For your medical school interview, you will require knowledge about the structure of the NHS. Primary, secondary and tertiary care are levels of healthcare within the NHS and understanding the distinction between the different levels is important for your medicine interviews.

In this article, you will learn about the differences between primary, secondary and tertiary care and why these levels of healthcare are important within the NHS. You can also have a go at example medicine interview questions and read through model answers.

NHS Primary, Secondary & Tertiary Care Explained: Your guide for medical school interviews. Understand key differences, roles, challenges & get example Q&As.

The Importance of Distinct Healthcare Levels in the NHS - Summary

These are different levels of healthcare, where primary care is the patient’s first point of contact with healthcare professionals. Secondary care is provided following a referral from primary care and when specialist treatment is required.
The higher levels of healthcare are tertiary and quaternary care. Tertiary care is used for complex health conditions like open heart surgery, and quaternary care entails experimental medicine for very rare diseases.
Levels of healthcare are crucial to ensure that the NHS provides cost-effective and efficient care. It also allows for continuity and coordination of care to occur.
An increase in waiting times, shortage of NHS staff and a lack of communication between the levels of care can prevent effective healthcare delivery.
A lack of integration and communication between the levels of healthcare can be improved by the use of Integrated Care Systems, shared electronic patient records and care coordinators.

NHS Primary Care & GP Services:

Primary care within the National Health Service (NHS) serves as the initial point of contact for individuals seeking medical attention in the United Kingdom. This encompasses many services in the NHS, but for the context of medical school interviews, we will largely focus on GP Surgeries.

The main goal of primary care is to treat and prevent disease from occurring. Primary care providers, such as GPs, can prescribe medication to treat these illnesses and can suggest preventive measures to reduce the risk of the patient becoming unwell again.

Another goal of primary care is to manage chronic conditions. Some patients may have regular check-ups with their GPs within the GP practice to monitor their long-standing health conditions (eg, asthma, diabetes), and this allows for the development of a patient-doctor relationship.

Furthermore, GPs function as the principal gateway to specialised services within secondary care. Should a patient's condition necessitate specialist investigation or hospital-based treatment, the GP typically facilitates the referral. In this capacity, they are pivotal in guiding patients through the broader healthcare system and within social care. Read more here: The healthcare ecosystem - NHS England Digital.

NHS Primary Care Examples:

General Practices (GP surgeries): For routine consultations (e.g., for monitoring conditions like hypertension), assessment of new symptoms, and the ongoing management of health.
Community Pharmacies: Provide advice on minor ailments, manage repeat prescriptions, and offer services such as vaccinations and health checks.
Dental Practices
Optometry Services (Opticians)
NHS Walk-in Centres / Urgent Treatment Centres: For urgent medical concerns that do not appear to be life-threatening.

Problems in NHS Primary Care:

You need to know which issues can hinder the administration of primary care.

Increased demand for appointments and GP shortages
Increased waiting times
Time constraints: consultations can often run longer than the allocated 10-minute mark, leading to a backlog of patients
Greater complexity of healthcare, alongside an ageing population and a greater prevalence of chronic conditions, GPs are trying to manage a larger variety of health needs.

👉🏻 Read more: NHS GP Shortage in the UK

👉🏻 Read more: Pharmacy First Initiative

NHS Secondary care:

Secondary care is provided when patients are referred to hospitals if they require specialised treatment or if they have a more complex disease that cannot be resolved by primary care. Secondary care can provide treatment, routine surgeries, rehabilitation, imaging and outpatient consultations with doctors.

The goal of secondary care is for specialists to use their expertise and knowledge to review and diagnose patients. They endeavour to support primary care providers by giving more specialised treatment for the patients’ conditions. They aim to provide continuity of care with primary care providers by devising treatment and care plans for the patient and helping manage the interface-between-primary-secondary-care.

