Multiple Mini Interview (MMI) NHS, Healthcare Systems and Hot Topics Syllabus

NHS, Healthcare Systems and Hot Topics syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for NHS, Healthcare Systems and Hot Topics in Multiple Mini Interview (MMI), not a summary of it.

1. 1

   Structure of the NHS

   4 topics

   • Founding principles and funding
     • Free at the point of use, tax-funded
     • NHS Constitution and the 1948 founding
   • Organisation of care
     • Primary, secondary and tertiary care
     • Integrated Care Systems and GP gatekeeping
   • Regulation and governance
     • GMC, CQC and NICE roles
     • Clinical governance and audit
   • The multidisciplinary team
     • Roles beyond doctors
     • Interprofessional collaboration
2. 2

   Current Challenges Facing the NHS

   3 topics

   • Workforce pressures
     • Staff shortages and retention
     • Industrial action and morale
   • Demand and demographics
     • Ageing population and multimorbidity
     • Waiting lists and access
   • Funding and sustainability
     • Rising costs and rationing
     • Private vs public provision debate
3. 3

   Public Health and Society

   3 topics

   • Determinants of health
     • Social determinants and health inequalities
     • Prevention vs treatment
   • Major public health issues
     • Obesity, smoking and alcohol
     • Mental health and addiction
   • Health promotion and screening
     • Screening programmes and their ethics
     • Behaviour change and nudge
4. 4

   Topical Issues in Medicine

   3 topics

   • Technology and innovation
     • Artificial intelligence in diagnosis
     • Telemedicine and data privacy
   • Equity and global health
     • Health disparities and access
     • Pandemics and preparedness
   • Ethics of emerging science
     • Genomics and gene editing
     • Research ethics and consent

NHS, Healthcare Systems and Hot Topics flashcards for Multiple Mini Interview (MMI)

18 of 50 cards from the NHS, Healthcare Systems and Hot Topics deck — real questions with worked answers.

1. When was the NHS founded, and who is regarded as its principal architect?

   The NHS was founded on 5 July 1948. Aneurin (Nye) Bevan, then Minister of Health, was its principal architect.

2. What are the three core founding principles of the NHS as originally set out in 1948?

   1) That it meet the needs of everyone, 2) that it be free at the point of delivery, and 3) that it be based on clinical need, not ability to pay.

3. How is the NHS primarily funded?

   Mainly through general taxation (around 80%), supplemented by National Insurance contributions (around 20%) and a small amount from patient charges (e.g. prescriptions, dental, optical).

4. Roughly what proportion of UK GDP is spent on health, and how does this compare with the USA?

   The UK spends roughly 10-11% of GDP on health. The USA spends far more, around 17-18% of GDP, yet without universal coverage.

5. Contrast the NHS (Beveridge) funding model with the social health insurance (Bismarck) model used in countries like Germany.

   The Beveridge model funds healthcare through general taxation with the state as provider, free at point of use. The Bismarck model funds care through mandatory social insurance contributions (employer/employee) via non-profit sickness funds, with mixed public/private provision.

6. What is meant by healthcare being 'free at the point of delivery', and what are notable exceptions in England?

   Patients are not charged when they receive care. Exceptions in England include prescription charges, dental treatment, optical (eye) tests/glasses, and some long-term social care.

7. Define primary, secondary and tertiary care with an example of each.

   Primary care is first-contact community care (e.g. GP, pharmacy, dentist). Secondary care is hospital-based specialist care, usually by referral (e.g. general hospital, A&E). Tertiary care is highly specialised care (e.g. neurosurgery, transplant, specialist cancer centres).

8. What is the role of the GP as a 'gatekeeper' in the NHS?

   The GP acts as the first point of contact and controls access to most secondary/specialist care through referral, helping coordinate care, manage demand and contain costs.

9. Since July 2022, what structures replaced Clinical Commissioning Groups (CCGs) for planning NHS care in England?

   Integrated Care Systems (ICSs), each comprising an Integrated Care Board (ICB, which plans and commissions services) and an Integrated Care Partnership (ICP, a broader strategic body).

10. What is the difference between commissioning and providing healthcare services?

    Commissioning is planning, purchasing and monitoring services to meet population needs (e.g. by ICBs). Providing is the actual delivery of care (e.g. by hospital trusts, GP practices).

11. What body sits at the top of the NHS England structure, and what is its overall remit?

    NHS England oversees the budget, planning, delivery and day-to-day operation of NHS services in England; it sets priorities and direction. (NHS England and NHS Digital/Improvement have been merged into a single body.)

12. What does NICE stand for and what is its main function?

    The National Institute for Health and Care Excellence. It produces evidence-based guidance on treatments, medicines and care, and assesses cost-effectiveness to advise what the NHS should fund.

13. What metric does NICE use to assess cost-effectiveness, and what is its approximate threshold?

    The Quality-Adjusted Life Year (QALY). NICE typically considers treatments cost-effective at roughly £20,000-£30,000 per QALY gained.

14. Define a Quality-Adjusted Life Year (QALY) and give its formula.

    A QALY combines length and quality of life into a single measure, where 1 = one year in perfect health and 0 = death. It is calculated as $$\text{QALY} = \sum_i (\text{years in health state}_i) \times (\text{utility weight}_i)$$ with utility weight between 0 and 1.

15. What is the role of the Care Quality Commission (CQC)?

    The CQC is the independent regulator of health and social care in England. It registers, inspects and rates providers (Outstanding, Good, Requires Improvement, Inadequate) to ensure care is safe, effective, caring, responsive and well-led.

16. Which body regulates doctors in the UK, and what does maintaining a 'licence to practise' require?

    The General Medical Council (GMC). Doctors must hold registration with a licence to practise and undergo revalidation (normally every 5 years) supported by annual appraisal.

17. Name the regulatory bodies for nurses and for pharmacists in the UK.

    Nurses and midwives are regulated by the Nursing and Midwifery Council (NMC). Pharmacists are regulated by the General Pharmaceutical Council (GPhC).

18. What are the four pillars of clinical governance (commonly cited)?

    Clinical governance is the framework for maintaining and improving care quality. Key components include clinical effectiveness/audit, risk management, education and training, patient/public involvement, openness and the use of information/research.

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