health services 2.docx
TRANSCRIPT
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HEALTH SERVICES
1. Introduction
The main objective of this paper is to explain and evaluate how people make use of
health services within the Unite Kingdom. The aim will be to explore certain factors which
may bear an impact on accessing health services, the way people make use of health
services and an examination of factors which could contribute to the incorrect use of these
services.
In terms of general access to health services, research suggests that a variety of
factors can influence accessibility. !eople in poor countries tend to have less access to
health services than those in better"off countries, and within countries, the poor have less
access to health services. #lthough a lack of financial resources or information can create
barriers to accessing services, the causal relationship between access to health services
and poverty also runs in the other direction. $hen health care is needed but is delayed or
not obtained, people%s health worsens, which in turn leads to lost income and higher health
care costs, both of which contribute to poverty& ' #nnals of the (ew )ork #cademy of
*ciences +olume -, Issue )
2. Access to Health Services
/I0U12 . 3onceptual framework for assessing access to health ser vices.
1
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/doi/10.1196/nyas.2008.1136.issue-1/issuetochttp://onlinelibrary.wiley.com/doi/10.1196/nyas.2008.1136.issue-1/issuetochttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1749-6632
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/igure illustrates, the 4 main elements that influence our access to healthcare within
the context of the UK 'working from the centre of the framework5. These elements are
categori6ed as geographical, availability, financial and acceptability. 7elow, these elements
are explained with the aid of hypothetical examples centred around a character based on a
farm and how each element would impact him.
8. 0eographical
8.. 9ow long does it take us to get to a service delivery point:
• 2xample;
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8.- /inancial
8.-. $hat is the relationship between the cost of the service and the willingness
and ability of the users to pay for it:
• 2xample;
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be free at the point of delivery, that it be based on clinical need, not ability to pay. These
three principles have guided the development of the (9* over more than = years and
remain at its core.&
'http;GGwww.nhs.ukG(9*2nglandGthenhsGaboutG!agesGnhscoreprinciples.aspx5
2ven though the core principles might be true to all UK H 2U 3iti6ens living within the
UK, the Buality and access may vary hugely. !eople who live in major cities 'ondon,
Janchester, iverpool, and 7irmingham to name but a few5 have more access to services
than people living in rural areas '3herwell, $ealden, (ewark and *herwood and 2ast Devon
to name but a few5. The proximity of the services differs greatly as well as the types of
services available.
$here one resides in the UK is not the only concern regarding access to health care
one%s occupation will also influence one%s access to health care 'the hours one works, the
type of employment, whether or not one is able to take time off from work5, including
language and one%s belief system. #ll these things play a significant role in access to health
care.
/igure A Illustrates The (9* 9ealth and 3are system as of #pril 8=- '*tructure of the
(9* www.nhs.uk5
4
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx
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The people are at the heart of the present (9* 9ealth and 3are system in the UK,
as illustrated in /igure , with a wider range of health care providers that will provide patients
with more choice and value.
The (9* provides all their health care services through organisations known as
Ltrusts%. The following E are the main types of (9* trusts;
• (9* !rimary 3are
• (9* 9ospital Trusts, often referred to acute trusts
• (9* #mbulance *ervices Trust
• (9* Jental 9ealth Trusts
• (9* 3are Trusts
The (9* suggest that one should consider whether one could treat oneself at home,
whether the local pharmacy could assist, if one should see one%s 0!, use a walk"in centre,
call (9* , use a minor injuries unit or dial @@@ in an emergency.
/igure 8 Illustration of primary care and secondary care within the (9*
'http;GGwww.yas.nhs.ukG#boutUsG..imagesGnhsMhowMweMfit.gif5
The difference between primary care and secondary care is where and with whomone receives the service as indicated above in /igure 8. !rimary care is ones local health
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care, the services that most often brings one in contact with the (9* 0!%s, (9* walk"in
centres, dentists, pharmacists and optometrists. These services are provided and managed
by 3linical 3ommissioning 0roups '330%s5 previously known as primary care. $hereas
secondary 'acute5 care is the care one would receive in a hospital. This may be either
unplanned emergency care 'including surgery5 or planned specialist care 'including surgery5.
