The best-known face of healthcare provision in England is the NHS. Funded by the government, this massive organisation has been through a seemingly endless series of reorganisations over recent years. At grass-roots level it is grouped into the following areas:
- Primary care: This is the care given to people when they first become aware of a health problem. Primary care providers also offer health education on subjects such as smoking, run clinics, give vaccinations and carry out small surgical operations. Some mental health care provision is also carried out by primary care providers.
- Secondary care and emergency care: This is the care that is provided to people in an emergency or following a referral from a primary care organisation. Conditions treated at this stage tend to be acute or specialist in nature. Primary care trusts plan for secondary care and commission the providers of secondary care services to deliver these plans.
- Tertiary care This refers to specialist care such as renal transplant or cardiac surgery. Tertiary care is usually accessed as a referral from secondary care.
The NHS isn’t the only public sector employer of nurses. The armed forces also employ nurses from all branches of nursing. Employers include the Royal Air Force, the British Army and the Royal Navy. Job opportunities are available in the UK and at overseas bases.
The private sector
Independent healthcare organisations
This sector provides the majority of long-term care available in the UK. The sector also provides acute care services. It has fewer acute hospitals than the NHS but these have a critical role to play in providing a service for private patients and in helping the Department of Health (DH) to reduce waiting lists for acute care mainly through the provision of routine surgery. The independent sector will also play a significant role in enabling the health service in England to introduce patient choice. Independent employers can be divided into three main groups:
- For profit: This term refers to single owners and large corporates who own single and groups of acute hospitals or nursing homes. Single owners are in the minority, particularly in the care-home sector following a spate of mergers and takeovers in recent years.
- Not for profit/registered charities: These can be national organisations, single owners or smaller set ups. The majority of these offer carehome facilities for older people, those with learning disabilities or those with mental health needs. It’s also worth noting that some corporate acute providers have charitable status since they plough any profits they make back into the organisation. Examples include BUPA and Nuffield Healthcare.
- Voluntary: Some organisations in the voluntary sector provide care homes. An example is Mencap.
The independent sector is not made up of independent healthcare providers alone. Additional employers include:
- independent schools, eg school nurses
- commercial organisations, such as pharmaceutical companies or publishing companies
- industry, eg occupational health nurses
- the Crown Prosecution Service or other legal representatives, eg expert witnesses
- recruitment consultancies and nursing agencies
Several years’ experience is usually required to do these jobs.
A job for life?
Whichever employer you choose, remember that there’s nothing stopping you from changing your career direction. In the past, those who had worked in the independent sector sometimes found it difficult to get back into the NHS. Given the current nurse shortages this is no longer the case. Many nurses who work in the NHS also do agency work in the independent sector.
So who would you choose?
One of the biggest factors that will affect your decision to work for an independent organisation or a public sector employer has to be the client group you want to work with. Both the public and independent sectors deal with all members of the community, but broad generalisations that can be made include the fact that the majority of primary care provision is carried out by the NHS, while the majority of care homes are run by independent organisations. Additional factors to consider include:
- Culture and objectives of the employer. Would you prefer to work for a not-for-profit organisation where all the money gets ploughed back into the organisation? Could you cope with the high levels of bureaucracy for which the public sector is renowned?
- Flexibility of the workplace, particularly when it comes to issues such as child care and working hours.
- Salary. Independent employers do not have a national agreement in terms of salary; you need to negotiate the best deal for you. This process is alien to most nurses since under the NHS system there is a set pay scale.
- Terms and conditions. Nurses offered jobs by independent employers should also check the small print in their contract. In particular look for explanations of whether you can expect an annual increment to your salary and what your annual leave allowance might be.
- Quality and standards met by the employer. There are national minimum standards for all independent healthcare organisations and they are inspected against them. Inspection reports are public records so you can ask to see the last report of any organisation you are considering working for.
- Career prospects. The NHS is attractive to nurses wanting to pursue a defined career path while the independent sector is less likely to fulfil all your career aspirations.