Defence Medical Services
The Defence Medical Services (DMS) comprises personnel from the Royal Navy Medical Service, Army Medical Service, the Royal Air Force Medical Service and the Headquarters Defence Medical Services (HQ DMS).
DMS promotes, protects and restores the health of the UK armed forces to ensure that they are ready and medically fit to deploy globally. The DMS is staffed by circa 11,000 service personnel (7,800 regular and 3,200 reserves) and 2,600 civilian personnel and provides healthcare to circa 148000 UK Regular Armed Forces personnel.
Service personnel and civilians work side by side as medical, dental and allied healthcare professionals with other personnel to plan and deliver excellent healthcare services wherever they are needed. The services offered by the DMS include primary healthcare, dental care, rehabilitation, occupational medicine, community mental healthcare and specialist medical care.
Defence Medical Services (DMS) in the UK
The HQ DMS is responsible for:
- Advising on the generation, delivery and assurance of medical operational capability for operations and fixed tasks.
- The provide and commission safe, effective and efficient healthcare services for all armed forces personnel.
- Provide policy and advice on health, healthcare and medical operational policy.
- Direct medical research and clinical innovation in Defence.
- Delivery of joint medical training for Defence.
The HQ DMS has:
- Regional Rehabilitation Units (RRUs) across the UK and Germany
- Joint Hospital Group (JHG) Units embedded within NHS Trusts
- The Royal Centre for Defence Medicine (RCDM) in Birmingham
- The Defence Medical Rehabilitation Centre (DMRC) Stanford Hall near Loughborough
- Mental health services are delivered through a network of Departments of Community Mental Health (DCMHs), Mental Health Teams (MHTs), and some additional locations have a dedicated permanent Community Mental Health Nurse.
- Deployable healthcare capability for military and humanitarian operations
The DMS offers a wide range of career opportunities both in the UK and overseas. Armed forces personnel, civilians and contractors work side-by-side in a variety of clinical and administration roles. You can find out more about these roles here:
UK armed forces
You can browse regular and reservist roles here:
The MOD employs civilians in clinical and other relevant business and technical roles:
- view clinical vacancies on NHS Jobs
- view all other vacancies on Civil Service Jobs
NHS Career Opportunities for Service Leavers and Veterans
The NHS Career Opportunities for Service Leavers and Veterans Booklet, published by the Defence Medical Academy and the NHS ‘Step into Health’ programme, explains the range of NHS employment opportunities available for Military and Civilian Service Leavers, Veterans and their families to help them build a new career in healthcare. The booklet signposts to information about the career opportunities and skills required in NHS England (also applicable to other parts of the NHS), the skills and experience sought, how to apply and find out more/get support. NHS Career Booklet for Service Leavers
Headquarters Defence Medical Services Group (HQ DMS Gp)
HQ DMS is the strategic headquarters of the DMS based at Whittington (DMS(W)) near Lichfield, Staffordshire. It is closely engaged with many Defence medical programmes, projects, initiatives, campaigns and policy areas.
The HQ DMS has an annual budget of circa £500m and responsible for delivery of the Healthcare and Medical Operational Capability Function on behalf of Defence. HQ DMS provides an occupationally focused primary healthcare service, encompassing primary medical and dental care, occupational health, public health, force preparation, travel medicine, mental health and rehabilitation, and selected outsourced services. Secondary healthcare is provided by the NHS with HQ DMS input to ensure it meets specific defence requirements. The HQ DMS is also responsible for the delivery of Joint Medical Training through the Defence Medical Academy.
Defence Functional Leadership of Healthcare and Medical Operational Capability
Defence’s medical capabilities lie at the heart of the moral component of fighting power. Healthcare and Medical Operational Capability (H&MOC) forms one of 15 Functions across Defence. The purpose of a Function is to provide leadership and coherence to activities that transcend organisational boundaries to enable the MOD to operate effectively and efficiently and deliver Government’s requirements.
The Functional Owner (3*) for the Healthcare and Medical Operational Capability Function is the Director General Defence Medical Services responsible for functional coherence and delivery of H&MOC Defence Functional Leadership strategy on behalf of MoD Head Office.
The Functional Leader (2*) is the Surgeon General (SG). SG is responsible for delivery and coherence of Defence medical policy and medical operational capability.