!lanned care would usually mean that a professional in a primary care setting has referred
you to a specialist, who is a secondary care provider.
-. !rimary health care
In order for one to understand the access to primary health care, one should
understand the professionals and services covered in !rimary health care.
-.. Traditionally the professionals that make up an !rimary 9ealth 3are Team
'!93T5 are;
• Doctors
o 0eneral !ractitioners '0!5 partners
o 0! assistants
o 0! registrars
o ?ther salaried doctors
• # practise manager
• (urses
o !ractise nurses
o (urse practitioners
o 3ommunity nurses
• *upport staff
o 1eceptionist
o *ecretaries
o 3lerical *taff
• Jidwives
• 9ealth +isitors
-..8 The premises of the ones primary care could also be used for secondary
care services
• 9ospital consultants
• Diagnostic imaging
•
?perating services
-..- #llied 9ealth services may also work closely with !93T
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• !hysiotherapy
• Dietetics
• !odiatry
•
!harmacy• 3ounselling
• *ocial *ervices
• 3omplimentary Therapists
o #cupuncture
o 9omeopathy
-.8 #ccess to 9ealth *ervices
-.8. (9* 0eneral !ractitioner
2very UK resident is entitled to (9* 0! services. ?nce one has decided which
practice to register with 'within your catchment area5, one can access the service. (ew
patients might be refused, if one is outside the catchment area or if the 0! surgery patient
list have reached full capacity, the (9* 3hoices website advises.
Jany practises use different methods to reserve appointments. The favoured
method for an appointment in most practises is to contact the practise telephonically, othersinclude internet appointments and many now also have patient '2JI*5 access. ?ne has to
formally register with the practise by completing the reBuired forms and most practices
reBuire a health assessment upon registering.
In bigger practises, some make use of telephone triage to assess patient needs and
which professional the patient could see. ?nce the appointment is made, the patient have
access to the professional.
Unfortunately due to oversubscribed practises, patients are often told that no
appointments are available and are not advised of alternative service like the nearest walk"in
clinic or to contact the (9* . Due to this, patients often go to #H2, regardless whether it
is an emergency or life threatening, which seBuentially then puts a strain on #H2
accompanied by long waiting periods. #part from this people often make appointments they
don%t keep and essentially hinder others from the service.
-.8.8 (9*
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The (9* is a service that replaced (9* Direct to assists the UK public with
health services when they need a health service fast but not in a life threatening situation.
This service is also accessible to hearing impaired users as well as non"2nglish speakers
that can reBuest a translator.
The (9* is available 84 hours a day, > days a week and is a free call from both
mobile phones and landlines. $hen one calls, the adviser will ask a series of Buestions
and input that data 'answers given by the caller5. # clinical assessment will assist the
adviser with the urgency of the call and advise which service one would need thereafter.
#ccording to (9* *tatistics A *eptember 8=4, There were @@E,EEE calls
offered on the (9* service in *eptember 8=4 eBuivalent to -= thousand per day or
million per year. This was the lowest rate per day since
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The waiting times at a $I3 could be long depending on the amount of people at the
$I3 as it is based on a first come first serve basis. Jost $I3 are also not eBuipped to deal
with certain injuries such as fractures 'even though the (9* specifically informs the public
that this is one of the $I3 services5 as they might not have access to a x"ray.
-.8.4 (9* Dentists
0ood Buality (9* dental services are available for everyone and even though the
(9* website suggests that one should not have to register with and (9* dentist, most (9*
dentists are oversubscribed and have a full patient list which results into lengthy waiting
times to access a dentist or the need to contact another surgery.
The (9* will provide any treatments that you reBuire to keep your teeth and gums
healthy and free of pain, which includes;
• Dentures
• 1oot 3anal
• /illings 'including white fillings5
• !reventative treatments
• 3rowns and bridges
The (9* will not however provide any treatment you would not need, but would like
to have to enhance your appearance like teeth whitening.
