Defence Medical Services
The Defence Medical Services (DMS) includes the Headquarters Surgeon General (HQSG), Joint Medical Command (JMC), Defence Dental Services (DDS) and the 3 single service medical organisations. It is headed by the Surgeon General (SG).
Medical, dental and related support services are provided to armed forces personnel by the Ministry of Defence (MOD), the NHS, charities and welfare organisations.
Primary role of DMS
The primary role of the DMS is to ensure that service personnel are ready and medically fit to go where they are required in the UK and throughout the world, generally referred to as being ‘fit for task’.
The DMS encompass the entire medical, dental, nursing, allied health professionals, paramedical and support personnel. It is staffed by around 7,000 regular uniformed medical personnel and provides healthcare to 196,000 servicemen and women.
Personnel from all 3 services, regulars and reservists, work alongside civil servants and other supporting units providing healthcare to service personnel serving in the UK, abroad, those at sea, and in some circumstances family dependants of service personnel and entitled civilians. It also provides some aspects of healthcare to other countries’ personnel overseas, in both permanent military bases and in areas of conflict.
The range of services provided by the DMS includes primary healthcare, dental care, hospital care, rehabilitation, occupational medicine, community mental healthcare and specialist medical care. It also provides healthcare in a range of facilities, including medical and dental centres, regional rehabilitation units and in field hospitals.
The DMS has:
- over 7,000 regular DMS personnel
- 15 Regional Rehabilitation Units (RRUs) across the UK and Germany
- 5 Ministry of Defence Hospital Units (MDHU) embedded into NHS acute trusts
- the Royal Centre for Defence Medicine (RCDM) in Birmingham
- 15 military run Departments of Community Mental Health (DCMH) in the UK with 5 DCMHs at the major permanent overseas bases
- the DMS provides healthcare to about 258,000 people
- BBC guide: How did World War 1 change the way we treat war injuries today?
- New Year honours for service personnel and defence civilians
- Soldier receives UK’s first mind-controlled robot arm
- Life-changing prosthetics technology
- 2013: birthday honours for service personnel and defence civilians
- online support for the armed forces community
- careers service launched for injured heroes
- military medics in Gulf casualty exercise
- royals open military recovery centre
- new mental health support app for service personnel
- Care Quality Commission review of Defence Medical Services
- Defence National Rehabilitation Centre: feasibility study report
- JDP 4-03: Joint Medical Doctrine
- Doctrine note 11/22: Military medical contribution to health sector development within security and stabilisation operations
- Clinical Guidelines for Operations (CGOs) (JSP 999)
The Surgeon General (SG) is the professional head of the DMS and the process owner for end to end defence healthcare and medical operational capability. He is accountable to the Defence Board, reporting routinely through the Defence Operating Board and Service Personnel Board, both of which he attends as required.
The SG is responsible for:
- defining the boundaries and processes, organisational structures and composition of forces, and the standards and quality needed, to provide advice on health policy, healthcare and medical operational capability in consultation with top level budget holders
- setting the overall direction on all clinical matters relating to the practice of medicine within the military
- setting and auditing the professional performance of all medical personnel
- setting clinical and medical policies and standards, and auditing compliance by military organisations across defence
- developing the science of military medicine to develop approaches and treatments that will best counter threats to the health and well being of service personnel
- providing deployable medical operational capability
- building and maintaining the medical infrastructure and cadre of people
- providing a comprehensive healthcare system that provides the appropriate timely healthcare to service (and other entitled) personnel
- ensuring coherence of health plans between defence and the NHS
- chairing the Defence Medical Services Board, the forum for providing strategic direction and guidance to the DMS
The current SG is Air Marshal Paul Evans
Headquarters Surgeon General
Surgeon General (London)
MOD Main Building
Joint Medical Command (JMC)
The JMC is to support Permanent Joint Headquarters (PJHQ), single Services, Defence Suppliers Forum (DSF) and other Joint users in providing medical operational capability, healthcare, education, training and research in order to maximise fighting power and medical excellence within the armed forces.
JMC will support the provision of continuously improving healthcare on operations and in peacetime. It will build on past training and research achievements, develop increasingly responsive ways of capturing operational evidence and lessons to ensure that they are incorporated at the earliest opportunity into the training given to personnel deploying on operations and into the treatment at every level of our patients.
Who is part of JMC?