Examples of NHS Secondary Care Services:

Accident and Emergency services
Specialist outpatient consultations (e.g. with neurologists, cardiologists, endocrinologists)
Mental health services (which can provide treatment for conditions like schizophrenia or depression)
Rehabilitation services (which can provide physiotherapy following injury or a stroke)

Problems in NHS Secondary Care:

Issues such as a lack of coordination of care between primary and secondary care can occur. There are also other problems like:

Delayed referrals from primary to secondary care can be due to a lack of communication.
Longer waiting lists
Inadequate funding and its challenges

👉🏻 Read more: NHS Backlog and Waiting Times

NHS Tertiary Care:

Tertiary care provides highly advanced care for complex and rare conditions that could not be resolved at the levels of primary and secondary care. Tertiary care utilises pioneering technology to treat severe or rare health conditions.

The goal of tertiary care is to provide specialised care for patients who have life-threatening conditions, such as advanced-stage cancer or severe burns. Tertiary care also entails complex surgeries such as open-heart surgery or organ transplants.

Many tertiary care centres are involved in teaching medical students and act as research centres, where they can contribute to further medical innovation.

Tertiary Care NHS Examples:

Intensive care units (neonatal or acute medical units)
Specialised surgeries (neurosurgery, organ transplants, open heart surgery or surgery for cancer)
Cancer units (which provide treatment like radiotherapy or immunotherapy)

👉🏻 Read more: Hot Topics in the NHS

NHS Quaternary Care:

There is also a fourth, more unusual level of care called quaternary care that you should also be aware of. This is only used for the rarest and most complex medical conditions.

Quaternary care aims to provide highly specialised treatments for patients with rare illnesses that cannot be treated with tertiary care. Quaternary care involves experimental medicine and conducting clinical trials for drugs and treatments that are still being researched.

Quaternary Care NHS:

Pioneering cancer centres (such as those that offer CAR-T-cell therapy for lymphomas and leukaemias)
Clinical trials for new drugs
Robotic surgeries
Multi-organ transplants

Why are levels of healthcare in the NHS important?

Understanding and knowing which level of healthcare a patient should be referred to is crucial for many reasons. The levels of healthcare are crucial within the NHS for:

Efficient referral of patients: it allows patients to be directed to the level of healthcare that is best suited to their medical needs
Improves patient outcomes: it allows early detection and preventative measures to be taken
Allows for continuity of care: it allows patients’ treatment to be smoothly transferred from primary care to higher levels, which is useful for the management of chronic diseases
Cost-effective: it prevents the usage of more expensive and valuable resources on minor illnesses, so it allows the condition to be managed according to its severity.
Integration of care allows for coordination of care between the various levels

Integration of Care In The NHS: What can be done to improve this?

The levels of healthcare allow for the integration and continuity of care to occur. We can consider different ways in which we can improve the integration of healthcare across the different levels of healthcare.

Use of Integrated Care Systems - which can be used to link different NHS organisations together and focuses on public health
Using shared electronic patient records - this allows communication across the different levels of healthcare and allows patient information to be continuously updated.
Use of NHS care coordinators - this can be used for patients with multiple health conditions and for patients who require more specialised treatment. A care-coordinator is a single person who can be used a point of contact for that particular patient.

👉🏻 Read more: Common Medicine Interview Questions

Differences between the levels of healthcare in the NHS

Primary Care - the first point of contact with healthcare professionals
Secondary Care - referred on from secondary care, and where specialist treatment is provided
Tertiary Care - advanced care involving complex surgeries
Quaternary care involves experimental medicine for very rare conditions

👉🏻 Read more: NHS Core Values

How to answer medical school interview questions on primary, secondary and tertiary care in the NHS

In your medical school interview, knowing these different levels of healthcare can impress your interviewer, as it shows that you are aware of how healthcare is structured within the NHS.

When answering interview questions, demonstrate an understanding of the differences between healthcare levels and their respective functions. You should also show an understanding of why having these different levels of healthcare is important for the NHS.