(9* Dentistry is not free of charge for every UK resident but rather to specific
groups. The following groups are entitled to free dental care;
• Under F%s
• Under @%s that%s in full time education
•
!regnant woman or if you had a bay in the last 8 months• If your are staying in a hospital and your treatment is being done by the
hospital dentist
?ther groups include people who;
• #re on income support
•
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• If you are named on a valid 938 certificate
There are - bands within the (9* Dental 3harges, ranging from NF.E= to N8@.==
pending on the course of treatment. Due to these fee allot of people do not attend their
appointments due to insufficient funds which in turn is not just time wasted but also the
another patients time that could have been seen but were not able to get an appointment.
-.8.E (9* !harmacists
!harmacists work all over the country in the community in different premises,
making their service extremely accessible to the UK population. 3ommunity pharmacists not
only prepare and dispense prescription and non"prescribed medicines, but are also able to
give advice on common problems such as colds, aches, pains, healthy eating and stopping
smoking.
)ou don%t reBuire an appointment or the need to register with a pharmacist and can
speak to them in confidence about your most personal symptoms. There are many
pharmacies that are able to provide one with a private consultation without being overheard
by others.
There is a cost on every prescription but there are various ways that you can gethelp with the costs of prescriptions through the (9*.
Unfortunately pharmacies are not able to assist you with all your medical
reBuirements and access is limited to their opening times or the stores opening times.
-.8. (9* ?pticians
(9* eye healthcare professionals are available to everyone and there is no need to
register with a specific one, but an appointment should be made prior to the visit.
It is advised that we visit a ophthalmic every 8 years for an eye test. #n (9* sight
test is free of charge if clinically necessary, unfortunately it is up to your ophthalmic
practitioner to weather the sight test is necessary or not.
#ll children under the age of receive free of charge eye sight tests as well as
some other groups including ow Income *upport and !regnant woman or woman who had
a baby within the last 8 months.
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-.- #ccess to (9* secondary care
-.-. (9* 2mergency and Urgent 3are
?ne should only call @@@ and visit an #H2 for life"threatening emergencies such as;
• oss of consciousness
• /its that are on going
• #cute confused state
• 7reathing difficulties
• 7leeding that can%t be stopped
• #ny life"threatening emergencies
Jajor #H2 departments offer a 84 hours service, -E days a year, however, all
hospitals do not have an #H2. #nyone can access, all one needs to do is find the nearest
#H2 and go there. ?n arrival the staff will assess the severity of the emergency and decide
on further action.
# recent newspaper article in the Jirror reported the following; #n investigation has
revealed >4 trusts are struggling to fill vacancies as staff are sacked or Buit under the strain
of day"to"day life on emergency units& There is a huge amount of stain on #H2 departments
and not enough #H2 doctors to facilitate the demand of patients coming through #H2 doors.
!eople abuse #H2 departments with non"life"threatening cases in many scenarios
due to the lack of knowledge of the amount of pressure, lack of staff, number of people and
that only it should only be used in life"threatening emergencies within #H2 departments.
-.-.8 (9* *ocial 3are
(9* *ocial 3are system provides a service to those who need help and assistance
in everyday life by allowing them their dignity and independence. *ocial care covers adult
services, children services and wheelchair services of which adult services include the
following;
• help in your home with things like cleaning and shopping
• disability eBuipment and adaptations to your home
• day centres to give you or the person who cares for you a break
• day care for your child if either you or they are disabled
• care homes
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• support for carers
• financial support
To access these services one needs to contact ones local adult services within ones
local authority%s social services or be referred to adult services by another professional in
primary care. #dult services are responsible for assessing people%s need for Lcommunity
care% or Lsocial care% services.
?ne of the major concerns of #dult social services is that from the day you contact
adult services they have 8F days before they need to the actual assessment to take place
and then thereafter depending on the need or the eligibility criteria, it could take up to
another months for the decided care plan to be actioned.
-.-.- (9* Jental 9ealth
Jental health services are free of charge to all UK residents on the (9*. )ou will
usually reBuire a referral from your 0! to be able to access them. 9owever there are some
mental health services that will allow people to refer themselves for help. This commonly
includes services for drug and alcohol problems, as well as some psychological therapy
services.