- HQ JMC: led by Comd JMC (currently Surg RAdm Calum McArthur) the HQ is responsible for providing direction and support to JMC
- Defence Dental Services (DDS): responsible for providing effective military oral health care through provision of dentally fit service personnel prior to, and during, operations
- Defence Medical Group (DMG): is responsible for providing secondary personnel to meet operational exercises, placing staff into the NHS to maintain clinical skills and the Role 4 pathway. This Role 4 pathway is the treatment of operational casualties from arrival at RCDM through to rehabilitation at Headley Court
- Defence Medical Services Training Group (DMSTG): is responsible for the design, development, assurance and provision of internal medical training for DMS personnel and the Front Line commands
- Defence Postgraduate Medical Deanery (DPMD): is responsible for the post graduate medical education and training of all DMS healthcare professionals as well as the ‘recruitment’ of doctors to speciality training positions
- Directorate Healthcare: is responsible for the commissioning of general secondary healthcare from the NHS and/or the independent sector for the Service population, primarily through the MDHU’s
- Medical Director: through academic teaching, research and clinical policy development provide input to strategic, operational, equipment and research matters
JMC is represented at the following sites:
- Defence Medical Services (Whittington), near Lichfield, Staffordshire. Since Apr 2010 the following have been co-located at DMS(W): HQ JMC, HQ DMG, HQ DDS, Directorate Healthcare and DPMD. Also on site is Headquarters Surgeon General (HQ SG).
- Defence Medical Rehabilitation Centre (DMRC) at Headley Court, Surrey
- Royal Centre of Defence Medicine (RCDM) at Queen Elizabeth Hospital, Birmingham, West Midlands
- Medical Director at Birmingham Research Park
- Defence Medical Services Training Group (DMSTG) at Keogh Barracks, Ash Vale, Hampshire
- Military Defence Hospital Units (MDHU) based at Portsmouth, Peterborough, Frimley Park, Derriford (Plymouth) and Northallerton
- Dental centres: There are 160 dental centres under 11 Regional Headquarters
Defence Dental Services (DDS)
The Defence Dental Services is lead by Brig Nicholas Young.
The DDS is a tri-service organisation employing around 1085 personnel from the Royal Navy, army, Royal Air Force and civilian sector who are trained dentists, hygienists, technicians or dental nurses as well as critical support staff. Most treatment is provided at Service establishments (dental centres) in the UK and overseas.
The DDS has its headquarters at DMS(Whittington) in Staffordshire and facilitates control via 12 regional headquarters each headed by a Principle Dental Officer, located in Germany, Cyprus and across the UK. The DDS also provides dental services to personnel on operations throughout the world in order to maximise the operational effectiveness of the armed forces by making armed forces personnel dentally fit for their task.
The DDS is part of the Joint Medical Command area within DMS.
- dental centre planning tool
Defence Medical Rehabilitation Centre (DMRC) Headley Court
DMRC has been located on this site near Epsom, Surrey for over 60 years and has seen much change in that time although perhaps the pace of change is at its greatest at this moment. Originally founded as RAF Headley Court after the Second World War, for the treatment of injured RAF Aircrew, it is now part of the Joint Medical Command (JMC). With a staff of over 360 service and civilian personnel, it provides a range of rehabilitation services from outpatients through residential courses for those with sports, exercise and industrial injuries up to those with complex life changing trauma injuries including amputation and brain injury. At present there are 135 hostel rooms for force generation patients and 96 in-patient beds to support those who need more nursing support.
DMRC is the services premier rehabilitation facility. The wide skill base of it’s personnel allow for the treatment of the most complex of rehabilitation cases offering support to the Regional Rehabilitation Units and forming an integral part of the Defence Medical Rehabilitation Programme.
DMRC offers access to all specialists engaged in rehabilitation with on site consultants, physiotherapists, remedial instructors, occupational therapists, speech and language therapists, social workers, prosthetics, podiatrists, a psychologist and a cognitive therapist. It has 5 gymnasiums, a large hydrotherapy pool to support the clinical departments and the new H4H (Help for Heroes) swimming pool.
The medical records department, workshops, supply and administration staff all support DMRC’s clinical role. It also contains the Joint Service’s School for Exercise Remedial Instructors.
DMRC is entering a period of rapid change and development. This is a direct consequence of the requirement for enhanced services to manage the increasing numbers of trauma survivors who reach Headley Court with ever more complex needs. However, there is also increasing pressure to return to full deployable fitness those with more minor conditions. These 2 groups of patients might appear to be mutually exclusive; however, each is of equal importance to defence. DMRC’S force generation work supports the physical component of fighting power whilst its rehabilitation of complex trauma cases supports the moral component. In addition, as the physical capability of trauma survivors increases so these individuals are now joining force generation groups.
History of Headley Court
The present day Defence Medical Rehabilitation Centre is a working rehabilitation unit so Headley Court is not open to the public. It has however an interesting history which led to it becoming Grade II Listed.
