Defence Medical Services in the UK
The uniformed and civilian medical and dental personnel from all 3 services are known collectively as the Defence Medical Services (DMS).
The DMS are grouped under Headquarters Surgeon General (HQ SG), the Director of Medical Policy and Operational Capability, the Director of Healthcare Delivery and Training and the 3 single service medical organisations. Medical, dental and related support services are provided to armed forces personnel by the Ministry of Defence (MOD) and the National Health Service (NHS). Charities and welfare organisations are also involved in the provision of support services where appropriate.
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. The organisation is staffed by around 9,100 personnel (6,900 regular and 2,200 reserve) and provides healthcare to 159,630 UK regular forces personnel (as at 1 April 2014: The UK armed forces annual personnel report).
Personnel from all 3 services, regulars and reserves, work alongside civil servants and other supporting units providing healthcare to service personnel 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, 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 (RRUs) and in Field Hospitals. From April 2013, the DMS has been responsible for providing primary healthcare to all service personnel and entitled civilians through the DPHC organisation. The DMS has 14 RRUs across the UK and Germany, four Ministry of Defence Medical Group Units (DMGUs) embedded within NHS Trusts, the Royal Centre for Defence Medicine (RCDM) in Birmingham, the Defence Medical Rehabilitation Centre (DMRC) in Surrey, and 16 military run Departments of Community Mental Health (DCMH) in the UK with 3 DCMHs at the major permanent overseas bases.
The Surgeon General (SG) is the three-star Military Officer and professional head of the DMS and the Defence Authority for end to end defence healthcare and medical operational capability. He is accountable to the Defence Board, reporting routinely through the Defence Audit Committee and Defence People and Training Board, both of which he attends as required. HQ SG became part of Joint Forces Command on 1 April 2012. SG continues to have responsibility for policy making and the provision of high level medical and strategic advice to ministers, the Defence Board and the Chiefs of the Defence Staff.
The SG is responsible for:
- defining the boundaries and processes, in consultation with top level budget holders (TLBs), 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
- setting the overall direction on all clinical matters relating to the practice of military medicine
- setting and auditing the professional performance of all military 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 wellbeing of service personnel
- providing deployable medical operational capability
- building and maintaining the medical infrastructure and cadre of people
- providing a comprehensive healthcare system that achieves 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 and the SG Designate is Rear Admiral Alasdair Walker who will take up post in December 2015.
HQ Surgeon General
HQ SG is the strategic headquarters of the DMS based at DMS Whittington (DMS(W)) near Lichfield in Staffordshire. It is involved in a number of defence medical projects, initiatives, campaigns and policy areas. HQ SG includes the positions of the three-star SG, the Director Medical Policy and Operational Capability, and Director Healthcare Delivery and Training, both of which are two-star military posts.
Director of Medical Policy and Operational Capability
Director of Medical Policy and Operational Capability is responsible for the core outputs of the DMS, including medical research and the development of medical strategy and policy which is then implemented across the armed forces. It comprises of 3 one-star pillars within HQ SG: Medical Operational Capability; Medical Policy and Personnel; and the Medical Directorate. These pillars function in close cooperation due to their combined focus on operational delivery. This synergy is supported by clear clinical and administrative policies and is enhanced by evidence based research with operational capability delivered by the right balance of trained personnel.
Director of Healthcare Delivery and Training (Dir HDT)
Directorate of Healthcare Delivery and Training was established in December 2014 following the amalgamation of Defence Primary Healthcare and Joint Medical Command. It is responsible for the delivery of all healthcare including primary healthcare which incorporates rehabilitation; mental healthcare; the placement of secondary care personnel in NHS facilities; and medical education and training.
In order to deliver this capability, healthcare delivery and training is divided into 4 pillars: Defence Medical Group; Defence Primary Healthcare; Defence Healthcare Education and Training; and Future Health. The organisation operates from sites across the UK to provide clinical support, academic and military education and training, ranging from new nurse and combat medical technician recruits through to hospital consultants.