The Head of Profession (2*) is Director Medical Personnel & Training (DMP&T). Dir MP&T is responsible for DMS’ people capability, developing and delivering skills frameworks, career pathways and strategic workforce planning, professional leadership, professional standards, promoting learning, development and talent management for all in the H&MOC Profession.
The H&MOC Function is responsible to Defence for:
- Delivering a comprehensive healthcare system that provides the appropriate timely healthcare to Service and other entitled personnel.
- Setting the overall direction on all clinical matters relating to the practice of military medicine.
- Setting the joint medical training requirements for Defence, to build and maintain the medical cadre.
- Providing and cohering deployable medical operational capability.
- Developing the science of military medicine to develop approaches and treatments that will best counter threats to the health and wellbeing of Service personnel.
- Setting and auditing the professional performance of all military medical personnel.
- Setting clinical and medical policies and standards, and auditing compliance by military organizations across Defence.
- Ensuring coherence of health plans between Defence and the NHS.
- Defining the boundaries and processes, in consultation with Top-Level Budget Holders, together with the organisational structures and composition of Forces, and the standards and quality needed, to deliver advice on health policy, healthcare and medical operational capability.
- Accountable to the 4* Defence Medical Services Board that provides strategic direction and guidance to the DMS.
Overview and linkage between the DMS and single Services
The Royal Naval Medical Service
The Royal Navy Medical Service (RNMS), also known as Navy Healthcare, provides comprehensive healthcare to ships, submarines and Royal Marine personnel at sea and on land.
It delivers healthcare to deployed service persons in the land and maritime environment, including surface and subsurface assets. Providing primary care and prehospital care including Damage Control Surgery (DCS) and Damage Control Resuscitation (DCR). Moreover, deployed hospital care is delivered in the maritime environment by surgical facilities aboard the Queen Elizabeth Class aircraft carriers and by Commando Forward Surgical Group (CFSG) on land. RFA Argus is also utilised as a Casualty Receiving Facility.
It provides specialist advice in fields of radiation protection, diving medicine and environmental medicine through the Institute of Naval Medicine. It also includes the Queen Alexandra’s Royal Naval Nursing Service.
The RNMS is headed by the Head of Navy Healthcare within the People and Training 2* Directorate. They are responsible for providing medical advice to the Naval Executive Board (NEC) and facilitate delivery of medical operations in support of the Royal Navy and wider defence operational outputs.
The Army Medical Service
The Army Medical Service (AMS) provides Army medical and veterinary policy, operational capability, healthcare advice and assurance, to enhance and sustain the operational effectiveness of the Army. Army operational healthcare is integrated within the Army’s organisational structure, regular Army medical regiments and regular and reserve multi-role medical regiments provide coordinated operational forward of hospital and hospital capabilities.
The AMS is made up of the following:
- Royal Army Medical Corps
- Royal Army Veterinary Corps
- Royal Army Dental Corps
- Queen Alexandra’s Army Nursing Corps
The Royal Air Force Medical Service
The Royal Air Force Medical Service (RAFMS) provides direct medical support to the deployed force and delivers medical expertise including aviation medicine, training and support to RAF personnel and the wider armed forces.
The RAF Centre of Aviation Medicine conducts a wide range of activities in support of air safety delivering aircrew and aircraft integration, aviation medical policy and training and specialist support through research and medical boards.
Tactical Medical Wing (TMW) provides operational outputs including aeromedical evacuation, deployed primary care, pre-hospital and hospital capabilities and delivers the 24/7/365 strategic aeromedical evacuation capability. TMW is supported by two medical Reserve squadrons: No 612 and No 4626.
Firm Base Health System
2* Led Directorate of Defence Healthcare
Responsible for delivery of healthcare to the Defence population, through Defence Primary Healthcare (DPHC) in the Firm Base (UK and overseas permanent bases) as well as leading the transformation of Healthcare through the Healthcare Improvement Programme (HIP). HIP targets four key delivery functions: Primary Medical Care, Dental Care, Healthcare Recovery (Mental Health, Rehabilitation and Occupational Health) and Pharmacy/Dispensing to develop an enduring Improvement capability for Defence personnel. ## 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.
Defence Primary Healthcare (DPHC)
DPHC delivers occupational health based primary healthcare. 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, mental healthcare and occupational health in the UK and overseas to service personnel and, where appropriate, their dependants.
