Provision of general practice and occupational health services is the responsibility of Defence Primary Healthcare (DPHC). DPHC’s purpose is to sustainably deliver and commission safe and effective healthcare, which meets the needs of patients and the chain of command. It provides primary healthcare, dentistry, rehabilitation and mental healthcare in the UK and overseas to service personnel and, where appropriate, their dependents.
DPHC supports medical force preparation of service personnel deploying on operations and exercises through the provision of health advice, preventative medicine, vaccinations, chemoprophylaxis and medical risk assessments. Responsibility for the day-to-day management of primary healthcare rests with six regional teams in the UK and a separate team embedded in HQ DPHC for overseas medical treatment facilities. UK based medical facilities are inspected by the Care Quality Commission.
Occupational health service
The DPHC Occupational Health (OH) service is responsible for the provision of safe, effective and continuously improving OH services to all entitled personnel within the firm base and overseas. The service is delivered through 13 UK and British Forces Germany based Regional Occupational Health Teams or Regional Occupational Medical Departments. The RAF Medical Board and Naval Board of Survey provide OH services, however they have single service specialist functions and therefore remain the responsibilities of single service authorities.
Rehabilitation services are provided through a tiered network of Primary Care Rehabilitation Facilities (PCRF) and RRUs across the UK and Germany. PCRFs are unit/station based outpatient departments offering physiotherapy and exercise rehabilitation therapy. Patients with injuries that cannot be cared for at this level are referred to RRUs, to allow rapid access to imaging services, podiatry and residential rehabilitation. This intermediate level of treatment nests between the PCRF and the DMRC at Stanford Hall.
The DMRC provides a key element of the tiered Defence Medical Rehabilitation Programme, delivering concentrated residential rehabilitation for complex musculoskeletal disorders and injuries (MSKI) including complex trauma, rehabilitation following neurological injury or illness, and in-patient care for joint and soft tissue disease. It also provides education and training in military rehabilitation and is the home of the Academic Centre for Rehabilitation Research.
Military mental healthcare includes clinical, educational and command liaison services, the latter supporting the wide range of command activities to maintain mental wellbeing. Community mental healthcare to service and entitled personnel is provided through a network of 20 permanent locations, comprising 11 Departments of Community Mental Health (DCMHs); 6 Mental Health Teams (MHTs); and 3 locations with a permanent Community Mental Health Nurse. Nearly 250 personnel, both uniformed and civilian, provide community mental healthcare.
Members of the reserve forces who have been mobilised for operations since 2003 are able to access mental health support through the Veterans and Reserves Mental Health Programme (VRMHP) for operationally related mental health problems.
In-patient mental healthcare services in the UK are provided under contract by a consortium of 8 NHS Trusts, located to provide assessment, stabilisation and treatment close to either the service person’s unit or home. The consortium is led by South Staffordshire and Shropshire NHS Foundation Trust (SSSFT) and includes:
- Cambridge and Peterborough NHS Foundation Trust
- NHS Glasgow
- NHS Grampian
- Lincolnshire Partnership NHS Foundation Trusts
- Somerset NHS Foundation Trust
- Southern Health NHS Foundation Trust
- Tees, Esk and Wear Valleys NHS Foundation Trust
Military mental health professionals are also deployed on operations overseas in order to provide assessment and care in theatre.
Working with the Department of Health and UK National Health Services, where necessary, the following mental health services are available to members of the armed forces, and veterans where appropriate:
- The VRMHP
- NHS England Transition, Intervention and Liaison Service (TILS) and Complex Treatment Service (CTS)
- structured mental health assessments at discharge
- specialist follow on treatment for up to 6 months after discharge
- Combat Stress 24 hour Mental Health helpline
- Big White Wall, an online intervention service
- Royal College of General Practitioners online training
- NHS Veterans’ mental health capability
- Veterans’ Information Service
The Academic Department of Military Mental Health (ADMMH) is located within the King’s Centre of Military Health Research at King’s College (KCMHR).
The provision of secondary healthcare for service personnel is the responsibility of the NHS. The majority of DMS secondary healthcare personnel work in clinical placements within the NHS to maintain and develop their clinical skills when they are not deployed on operations or other commitments. DMS staff treat both military and civilian patients within the various NHS Hospital Trusts that host military personnel. There are five centres that have a military presence including the RCDM based at the Queen Elizabeth Hospital, Birmingham (QEHB).
Deployed hospital care
Deployed hospital care is delivered on a joint basis, with each service providing trained and equipped personnel for the deployment. The aim is to return the sick and injured to duty as quickly as possible. The intent is to provide a seamless continuum of consultant-led (where possible) specialist care encompassing preventive medicine, pre-hospital emergency care, primary and secondary care (including dental), imaging and diagnostics, and medical resupply and evacuation.
Patients requiring care beyond the capabilities of deployed medical treatment facilities are evacuated to the UK, usually to the RCDM at the QEHB. Established in 2001, the RCDM’s primary role is the focal point for the military reception of operational casualties, providing the ‘front door’ component of the Role 4 aspect of the operational patient care pathway.
Medical Force Protection (Med FP)
NATO defines Medical Force Protection (Med FP) as ‘the conservation of the fighting potential of a force so that it is healthy, fully combat capable, and can be applied at the decisive time and place. It consists of actions taken to counter the debilitating effects of environment, disease, and selected special weapon systems through preventive measures for personnel, systems and operational formations’. Med FP permeates all levels of pre-deployment operational activity. It endures throughout the operation and into the post-deployment period.
While all aspects of medical support to operations might be considered to be a form of Med FP, this activity concentrates on other medical, mainly preventative, contributions to Med FP:
- the maintenance of a fit and healthy force by promoting behaviour that promotes health, prevents disease and minimises risk: this is a command responsibility, using advice from relevant subject matter experts, as the leadership, conduct and discipline of a deployed force significantly impacts upon the numbers of avoidable accidents and diseases
- measures taken to counter the debilitating effects of infection, adverse environmental conditions including climatic extremes, environmental industrial hazards and chemical, biological, radiological and nuclear hazards: these measures require input from medical intelligence and may require specific medical countermeasures to be put in place to mitigate the risks generated by the threat
- input to the operational equipment programme to avoid or mitigate injuries
- input into the development of collective protection systems for deployed force elements