The Royal Naval Medical Service (RNMS)
The vision of the RNMS is to excel in supporting the operational capability of the Royal Navy. It provides comprehensive healthcare to ships, submarines and Royal Marine personnel at sea and on land. It provides primary care, deployed surgical support and, through the Primary Casualty Receiving Facility on board RFA Argus, deployable hospital care. It provides specialist advice in fields including radiation protection, diving medicine and environmental medicine through the Institute of Naval Medicine.
It is headed by the Medical Director General (Naval), a member of the Second Sea Lord’s Board of Management and the medical adviser to the Admiralty Board. Daily management of the service is provided by the Head of the RNMS, whose mission is to deliver the healthcare component of Naval Operational Capability.
The RNMS includes the Queen Alexandra’s Royal Naval Nursing Service
The mission of the RNMS is to provide a fully manned, sufficiently trained, equipped and resourced organisation with high morale, capable of providing timely, high quality medical support to the operational capability of the Royal Navy to meet the requirements of Commanders.
The Army Medical Services (AMS)
The mission of the AMS is to provide army medical and veterinary policy, operational capability, healthcare advice and assurance, in order to enhance and sustain the operational effectiveness of the army.
Army operational healthcare is provided through the following:
- regular and reserve army medical regiments that provide primary and pre-hospital emergency care
- regular and reserve field hospitals
Members of the AMS contribute the largest numbers of staff to the DMS and run the majority of Field Hospital deployments, which is a key capability of the DMS. The AMS encompass:
- Royal Army Medical Corps
- Royal Army Veterinary Corps
- Royal Army Dental Corps
- Queen Alexandra’s Army Nursing Corps
The Royal Air Force Medical Services (RAFMS)
The RAFMS mission is ‘to be a world class medical service in support of air power’. Comprising of regular and reserve personnel, to provide an air-minded approach, the RAFMS specialises in understanding how the unique attributes of the air environment affect both personnel and patients. Moreover, the evacuation of casualties by air remains an RAF led initiative that continues to develop and improve in line with both clinical and technological advances and experience.
The following organisations within the RAFMS are key facilitators in meeting the strategic priorities and objectives:
- the Health Directorate, at HQ Air Command, supports the Head of the RAFMS through 4 pillars focused towards Medical Personal Capability, Medical Operational Capability, Revalidation and Training and Health
- the Centre for Aviation Medicine, based at RAF Henlow, is the lead in aviation medicine on behalf of defence
- Headquarters Tactical Medical Wing (TMW), based at RAF Brize Norton, provides the expertise to prepare and support the wider RAFMS for operational deployments; TMW places significant reliance on RAFMS personnel being drawn from across Defence (including those employed within the NHS) for deployment on operations and exercises worldwide.
The provision of general practice and specialised occupational health services is the responsibility of Defence Primary Healthcare (DPHC). It provides primary healthcare In the UK and overseas to service personnel and their dependants, where appropriate, to a common standard as directed by the Inspector General. In addition to primary healthcare, DPHC is also responsible for the provision of specialist occupational health services including rehabilitation and mental healthcare. Nine regional teams in the UK and a separate team embedded in HQ DPHC to manage overseas medical centres are responsible for the day-to-day direction of primary healthcare.
Occupational Health Service
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.
Physical rehabilitation services are provided through a tiered network of rehabilitation facilities including; 152 Primary Care Rehabilitation Facilities (PCRF) and 14 RRUs across the UK and Germany. The PCRFs are Unit/Station based rehabilitation departments offering physiotherapy and exercise therapy on an outpatient basis. Patients with injuries that cannot be resolved at this level are referred to RRUs who provide rapid access to imaging services, podiatry and residential rehabilitation.