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 regional teams in the UK and a separate team embedded in HQ DPHC for overseas medical treatment facilities. DPHC facilities are regulated by the Defence Medical Services’ Regulator supported by the Care Quality Commission.
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.
For any military medical enquiries email DMRC-PSSMailbox@mod.gov.uk or call 01509 251500, ext: 4804.
For all other DMRC enquiries email DMRC-PSSMailbox@mod.gov.uk or call 01509 856277.
On operations, assessment and treatment for MSKI is provided by specialist multidisciplinary teams: rheumatology and rehabilitation; sport and exercise medicine; physiotherapy and exercise rehabilitation. Within deployed hospital facilities, military physiotherapists also provide advice and treatment across the spectrum of clinical specialties including critical care, medical and surgical, chests, burns, trauma orthopedics and MSKI.
Joint Hospital Group (JHG) and Royal Centre for Defence Medicine (RCDM)
JHG provides highly capable secondary healthcare personnel for operations and Defence activity other than operations (DAOTO) and delivers the Firm Base medical care as part of the operational patient pathway. Defence secondary healthcare personnel are assigned to carefully selected NHS Trusts. Day-to-day interaction with these Trusts and operational command of military personnel embedded within them is conducted by five JHG regional headquarters (Royal Centre for Defence Medicine (RCDM), JHG North, JHG South, JHG South-East and JHG Southwest). This ensures that our secondary healthcare personnel develop their clinical skills, meeting statutory and professional needs, whilst remaining available to Defence at the required readiness. Military training and experience is maintained through a combination of unit based training, exercises and deployments. The Role 4 element of the Operational Care Pathway is undertaken mainly at RCDM at the Queen Elizabeth Hospital, Birmingham.
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 0800 323 4444
- 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).
Medical Force Protection
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
Mefloquine signposting service
The Mefloquine Single Point of Contact launched on 5 September 2016 and is for current and former service personnel who have concerns about their experience of mefloquine (commercially known as Lariam).
The MOD takes the health and wellbeing of its personnel seriously and acknowledges its duty of care to provide the best possible support to them. This service provides information and signposting to a range of services to address their concerns.
All health care provision for UK Veterans and their families is delivered by the National Health Service (NHS). Information on the support available can be obtained from Healthcare for the armed forces community - NHS (www.nhs.uk).
Defence Medical Directorate
2* Surgeon General
The mission of the Defence Medical Directorate is to develop, deliver and maintain the moral, physical and conceptual components of the operational patient care pathway for which the HQ DMS has a direct responsibility; influence those areas where HQ DMS has a direct interest and advise in those where HQ DMS’ interest is more indirect but where our expertise and experience adds value. In doing this we will have the greatest opportunity to maximise the health and optimise the care of the Defence population. The Directorate comprises 2 main pillars namely Medical Operation Capability and Research/Clinical Innovation.
Military Medical Research and Innovation
The Research and Clinical Innovation (RCI) pillar of the Defence Medical Directorate is responsible for the innovative development of military medical care through academia, research, clinical policy and equipment capability developments to better prevent, detect and treat illness or injury resulting from operations and improve outcomes in operational healthcare. A diverse programme of research across primary care, secondary care, nursing, rehabilitation and mental health, seeks to develop the quality of patient care for current and anticipated medical requirements in the UK and the deployed environment. The Defence Medical Services innovation hub, jHubMed, seeks to deliver the latest technological solutions into the hands of the end user at pace. Alongside this, RCI’s development of strong national and international collaborative links, both military and civilian, are crucial to support future innovation in the healthcare environment. Robust educational ties with the Defence Medical Academy enable new developments, innovations and lessons to be passed onto Defence clinicians and support staff, directly enhancing delivery patient care.
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 Royal Centre Defence Medicine (RCDM) at the Queen Elizabeth Hospital Birmingham. Established in 2001, 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/
Military Medical Personnel
2* Led Directorate of Medical Personnel and Training (DMP&T)
DMP&T is responsible for DMS workforce planning, command of medical training and placement of DMS personnel into the NHS. It provides a balanced, qualified, experienced, and motivated workforce that enables HQ DMS to support the operational needs of Defence. This is achieved through high-quality clinical placements to develop clinical competency in support of operations and the efficient force generation of medical capability. In parallel, it delivers, assesses, and innovates medical training and education through courses delivered on-site and a system of external training.
