The Defence Medical Services (DMS) is headed by the Surgeon General (SG) and includes the Headquarters Surgeon General (HQ SG), Joint Medical Command (JMC), Defence Primary Healthcare (DPHC) and the three single service medical organisations. HQ SG includes the posts of SG and the Director Medical Policy and Operational Capability. HQ SG is part of Joint Forces Command.
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 promote, protect and restore the health of service personnel to ensure that they 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 6,900 regular uniformed medical personnel and provides healthcare to 159,630 servicemen and women.
Personnel from all three 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, secondary healthcare, 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 as well as the RAF led Aeromedical Evacuation service.
The DMS has:
- 6,900 regular DMS personnel
- 15 Regional Rehabilitation Units (RRUs) across the UK and Germany
- 4 Ministry of Defence Hospital Units (MDHU) embedded into NHS acute trusts
- the Royal Centre for Defence Medicine (RCDM) in Birmingham
- 16 military run Departments of Community Mental Health (DCMH) in the UK with 5 DCMHs at the major permanent overseas bases
- Forces medics bid farewell to Bastion
- His Royal Highness Prince Mired visits UK military medical and rehabilitation centres
- £100 million bank fines allocated by government to good causes
- £300 million upgrade for defence rehabilitation services
- Military courage recognised by operational honours list
- BBC guide: How did World War 1 change the way we treat war injuries today?
- 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 SG is the three-star professional head of the DMS and the Defence Authority for end to end defence healthcare and medical operational capability. The SG is accountable to the Defence Board, reporting routinely through the Defence Audit Committee and the Defence People and Training Board.
The SG is responsible for:
- defining the boundaries and processes, in consultation with Top Level Budget Holders, together with organisational structures and composition of forces, and the standards and quality needed, to provide advice on health policy, healthcare and medical operational capability
- setting the overall direction on all clinical matters relating 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
- building and maintaining the medical infrastructure and cadre of people
- delivering a comprehensive healthcare system that provides the appropriate timely healthcare to service and other entitled personnel
- ensuring coherence of health plans between defence, the NHS and the devolved administrations’ Departments of Health; and
- chairing the DMS Board, the forum for providing strategic direction and guidance to the DMS
 This includes all healthcare providers within the DMS.
 This includes all healthcare providers within the DMS.
The current SG is Air Marshal Paul Evans
Headquarters Surgeon General
Director Medical Policy and Operational Capability
Director Medical Policy and Operational Capability is responsible for the core outputs, including medical research and the development of medical strategy and policy which is then implemented across the armed forces.
Director Healthcare Delivery and Training
Director Healthcare Delivery and Training is responsible for the delivery of primary healthcare including rehabilitation; mental healthcare; the placement of secondary care personnel in NHS facilities; and responsibility of medical education and training.
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. Originally founded as RAF Headley Court after the Second World War, for the treatment of injured RAF aircrew, it is now part of the 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. 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 a swimming pool built with donations from Help for Heroes.
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.
Medical strategy and policy
The Director Medical Policy and Operational Capability 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 NHS Revalidation 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.
- NHS revalidation
- GMC Responsible Officer protocol
- GMC 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
Programme Cortisone will address the support requirement for information gathered by the DMS to fully and effectively support the delivery of evidence based medical, dental and healthcare outputs.
The primary objectives of the programme are to:
underpin patient clinical care and patient safety through delivery of a relevant defence integrated Electronic Health Record (iEHR) capability for the defence population at risk that is fully accessible across all clinical environments, connected to the individuals’ UK civilian health and healthcare records and meets all governance and assurance regulatory
underpin provision of health advice, health and healthcare services and medical operational capability by delivering information management and exploitation of health and healthcare data to the right people, at the right time and in the right format
improve and provide enhanced information support for medical delivery processes
adopt a more coherent and holistic approach to the development and introduction of future medical information services, thus ensuring that services are agile, and deliver the defence medical information capability efficiently, effectively, and represent value for money
provide a fully integrated information service that supports medical processes seamlessly between the firm and deployed operational locations
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 to Bolivia took place with the combined aim of carrying forward the research objectives and to achieve some challenging ascents of mountains over 6000m.
More details are available from Surg Cdr Adrian Mellor