Royal Navy medics are going on the offensive in a concerted effort to improve the health of the Fleet.

In a package of measures which falls under the umbrella of Rebalancing Lives – a programme which has introduced improvements to the work-life balance of sailors – the Medical Director General (Navy)’s Primary Care Team (PCT) is putting the emphasis on prevention, rather than cure, which will be felt across the Naval Service.

Surgeon Commander Sally Ross, who heads the team, explained that the measures ranged from guaranteeing standards wherever Navy personnel serve, through mentoring and support of medical ratings at sea to taking providing services where they are most needed.

That covers a range of medical concerns, including the General Practitioner role, occupational and environmental health – virtually everything before hospital care.

“Over the past 18 months we have shifted our approach to proactive from reactive,” said Surg Cdr Ross, who explained that the shift has been made possible because the new team has now settled in and been able to take stock of the wider picture.

“For example, if you had gone into a sick bay ten years ago you would have seen a lot of emergency and resuscitation equipment and procedures, but nothing to help people stop smoking.

“We are trying to stop people from needing the ambulance and hospital care through promoting a healthier lifestyle.”

There are a number of targets which the PCT, part of the Fleet organisation and working under the Director Medical Operations, hopes to hit.

The PCT has implemented a programme of inspections in its role as guardian of medical standards within the Royal Navy – the counterpart of a Flag Officer Sea Training (FOST) regime of ship inspections – and specially-tailored teams are constantly on the road checking out sick bays.

“We should expect the same level of care at any sick bay – we are looking at standardisation across the Navy as well as the quality of those standards,” said Surg Cdr Ross.

The Navy and Royal Marines have a total of 26 sick bays, including Gibraltar, Lisbon and Naples, but the PCT’s influence has spread beyond these as they have now begun to carry out advisory visits to non-Naval military medical centres such as Abbey Wood, looking at the level of care provided to Navy personnel.

“These advisory visits have been very well received,” said Surg Cdr Ross. “Abbey Wood were delighted, and Baird (in London) have asked us for a report as they were so pleased with the visit.”

Another priority is the Well Man Clinic, an area which has been outstripped in recent years by the female equivalent.

“The Navy has fantastic facilities for women, but they make up only seven per cent of the Navy,” said Surg Cdr Ross.

She said the lead taken by Dr Nick Imm at HMS Raleigh at Torpoint was a good example of best practice, and HMS Nelson in Portsmouth was currently reconfiguring its sick bay to provide a new Well Man facility.

Rapid progress is being made in a smoking cessation campaign while targeted medical support is proving invaluable – the RM Commando Training Centre has a physiotherapy-led back clinic to deal with the niggles of a demanding physical course, for example, while other establishments have set up hypertension and travel clinics.

The Primary Care Team is also behind a push to get more nursing officers back in the sick bays, while other sick bays are boosting their quota of MOD nurses.

And just as sick bays are given an MOT, so medical personnel are also being monitored – a statutory requirement – to ensure they are receiving the correct training and appropriate levels of support.

Professional appraisal for the Navy’s General Practitioners has been introduced, in line with edicts from the General Medical Council, and Surg Cdr Ross said that the Navy’s peer review process is probably one of the most effective in British medicine, as few civilians move from the care of one doctor to another as frequently as a Senior Service rating or officer.

One major change which is due by next January sees the ship’s Logistics Officer take over from the Executive Officer as Officer in Medical Charge when there is no medical Officer on board.

“The Logistics Officer is closer to the task and work of a Medical Branch rating than the Executive Officer, who is looking after the whole ship, so the change made sense in terms of clinical support,” said Surg Cdr Ross.

Handovers from an outgoing Medical Branch rating to his or her successor have also been brought within the PCT’s remit; a standardised routine means no nasty shocks or missing paperwork for the new incumbent.

Another big step forward in making life easier for sailors has been the introduction of a Visiting Vaccination Team (VVT) in each base port.

Before the VVT’s inception, when a ship was preparing to deploy, the whole ship’s company would have to get to the sick bay for the appropriate jabs.

Although no vaccinations are compulsory, medical staff strongly recommend whichever vaccinations would ensure protection from local disease in the area to which they are deploying, and thus guarantee each member of the crew would be fit to play his or her part while overseas as well as avoiding a “significant health risk”.

Now a team of experts visits the ship with all necessary medical and emergency equipment, and assists the ship’s Medical Officer or Medical Branch rating.

A similar initiative has seen Mobile Medical Teams (MMTs) go to units to do Pulhheems (compulsory employability medicals for over-30s).

“Rather than send people from ships to sick bays we now send teams to the ships to deliver the service at the coal-face,” said Surg Cdr Ross.

“With the vaccinations, a ship’s company does not now have to waste hours at the sick bay, and the new system proved very popular before ships deployed on Operation Telic. This is a real improvement in service.”

Another such improvement has been the ongoing investment in telemedicine, led by Surg Cdr Peter Buxton.

He is developing a website which will be available to all Medical Branch ratings afloat, allowing them to access a wide range of specialists at any time and from anywhere in the world.

With so many measures being introduced, one important element is the linking-up of information sources, and the past 18 months has seen a unified database for Force Protection (medical) information come into being, covering medical matters including vaccinations.

This allows medical chiefs to look at patterns – which commands or sick bays have lower levels of uptake of vaccinations, for example – so that resources can be more closely targeted on where they are most needed.