI, even if you have a child. For more information, click here.

Prescription charges

There is no charge for prescriptions for anyone in NI.

Dental services

There is no local variation within NI for dental services. Orthodontic treatment is provided at certain dental surgeries. It is important to research the provision available and whether ongoing treatment can be continued in NI, before leaving your current location. Click here to find a dentist in Northern Ireland.

Mental health

Mental health treatment and counselling is available on the NHS in NI but there is also other support available to Armed Forces families. Families requiring mental or emotional support can be referred to Staffcare. Staffcare are external to the military and are all qualified counsellors. Staffcare is unique to NI and is provided in support of the Army Welfare Service (AWS) due to it not always being appropriate for people to make use of all the civilian agencies that would be an option in England.

An individual can refer themselves or can be referred by welfare agencies, doctors or other healthcare professionals with the individual’s permission. The AWS Intake and Assessment Team (IAT) will usually refer to the AWS Personal Support team (this is a team of four, two military, and two civilian trained Army Welfare Workers). They are there to help single and married personnel and their families. They are based in Lisburn but cover all of NI and can do home or office visits as appropriate. They are trained in counselling skills and can deal with most matters but can also refer to Staffcare.

All requests for help and advice should go via the Intake and Assessment Team (IAT) on 01904 882053 or 882054 or email AWS-HQ-IAT@mod.uk

Some families may have concerns about their current treatment and future assignments and may need to consider one of the following:

• Geographical stability if undergoing assisted conception treatment
• Retention of Service Family Accommodation in your current location if your healthcare or additional needs cannot be met in NI
• Discuss transferring care with your healthcare professionals before accepting an assignment to NI

Contact AFF: Karen Ross, Health and Additional Needs Specialist at additionalneeds@aff.org.uk or Annabel Ingram, Regional Manager North at rmnorth@aff.org.uk

08   Putting your health first overseas

Are you travelling overseas to visit friends or family this summer? No matter how familiar the destination – even if you have previously lived there – you may no longer have any immunity to diseases common in that location. What’s more, if your children have never lived there, they definitely won’t.

Here are some top tips from the Defence Public Health Unit to stay healthy while overseas:

• Seek travel health guidance from your GP, nurse, pharmacist or travel clinic at least four to six weeks before travel, but even if time is short it’s not too late to get advice.

• Some vaccines can be given at short notice and antimalarial tablets, if needed, can be started just before travel, or in some instances on the day you travel.

• If you’re travelling to an area where insect-borne diseases such as sandfly fever, sleeping sickness, malaria or dengue fever exist, use an insect repellent covering exposed areas of skin, and sleep under a bed net.

• Illnesses spread by contaminated food and drinks, like travellers’ diarrhoea or more seriously typhoid, are common in some countries. Only eat or drink from assured sources and wash your hands, especially before eating or drinking.

• If you’re ill with symptoms such as fever, flu-like illness or persistent diarrhoea after you get back, seek immediate medical advice and tell your doctor where you’ve travelled.

• For travel in Europe, carry your European Health Insurance Card (EHIC) and for more distant locations get comprehensive travel health insurance.

For more information about looking after your health abroad, visit www.nhs.uk or contact our Health Specialist Karen on additionalneeds@aff.org.uk.

09   Have your say and get involved

It’s really important to get involved in feedback. This is because it shapes the services available in your area but you can also help other army families access good services. Healthwatch is an initiative where the NHS must consult with the public on how their local health services are run. As a service family they would really like to hear from you because your experiences of frequent moves and transferring healthcare can provide a unique perspective. It will help them provide a service structure that supports you.