You could also consider reflecting on your own work experience and volunteering, and linking this to the question. For example, if you have shadowed doctors in a general practice and in a hospital, you could explain how more specialised treatment was provided within the hospital setting.

You could consider other examples in a GP setting, where a patient is referred to a specific department of the hospital. In this scenario, you could explain how this escalation enables the patient to seek the appropriate care according to their medical needs and how it facilitates continuity of care.

👉🏻 Read more: 7 Tips to Ace Your MMI Medical School Interview

Primary, Secondary and Tertiary Care: Model Medicine Interview Question and Answer

Can you please explain why separate levels of healthcare are implemented in the NHS?

There are different levels of healthcare in the NHS. Primary care is the patient’s first point of contact with healthcare professionals and can be used to treat, manage and prevent illness. Examples of this would be in the General Practice, walk-in centre or opticians.

Secondary care occurs when more specialised treatment is required and occurs on a referral basis. Tertiary care provides advanced treatment, such as open heart surgery or cancer treatment. Quaternary care is used for very rare health conditions and involves experimental medicine and clinical trials.

Separate levels of healthcare are used as they allow for efficient treatment of patients and enable patients to be directly seen by the relevant healthcare professional. Therefore, this allows for patients to be streamlined to the appropriate level of healthcare.

Implementing the levels of healthcare is also more cost-effective and enables integration of care to occur. Patient care is transferred from one level to another, which allows for continuity and coordination of care.

During my GP shadowing, I saw how primary care manages a vast range of issues and acts as the crucial first step. I observed a GP referring a patient with complex heart symptoms to a cardiologist, demonstrating the gateway role to secondary care.

👉🏻 Read more: Medicine Interview Preparation Help

Primary, secondary and tertiary care: interview questions for medical school

Could you describe what the difference is between primary, secondary and tertiary care?
Can you describe the difference between secondary and tertiary care and provide examples?
Can you explain some problems that can prevent the delivery of primary care?
What is the main purpose of primary care in the NHS?
Can you explain the problems that are encountered within secondary care? Did you see any during your work experience?

Less likely to come, but useful to know!

(Hard) Can you explain what quaternary care is and provide examples?
(Hard) How might a lack of communication between primary and secondary care affect the NHS?
(Hard) What are the advantages of having separate levels of healthcare in the NHS?
(Hard) How can greater integration of care be encouraged in the NHS?

👉🏻 Read more: 280 Medical School Practice Interview Questions

Primary, secondary and tertiary care FAQs

Describe the levels of healthcare in the NHS.

The different levels of healthcare are primary, secondary, tertiary and quaternary care.

Primary care acts as the patient’s first point of contact and involves GPS, dentists, pharmacists and healthcare professionals from walk-in centres.
Secondary care normally occurs after a referral from primary care and provides specialist services, like inpatient consultations.
Tertiary care provides more advanced treatment for conditions like cancer.
Quaternary care involves experimental medicine.

Why are levels of healthcare in the NHS important to understand?

It allows patients to be directed to the level of healthcare that is most tailored to their medical needs. It is the most cost-effective way of providing care, as well as supporting primary care and allowing continuity of care between the different levels.

What is the main purpose of primary care, such as general practice?

It allows for common illnesses (like infections and the flu) to be treated. It allows for long-standing health conditions to be managed and primary care providers to give advice on preventive health measures.

What is the difference between primary and secondary care?

The level of specialisation and whether it is referral-based or not. Primary care allows for management, treatment and prevention of disease, whereas secondary care occurs following a referral and provides more specialised treatment.

What are examples of NHS primary care services?

Opticians
General practice
Walk-in centres
Dentists

What are examples of NHS secondary care services?

Hospitals
Accident and Emergency services
Mental Health centres
Rehabilitation centres

Describe Quaternary Care

This is used for very rare and unusual conditions that have not been resolved by secondary or tertiary care. Quaternary care involves clinical trials and experimental medicine, and also doubles as a teaching and research hospital.