In addition to the service provided at the RRUs, consultant opinion, social work, occupational therapy, prosthetics, mental health support and nursing care with intensive, specialist, inpatient rehabilitation is provided at the Defence Medical Rehabilitation Centre (DMRC) at Headley Court. This is a nationally recognised centre of excellence that provides rehabilitation for more complex injuries, including amputee and neurological patients. Patients can be referred to the DMRC from secondary care or directly from primary care.
The RRUs provide patients with musculoskeletal injuries (MSKI) with an intermediate level of treatment (inpatient and outpatient) between the Primary Care Rehabilitation Facilities at Station and Garrison level and the DMRC.
On operations assessment and treatment for MSKI is provided by specialist multidisciplinary teams consisting of: Rheumatology and Rehabilitation or Sport and Exercise Medicine consultants, Physiotherapists and Exercise Rehabilitation Instructors. Within deployed hospital facilities military physiotherapists also provide advice and treatment across the spectrum of clinical specialities including: critical care, medical and surgical, chests, burns, trauma orthopaedics and MSKI.
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 16 DCMHs across the UK and three DCMHs at the major permanent overseas bases. In addition a mental health team is located at the DMRC. 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, where necessary, the following mental health services are available to members of the armed forces, and veterans where appropriate:
- The VRMHP
- structured mental health assessments at discharge
- specialist follow on treatment for up to 6 months after discharge
- 24 hour helpline 0800 138 1619
- 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), London and provides a research focus for military-related mental health issues.
Secondary and Tertiary Healthcare
Placement of Defence Consultants in secondary healthcare is the responsibility of DMG. Within the UK, healthcare for service personnel is provided by the NHS, enabling the DMS to take advantage of recent government investment in infrastructure, equipment and staff. Treatment will often be provided in the NHS Trusts that house DMG Units where many DMS staff work to maintain and develop their skills when not on deployment. DMG Unit locations are as follows:
- RCDM, based at the Queen Elizabeth Hospital Birmingham
- DMRC Headley Court In Surrey
- DMG South West: Derriford In Plymouth
- DMG South East: Frimley Park in Surrey
- DMG North: Northallerton In Yorkshire
- DMG South: Portsmouth in Hampshire
Members of the armed forces recovering from orthopaedic and neurological problems are generally treated at one of the RRUs or the flagship DMRC at Headley Court.
Deployed hospital care
Deployed hospital care is delivered on a joint basis, with each Ssrvice 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) and 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 RCDM at the QEHB, Established in 2001, the 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. Nested within the QEHB  the RCDM provides support in its role as the principal acute Role 4 hospital in the UK.
Medical Force Protection (Med FP)
NATO defines 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 encourages health and minimises risk; this is largely an issue for military commanders, using advice from relevant subject matter experts on issues, as the 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 medical intelligence and may require medical countermeasures
- medical input to the operational equipment programme to avoid or mitigate injuries
Programme Cortisone addresses the need to record and archive all medical information generated by the Defence Medical Services (DMS) in producing their mandated outputs. Read more about Programme Cortisone here.
 Part of the University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Defence Primary Healthcare (DPHC) Overseas
The main objective of DPHC Overseas is to bring coherence to governance and assurance of healthcare delivery to overseas entitled personnel.
DPHC Overseas now consists of medical facilities in Nepal, Brunei, BATUK, BATUS, Ascension, Falklands, Gibraltar and Cyprus. However, there are lots of smaller overseas locations that do not have the support of a Defence Medical Services (DMS) medical facility and are unable to provide feedback through the normal channels.
If you would like to provide DPHC Overseas with feedback on the medical care you have accessed overseas please do so using either of the following:
This online survey asks 22 questions concerning your experience of medical care overseas. It does not allow for free text comments. Use this survey if you have internet connectivity and wish to make no comments.
This MS Word document copy of the survey asks the same questions on your experience of medical care overseas but includes space for free text comments.
Use this survey if you wish to provide free text comments or feedback to DPHC Overseas.