Military Medical Recruitment
The DMS utilise a vast range of recruitment routes to ensure they meet their workforce demands. These include internal training pathways and the recruitment of qualified nurses, medics and allied healthcare professionals, and the external recruitment of medical and dental university cadets through to fully qualified hospital consultants and general practitioners. Terms and conditions of Service can be adapted to reflect the qualifications and experience of professional healthcare recruits to ensure the recruitment offer is attractive. As per the rest of the Ministry of Defence, recruitment is subject to various nationality and security considerations.
Defence Medical Academy
Individual Education and Training
The largest majority of DMS clinical education for both OF and OR cadres is sourced through civilian healthcare education providers. This includes entry level qualifications such as bachelor’s degrees and training for specialised roles for nurses and doctors. The Foundation Medic training program and Healthcare Assistant training program are delivered through the DMA.
This is the official list of Defence Medical Services training courses and fellowships, including face to face courses, eLearning packages and conferences/symposia for regular and reserve personnel.
2* Led Directorate for Defence Transformation
The Defence Medical Services (DMS) is transforming to ensure it is prepared for the demands of the future. The Transformation journey that has no fixed end point, is a vehicle to support the DMS in achieving its strategic objectives and its goal of being “A world class, values-led provider of excellent patient focussed Defence Healthcare, committed to those we serve.”.
Success will be measured against all aspects of the Quadruple Aim: Improved patient outcomes; increased deployability; improve experience for our people and better value for money.
In pursuit of this, high quality medical care on Operations and in the Firm Base will maximise the number of personnel who are fit for deployment. This will be delivered through reviewing our skills, structures, infrastructure, processes and ways of working to ensure we are as effective and efficient as we can be, harnessing improved digital technology and systems.
Healthcare Improvement Programme (HIP)
Modernising Primary Healthcare, Improving Patient Care
HIP will enhance the provision of primary care (medical and dental), drive the re-organisation of care that contributes to patient recovery (rehabilitation, occupational and mental health), and will network the facilities from which healthcare is provided. Modern, data-driven Performance Management and Quality Improvement (PMQI) tools are being woven throughout all these endeavours. HIP will build on the established and successful operating model for Defence Primary Healthcare (DPHC) by exploring and exploiting modern ways of working and emerging digital technologies, In doing so, HIP will address each of the elements of the Defence Medical Services’ Quadruple Aim; to improve patient outcomes, to enhance the experience of Healthcare staff, to maximise the deployable Force available to Commanders, and to offer Defence the best value for money in doing so.
The vision for Programme CORTISONE is to deliver a sustainable, integrated, cohesive and enduring information capability that will fully and effectively support the delivery of evidence-based medical and dental health and healthcare outputs, in order to achieve the aim of the Defence Medical Services (DMS). CORTISONE will deliver an Ecosystem of Healthcare Information Services to enable better patient outcomes and contribute to DMS resource optimisation, to maximise the number of personnel fit for role for Defence. Read more about Programme Cortisone - GOV.UK (www.gov.uk).
Civil-military medical co-ordination in response to national emergencies
The policy covering Military Aid to Civil Authority (MACA) requests is based on the UK government’s intent to provide an effective response to all types of emergencies and major crises at national level. This means having a pre-planned, integrated and coordinated response from the emergency services, civil authorities and, where appropriate, the Ministry of Defence. If there is an emergency or crisis in the UK, local emergency services provide the first response; government departments or civil authorities may then seek to request military assistance as part of their coordinated multi-agency response to augment local responders. The contribution of Defence reinforces national resilience through effectively providing military capacity, capability, and resources, to assist in the planning, response and recovery for a wide range of disruptive events. Defence maintains a health and medical capability that in certain circumstances may be able to assist with MACA. Assistance to MACA may be where an aspect of the National Health Service is in crisis and under pressure to meet demand, or where a situation would benefit from specific military medical expertise or equipment and contracted provision cannot be provided due to the urgency of the situation, in line with MACA principles. Examples include providing military personnel to uplift NHS staff, establishing field medical treatment facilities, providing medical teams to operate in hazardous environments or advising on specialist areas such as mass casualty management, disease outbreaks, chemical, biological, radiological and explosive injuries, medical logistics and the provision of care in hostile and austere conditions