Understanding healthcare

Healthcare services are ones the public have a right to access through the NHS, or by paying privately, and including but not limited to: general practitioner (GP) practices, hospitals, community health centres, dental practices, pharmacies, opticians, ambulance, (community) mental health services, etc.

Healthcare services are often referred to as statutory services, as they must provide certain things by law because they are funded by public money. This guide focuses on public funded services, but equally much of the same information applies to private healthcare services.

GP practices are also usually separate businesses that deliver under a contract for a specific area. GPs are often business owners, and not only deal with healthcare but also business management, like managing staff. This can often surprise people as we can assume the NHS is the employer for all healthcare staff.

NHS general dental services (GDS) are provided by general dental practitioners. These dentists are either in contract with, or employed by, their local NHS Board to provide general dental care and treatment.

Alongside these, healthcare also includes third sector and private sector organisations, who deliver services on behalf of these statutory services. These are called commissioned services because they are selected to deliver specific services under a contract as part of a commissioning process after competing with other organisations.

This guide focuses on healthcare; however, increasingly social care is being integrated as part of joined up, known as person-centred, care. Differences in defining what is healthcare and what is social care often come from the historical way the services were delivered, funded and overseen. Traditionally, the NHS provides healthcare, and local council departments provide social support.

• Healthcare - services like treatment provided to maintain and improve your health
• Social care - social work, personal care, protection and practical assistance for those that need extra support.

The NHS, local council and commissioned services operate as part of an integrated system in Scotland since 2016. They used to operate in a more individual way, but legislation aimed to bring these together to make better use of resources and improve the services people received. Despite the legislation and the changes, it can still be confusing for those who work within the system, as well as for those who are supported by it; including what names to use and who does what. For more detail explore the Additional Tools and Resources section on current health and social care structures.

TIP! - Asking ‘how is this service/support funded?’ is a good way to understand how an organisation links formally to the health and social care partnership. When you understand how something is funded you can then make better choices when choosing how to influence change and what tools to use. E.g. legislation, complaints processes or national oversight bodies.

“All these years and I never realised GP practices were separate businesses. It explains a lot.” Moray workshop participant, 2024

Figure 2 shows the basic approach Health & Social Care Partnerships (HSCP) use when planning to deliver different services. These can be split into different service types. Moving from the bottom to the top of the triangle, the aim is to support fewer people but with higher needs – Primary, Secondary and Tertiary. Propping these up are foundational community supports that are not commissioned by HSCP, and below that is the activity we all do that looks after our own health and wellbeing.

Scottish Parliament set down policies, regulations and standards that services need to adhere to; e.g., National Care Standards or NHS Patient Charter. Citizens have the opportunity to respond to consultations when these are being produced to ensure their views are taken into account. This can be as an individual, through a group response or as part of an organisation.

Alongside this ability to comment on drafts before publication, it is worth being aware that the legal processes around creating policies have been improved in recent years as part of law reform to ensure there is protection and support for rights of people experiencing mental health problems.

In the Additional Tools and Resources section there’s a handy list of key policies and legislation that support healthcare you can also check out Scottish Government website for more.