?nes 0! surgery may be able to provide one with these services or one might find
them within, a large local health centre, a specialist mental health clinic, or hospital.
Depending on the treatment reBuired, it might be provided on a one"to"one basis or in a
group with others with similar difficulties, and therapy sometimes also involves partners and
families.
The (9* website advises that if one has concerns about a person%s social
circumstances the correct path to follow would be to contact social services, however if If
you or someone you know experiences an acute emergency, you should call @@@ and ask for
the ambulance service or the police.
!eople often abuse this service in order to be able not to work but claim state
benefits due to the mental illness they supposedly have.
-.-.4 (9* #mbulance *ervices
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The (9* #mbulance services range from urgent care, planned health care to and
can include transport service.
ife"threatening care can be accessed through dialling @@@ and asking for the
ambulance services. #ccording to the (9* website, once the @@@ call is received they are
divided into 8 categories to provide the best service for the situation;
• Immediately life threatening Alife"threatening calls will receive an
ambulance capable of transporting the patient safely within @ minutes of
the reBuest for transport being made.
• #ll other calls A /or conditions that are not life threatening, response
targets are set locally
Unfortunately the above times are not realistic numbers due to allot of (9*
Trusts closing down hospitals and #H2 that are only available at certain hospitals. #part
from longer traveling times, road works and traffic has a huge impact on the route and
time an ambulance will take to reach the intended person.
@@@ calls are also not always life"threatening which diverts the service from serious
injured and ill patients.
-.4 (9* vs !rivate
There are various discussion one could consider when comparing the (9* services and
those of !rivate 9ealth care, unfortunately there will always be pro%s and con%s in every
discussion. ?ne however need to look at the comparison of a patient%s journey for different
perspectives to comprehend the differences.
3igna, a private medical provider of private health care have done just that
the following diagram 'https;GGwww.cigna.co.ukGdownloadsGmedicalGarticlesG2xperience
C8=theC8=differenceC8="C8=diagram.pdf 5 below shows the patient journey from three
perspectives;
• (9* !atient
• !rivate !atient
• 3igna private !atient&
This highlights the five main steps in the patient journey and compares these across
the - and through reforms it has made many efficiency improvements in recent years. 7ut
13
https://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdfhttps://www.cigna.co.uk/downloads/medical/articles/Experience%20the%20difference%20-%20diagram.pdf
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there are still limits in the (9* in terms of access to care and patient choice. #s an example,
an (9* patient may be referred to a private hospital for a consultation but theyOll have to
attend a group clinic where they are unlikely to be seen by a consultant. Then theyOll have to
meet stringent criteria to have access to some surgical procedures and must then wait a
minimum of 4 weeks to have the treatment.
?nce in hospital the different experience for an (9* and private patient continues.
!rivate patients often have their own private room and services. !rivate healthcare also
means more personal care. 3onsultations are based on individual appointments rather than
clinics. /ollow up care is one to one. #nd members of 3ignaOs medical plans enjoy an even
better experience. ?ur nurses can provide advice and support throughout the patient
journey. They can help patients get the information they need from their consultant, provide
additional support through the 3are 3o"ordination !rogramme and continue to support the
patient and their family in their recovery after treatment is completed.&
'https;GGwww.cigna.co.ukGmediaGproduct"newsGexperience"the"differenceGindex.html5
$ith the above one can argue that 3igna used this as a marketing tool to sell their
product and have not disclosed the cons to (9* vs !rivate 9ealth care.
!amela 7rooks, a health journalist edited a base document written by
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proviso that some policies restrict treatment
to set lists of hospitals
offering !JI, itOs worth talking to an
independent financial adviser, who can help
you see the differences between the
policies. #dvisers at insurance companies
can only discuss their own policies and
canOt give you advice on how it compares
with others.
Private room; you donOt have to worry
about being on a mixed"gender ward.
Depending on your policy, you may have an
ensuite bathroom.
$ou %et !hat #ou pa# for ; the more cover
you want, the higher your premium will be.
