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Resources for GPs - Care of Military Personnel and Veterans

The Armed Forces Covenant

To support fair access to treatment, the Armed Forces Covenant sets out a number of health commitments for the Armed Forces community:

• The Armed Forces community should enjoy the same standard of, and access to healthcare as that received by any other UK citizen in the area they live.

• Family members should retain their place on any NHS waiting list, if moved around the UK due to the service person being posted.

• Veterans should receive priority treatment for a condition which relates to their service, subject to clinical need.

Those injured in service should be cared for in a way which reflects the nation’s moral obligation to them, by healthcare professionals who have an understanding of the Armed Forces culture. To find out more, visit: www.armedforcescovenant.gov.uk .

Serving personnel

• Due to the nature of their job, many service personnel are very fit and active and tend to be younger than the general population.

• There is a detailed screening and assessment process prior to joining the military, which typically means that long-term illnesses found within civilian counterparts are less common. However, musculoskeletal problems (especially involving a patient’s back, knees and lower limbs) are more common.

• Reservists make up about a sixth of serving personnel at any one time and tend to be older than Regulars. They are primarily cared for by their registered civilian GP, but receive occupational health advice and care from military GPs when mobilised.

• Military personnel may access NHS primary care when on leave (including out of hours services), however, in all cases (apart from Reservists) their normal GP remains their military GP. Military personnel can only register with an NHS GP as a temporary resident – although special arrangements are possible for extended temporary registration. In both cases, the NHS GP should liaise with the patient’s military doctor.

• Service personnel are unable to self-certify for their first seven days of illness and require a ‘Fit Note’ for every day they are unable to work.

Veterans

• There are around 2.6 million Veterans in Great Britain of whom 52% are 75 years or older.

• A Veteran is someone who has served in the Armed Forces (Regular or Reservist) for at least one day.

• In many cases, Veterans have similar levels of health to the general population, however, a minority have physical and mental health issues specific to their time in service.

• Whilst there has been an emphasis on Post Traumatic Stress Disorder (PTSD), the actual rates for Veterans are not high (around 6%), which is broadly equivalent to the incidence amongst civilians.

• More common issues include other mental health difficulties, such as anxiety, depression and problems related to alcohol.

• There is growing evidence that a range of mental health conditions may appear (or patients may present) some years after Veterans have left the Armed Forces. These conditions may relate to their military experiences, transition out of service, or pre-service vulnerabilities

Armed Forces families

• Service families often have additional pressures on family life and may be more vulnerable as a result. These pressures include:

• stress around deployment

• extended and repeated periods of separation from spouses and partners

• social isolation from family and friends

• additional and sudden caring responsibilities.

• Service families tend to move every two years, however, should not be disadvantaged by losing their place on hospital waiting lists when this happens

Reference: http://www.blown-away.org/content/uploads/2018/06/587_NHS-England-Military-veteran-aware-accreditation-A5-GP-top-tips-LEAFLET-S8.pdf

NHS Veterans Top Tips for GPs and Practices

1. Ask the question - “Have you or any members of your family ever served in the Armed Forces?”

Ask on registration form and Read code them as ‘Military Veteran’ or ‘Member of Military Family’

Ask patients who attend with specific health problems, especially mental health, as additional options may be available to them

2. Consider the additional referral pathways/services which may be available for Veterans and Military family members (see examples of services of pages below)

3. When referring a Veteran to secondary care, ensure that this status is included in their referral letter, as they may be entitled to priority treatment if the problem is attributable to their time in uniform. Eg: “As this patient is a military veteran, and his (or her) current condition may be related to military service, this referral should be considered for priority treatment under the rules set out in the NHS Operating Framework 2008/9, paragraph 3.15, 2009/10 paragraph 66 and 2010/11 paragraph 2.55.”

4. Ensure you and your practice team have sufficient awareness to meet your patient’s needs:

a. Complete the free Health Education England CPD accredited e-learning package that looks at the similarities and differences between Armed Forces patients and their civilian counterparts.www.e-lfh.org.uk/programmes/nhs-healthcare-for-the-armed-forces

b. Join your regional NHS Armed Forces network. To find out more, email england.armedforceshealth@nhs.net.

c. Become an Armed Forces Veteran friendly accredited GP practice. In Wessex contact Katie McMahon wessex@rcgp.org.uk

Further resources:

Services Supporting Veterans

Services Supporting Family Members

Support for Family Members of Injured, Wounded & Sick currently serving, reservist or veterans

Support for Parents of Serving Military Personnel – NOT injured

These organisations will give information to ALL adult family members (including parents) of those who are currently serving:

Support for Children of Serving & Ex-Serving Military Personnel

Sometimes the support is not because a parent has been injured, but perhaps a parent is deployed, or about to be deployed and the child(ren) is anxious and in need of additional support.

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Updated on Monday, 24 February 2020 373 views