The Headley Court site has through its history been the location of a small Roman villa; the Court House of the Headley Manor (which was in Headley village); Elizabethan farm buildings and a Queen Anne house. Written records go back to the 17th Century, but these earlier buildings have been demolished.
The mansion used as the Officers’ Mess today is late Victorian, designed in the Jacobean style by Edward Warren and built by Walter Cunliffe as a family home between 1895 and 1910. It incorporates some surviving features from the Queen Anne house, like the sections of original basement and garden walls, and some external steps and railings.
Walter Cunliffe was a chairman of the North Eastern Railway, and while Governor of the Bank of England from 1913 to 1919, was responsible for arranging the finances of the First World War. He was created Lord Cunliffe, 1st Baron Headley, for his work.
The wider estate was a shooting estate spanning 300 acres which went into decline due to the loss of so many men to the First World War. Headley Court occupies 85 acres of that estate.
Lord Cunliffe died in 1920, but his widow, Lady Cunliffe, continued to live at Headley Court for the next 20 years.
Early in the Second World War, the house and 85 acre estate were requisitioned for use as the Canadian Forces’ HQ in Europe. Headley Court was chosen for the Canadians for its close proximity to Headley Heath which was used for training in trench digging, and neighbouring Headley Park, wartime home of the evacuated Canadian High Commission.
At the end of World War 2, the British public donated to a fund in gratitude for the Battle of Britain and the efforts of the wartime Royal Air Force aircrew.
Lady Cunliffe sold the house and 85 acres at a generously low price to the Estate Agents and Auctioneers Institute (now the Royal Institute of Chartered Surveyors) who managed the fund, so they could build additional buildings and endow a memorial rehabilitation unit to the Air Ministry.
The Government topped up the gift and provided funds to equip and run the rehabilitation and administrative facilities, which were initially for treating injured RAF pilots.
RAF Headley Court opened in 1950 as a unit for officers, expanding to become the Defence Services Medical Rehabilitation Unit for all ranks in 1985, when the Joint Services Medical Rehabilitation Unit at RAF Chessington closed.
Divisions at DMRC Headley Court
To provide patient centred rehabilitation nursing care with a focus on continuous improvement and evidence based practice, to achieve nursing excellence within the speciality in support of optimal rehabilitation outcomes.
The provision of 24 hour evidence based nursing care to patients undergoing consultant led, multidisciplinary intensive rehabilitation. This involves working collaboratively with patients to achieve maximum independence while providing information, guidance and support in self care, pain and wound management to optimise engagement in rehabilitation activities. Nursing supports to patients in the achievement of personal goals while providing a safe environment in which to do so.
The Rehab Div HQ provides the executive overview and strategic direction for the Division. They work to balance the manning of staff and personnel, to ensure the teams can deliver optimal care.
The role of Administration Division is to provide administrative support to all Unit personnel including patients both at home and on Operations, and to their families. This support is encompassed in 4 important functional areas:
- Personal Management Flight (PMF) including Accounts Flight
- Registry, Welfare and Community Support
- PSS (Personal Support Services) including Patients Admin, Medical Records and Unit Medical Centre
- Education and Training and Police and Security.
Admin Division internal priorities are to value the contribution of all staff, to ensure that they are prepared and supported for their daily task across the full spectrum of the administrative support services and where applicable in accordance with single service policies, provide welfare support and develop community support initiatives
Other Sections at DMRC Headley Court
At DMRC, Battle Back provides a range of activities for inpatients which include; archery, climbing, kayaking, ice sedge hockey, horse riding, gliding, tandem parachuting, sporting talent ID days, wheel chair sports, water skiing and many more. There are also opportunities when patients are not on admission at DMRC to deploy on larger expeditions in multi disciplines across the world.
Defence Postgraduate Medical Deanery (DPMD)
This site is designed to provide you with important information to help support you through your training programme and provide you with the opportunity to provide feedback on your training and share best practice with colleagues.
The defence deanery is to oversee the postgraduate training of doctors, nurses, dentists, vets and allied health professionals, ensuring that the training meets the needs of the services and the relevant national bodies.
- defence postgraduate medical deanery: external training form
Medical strategy and policy
The Assistant Chief of the Defence Staff (Health) (ACDS(H)) is responsible for the development of medical strategy and policy which is then implemented across the armed forces.
The DMS is moving to publish copies of its medical policy documents.
Appraisal and revalidation
JSP 950 Leaflets 10-2-1 and 10-2-2 detail the processes for the Appraisal of Medical Officers (10-2-1) and the Revalidation of Medical Officers (10-2-2).
