Tertiary care in the health and social care system refers to specialised consultative healthcare services typically provided by specialist hospitals or units within hospitals.
It is often characterised by highly specialised care, advanced medical procedures, surgical interventions, and complex treatments that are not available in primary or secondary care settings.
Patients usually access tertiary care through a referral from primary or secondary care providers.
Key Features of Tertiary Care:
Specialised Services
Tertiary care facilities offer services that require highly specialised equipment, advanced technology, and expert medical professionals. Examples include neurosurgery, cardiac surgery, oncology treatment, burn care, and organ transplantation.
Referral System
Access to tertiary care usually comes through referrals. General practitioners (GPs) or secondary care providers (consultants in general hospitals) typically refer patients when their condition requires more specialised care than they can provide.
Complex and Critical Interventions
Tertiary care often involves complex surgical procedures, critical care for severe and life-threatening conditions, and advanced diagnostic services such as MRI and PET scans. These interventions require specialised training and resources.
Multidisciplinary Teams
Care in tertiary settings is frequently provided by a multidisciplinary team of health professionals, including specialists, surgeons, specialist nurses, anaesthesiologists, physiotherapists, and other allied health professionals. The collaborative approach ensures comprehensive care tailored to the specific needs of the patient.
Research and Education
Many tertiary care centres are also involved in clinical research and training. They may be affiliated with universities and medical schools, contributing to the advancement of medical knowledge and the education of future healthcare professionals.
Types of Tertiary Care Providers:
- Major hospitals with specialised units (e.g., Great Ormond Street Hospital for Children, Royal Marsden Hospital for cancer treatment).
- Teaching hospitals, often part of university medical schools (e.g., King’s College Hospital).
- Specialist centres focused on specific conditions or treatments (e.g., Moorfields Eye Hospital for ophthalmology).
Examples of Tertiary Care Services
Here are detailed examples of specific tertiary care services and centres across various medical disciplines:
Cancer Treatment
The Royal Marsden Hospital (London and Surrey)
Specialisation:
- The Royal Marsden is a world-leading cancer centre offering comprehensive cancer treatment, including surgery, chemotherapy, radiotherapy, and immunotherapy.
Services:
- Advanced diagnostic imaging (MRI, PET/CT scans).
- Specialist cancer surgery (robotic surgery, minimally invasive techniques).
- Innovative radiotherapy technologies like CyberKnife and proton beam therapy.
- Participation in clinical trials for new cancer treatments.
Interdisciplinary Approach:
- Multidisciplinary teams comprising oncologists, surgeons, radiologists, and specialist nurses ensuring personalised treatment plans.
Cardiac Surgery
Specialisation:
- Papworth Hospital is renowned for cardiac and thoracic surgery, as well as heart and lung transplants.
Services:
- Coronary artery bypass grafting (CABG).
- Heart valve repair and replacement.
- Complex arrhythmia management (including advanced catheter ablation techniques).
- Extracorporeal membrane oxygenation (ECMO) for severe heart and lung failure.
Rehabilitation and Follow-up:
- Specialised cardiac rehabilitation programs tailored to individual patient needs, ensuring effective recovery and long-term heart health management.
Neurosurgery
National Hospital for Neurology and Neurosurgery (Queen Square, London)
Specialisation:
- This hospital is a premier centre for treating complex neurological conditions.
Services:
- Surgical management of brain tumours, aneurysms, and epilepsy.
- Advanced procedures such as deep brain stimulation for Parkinson’s disease.
- High-precision stereotactic surgery for movement disorders and certain cancers.
- Comprehensive diagnostics, including functional MRI and intraoperative imaging.
Research and Innovation:
- Active participation in neurological research and clinical trials to innovate new treatment modalities.
Organ Transplantation
Birmingham Children’s Hospital (Birmingham)
Specialisation:
- This hospital is one of the few in the UK specialising in pediatric organ transplants.
Services:
- Liver, kidney, heart, and multi-organ transplantation for children.
- Pre-transplant interventions to manage organ failure.
- Post-transplant follow-up including immunosuppressive therapy management.
- Psychological and social support services for children and families during the transplant journey.
Family-Centred Care:
- In-depth preparation and support programs for families to ensure smooth transition and care for patients post-operation.
Pediatric Care
Great Ormond Street Hospital for Children (London)
Specialisation:
- This hospital provides tertiary care for a wide range of pediatric specialties.
Services:
- Specialised treatments for rare and complex conditions such as congenital heart defects, rare cancers, and metabolic diseases.
- Advanced surgical procedures tailored to pediatric patients.
- Neonatal intensive care units (NICU) for critically ill newborns.
- Comprehensive diagnostic services, including genetic testing and advanced imaging.
Integrated Care Model:
- Multidisciplinary care teams, including pediatric specialists, nurses, therapists, and social workers, providing holistic care.
Burn Care
St Andrew’s Centre for Plastic Surgery and Burns (Chelmsford)
Specialisation:
- One of the largest burn centres in Europe, offering acute and long-term care for burn injuries.
Services:
- Emergency management of severe burns, including debridement, skin grafting, and reconstructive surgery.
- Long-term rehabilitation services, including physiotherapy and occupational therapy.
- Psychological support to assist with the emotional recovery of burn victims.
Research and Training:
- Leadership in research on burn care and reconstruction techniques, providing training for healthcare professionals in burn management.
These examples illuminate the highly specialised nature of tertiary care, showcasing how it provides critical, life-saving services and encompasses a multidisciplinary approach to ensure comprehensive and effective treatment.
Integration with Social Care
Tertiary healthcare often involves close cooperation with social care services to manage the patient’s ongoing needs post-treatment. For example:
- Discharge Planning: Collaborative planning for safe discharge from hospital to home, including home adaptations and community health services.
- Long-Term Rehabilitation: Social care professionals work with healthcare providers to create rehabilitation plans, such as physical therapy, home nursing services, and social work support.
- Support for Carers: Providing resources, training, and respite care for family members and caregivers.
While tertiary care primarily pertains to medical and surgical services, its integration with social care is crucial for comprehensive patient management. Post-treatment rehabilitation, long-term care planning, and support services for families and carers are important aspects that social care professionals address, often in collaboration with tertiary care providers.
Summary
Tertiary care in the healthcare system provides the highest level of specialised medical care and is an essential component for treating complex and severe health conditions. It operates through a system of referrals, leveraging multidisciplinary expertise and advanced technology to deliver optimal patient outcomes.