• &nrestricted visitin% hours. Premium costs are risin% above the level
of inflation; medical treatment costs arerising by = per cent each year, according
to group health intermediary Jercer. $hen
insurersO costs rise, premiums tend to rise in
line with the costs
Personal care; a retinue of medical
students wonOt accompany your
appointment with the consultant, you wonOt
be kept waiting for hours to see them andyou will have more time to discuss your
symptoms.
'(pertise; private hospitals might not have
the same depth of expertise found in teams
within the (9* or all departments on one
site. *o if you have a problem with yourmouth, it might not be easy to coordinate
treatment between a dental department and
the 2(T 'ear, nose and throat5 unit.
pecialist claim team; your insurer may
have a team that deals specifically with a
certain type of condition, such as cancer,
who can help advise you.
)ime constraints; if your consultant also
works in the (9*, your treatment will need
to be given in the time he or she has free
from the (9*.
#ll the information above is available at http;GGwww.netdoctor.co.ukGfocusGpmiGadvantages.htm
-.E 3onclusion
There are a huge number of factors that influence how people in the UK access
health care. $ith all services, regardless whether or not in health care, there will always be
pros, cons and misuse. It seems that one of the biggest hurdles within the (9* is trying to
educate a nation the use of the right service for the right need.
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http://www.netdoctor.co.uk/focus/pmi/advantages.htmhttp://www.netdoctor.co.uk/focus/pmi/advantages.htm
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$ith a growing population and people living longer because of this improved and
expanded services, the strain on the (9* will grow bigger year by year and people will make
more and more misuse of services in order to fill their individual needs.
1eferences
0! *ervices at 7reaking !oint with longer waiting times #vailable at
http;GGwww.independent.co.ukGnewsGukGhome"newsGgp"services"at"breaking"point"with"
longer"waiting"times"on"the"way"claims"survey"F>>8-.html #ccessed on 8> (ovember
8=4
Transforming !rimary care available at
https;GGwww.gov.ukGgovernmentGuploadsGsystemGuploadsGattachmentMdataGfileG-=4-@GTransf
ormingMprimaryMcare.pdf #ccessed on 8> (ovember 8=4
Inclusive !ractise #vailable at
https;GGwww.gov.ukGgovernmentGuploadsGsystemGuploadsGattachmentMdataGfileG-=E@8GInclusi
veM!ractice.pdf #ccessed on 8F (ovember 8=4
(9* 0eneral !ractitioners '0!%s5 available at
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGdoctorsG!agesG(9*0!s.aspx accessed
on 8F (ovember 8=4
(9* #vailable on
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG2mergencyandurgentcareservicesG!age
sG(9*".aspx #ccessed on 8@ (ovember 8=4
(9* *ervices explained available onhttp;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG!agesG(9*services.aspx #ccessed on
8@ (ovember 8=4
# guide to mental health services in 2ngland available on
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGmental"health"services"
explainedG!agesGaccessingC8=services.aspx #ccessed on - December 8=4
16
http://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttp://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttp://www.independent.co.uk/news/uk/home-news/gp-services-at-breaking-point-with-longer-waiting-times-on-the-way-claims-survey-8772361.htmlhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304139/Transforming_primary_care.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/305912/Inclusive_Practice.pdfhttp://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/Pages/NHSservices.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspxhttp://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/accessing%20services.aspx
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2mergency and Urgent care available on
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG2mergencyandurgentcareservicesG!age
sG#2.aspx accessed on - December 8=4
(9* hospital *ervices available on
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesG(9*hospitalsG!agesG9ospitals*ummary.
aspx accessed on - December 8=4
(9* healthcare available at
http;GGwww.theguardian.comGsocietyG8=4GjunG>Gnhs"health accessed 8@ (ovember 8=4
?pticians. #vailable at
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGopticiansG!agesG(9*opticians.as
accessed -= (ovember 8=4
(9* !harmacy #vailable at
http;GGwww.nhs.ukG(9*2nglandG#bout(9*servicesGpharmacistsG!agesGpharmacistsandche
mists.aspx #ccessed -= (ovember 8=4.
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