Medical appraisal, as defined within the Medical Appraisal Guide (MAG) produced by the National Health Service (NHS) Revalidation Support Team (RST) , is a process of facilitated self-review supported by information gathered from the full scope of a doctor’s work . Effective medical appraisal and subsequent Revalidation  will satisfy the requirements of the General Medical Council’s (GMC) Good Medical Practice and support the doctor’s professional development.
All doctors, defined in this policy as registered medical practitioners with a licence to practise, including those whose role as a doctor does not involve direct patient care, are required by the GMC to have an appraisal in each year (1 Apr to 31 Mar) that promotes their personal and professional development. Most doctors will have no difficulty demonstrating over the five-year cycle that they are up to date and fit to practise, and so will be revalidated by the GMC.
 Although uniformed and civilian doctors are employed by Defence across the UK, and overseas, the process for Revalidation and appraisal will follow that for NHS England; accordingly the RST guidance (for England) has been utilised in formulating this policy.
 Medical Appraisal Guide available through the Revalidation Support Team website.
 Revalidation started on 3 Dec 2012. The GMC began to revalidate licensed doctors from this date onwards and expects to revalidate the majority of doctors in the UK by March 2016.
Medical revalidation is the process by which all doctors who are licensed with the General Medical Council (GMC) will regularly demonstrate that they are up to date and fit to practise. It will provide assurance that licensed doctors are practising to the appropriate professional standards.
There has been extensive consultation on the legislation underpinning the introduction of revalidation for doctors which HQ Surgeon General and the Defence Medical Services (DMS) have been involved in, and it is anticipated that the General Medical Council (Licence to Practise and Revalidation) Regulations will become law in December 2012.
All doctors working within the DMS, regardless of the role in which they are employed, are required by the Surgeon General to retain their licence to practise and will, therefore, need to revalidate. In order to enable this, it is essential that all doctors working in the DMS have an annual appraisal.
Please note that all documents will need to be printed and submitted hard-copy until a writeable PDF is available. Copies should be retained for individual records. Further information is available from HQ SG.
Updates on revalidation are available here.
The General Medical Council (GMC) have published their protocol on revalidation recommendations (see external links below). This is aimed at responsible officers but all doctors are encouraged to at least scan it as it provides useful background information about revalidation recommendation.
- GMC Responsible Officer protocol
- Responsible Officer dashboard
- GMC revalidation
- NHS Revalidation Support team
- Guide to medical appraisal for revalidation
- good medical practice
- GMP framework for revalidation
- supporting information for revalidation and appraisal
- How doctors can meet the GMC’s requirements for revalidation in the first cycle
- GMC revalisation recommendations
- GMC online
DMS medical scientific expeditions
The military has a long association with medical research which is supported through funding from the Joint Services Expeditions Trust and the Drummond foundation.
In the recent past successful expeditions have taken place in 2007 (to Aconcagua 6959m) and 2009 (Everest Base Camp EBC and Island Peak, Nepal, 6300m). These expeditions have introduced many DMS personnel to the Joint Services Adventurous Training (JSAT) scheme and generated significant data on acclimatisation to high altitudes.
Ex Imja Tse (to EBC and Island Peak) was a very successful expedition involving 35 personnel from all elements of the DMS. The expedition (under the leadership of PONN Rob Wakeford) had a well co-ordinated strategy of training through the JSAT scheme creating some new instructors and many proficiency awards. Future expeditions are being planned to build on this success and create more instructors and experience within DMS.
The research conducted during Imja Tse built on that carried out on Aconcagua, including measuring Brain Naturetic Peptide (BNP), aldosterone, NGAL and cortisol. The interaction between these hormones at altitude is relatively unstudied and potentially crucial for acclimatisation. The initial evidence suggests a link between BNP and acute mountain sickness which has never been reported before. Work from this expedition is in press with the European Journal of Applied Physiology and the Journal of Biological Sciences.
As anticipated these field trials (as on Aconcagua) have created many other potential strands for research. In May 2011 23 trekkers made the journey to Kala Pattar (5600M) collecting data on hormonal adaptation to hypoxia as well as recording electrocardiogram (ECG) traces during exercise and monitoring cardiac function with portable ultrasound. Blood samples were successfully collected at 8 time points, transported frozen along the trail and returned to the UK on dry ice, no mean feat in itself! The samples collected will be analysed over the forthcoming months using funding provided by the Defence Medical Services Research Study Group and the Drummond Foundation.
In June 2012 a large expedition will be taking place to Bolivia with the combined aim of carrying forward the research objectives and achieving some challenging ascents of mountains over 6000m. This expedition hopes to match a significant programme of research to some ambitious adventurous training goals.
These expeditions have the support of the Surgeon General, Surg Vice Admiral Raffaelli who is acting as Service Patron for the expeditions.
More details are available from Surg Cdr Adrian Mellor