Defence Medical Services

Defence Medical Services (DMS) is made up of the Navy Medical Service, Army Medical Service, the Royal Air Force Medical Service and the Joint Medical Group (JMG).

Defence Medical Services (DMS) in the UK

The DMS is made up of the Navy Medical Service, Army Medical Service, the Royal Air Force Medical Service and the Joint Medical Group (JMG). The primary role of the DMS is to promote, protect and restore the health of the UK armed forces to ensure that they are ready and medically fit to go where they are required in the UK and throughout the world.

The DMS is staffed by around 11,200 service personnel (7,600 regular and 3,600 reserve) and 2,200 civilian personnel and provides healthcare to 135,360 UK Armed Forces personnel (as at 1 Oct 2018: The UK armed forces quarterly service personnel statistics).

Service personnel and civilians work side by side as medical, dental and allied healthcare professionals and with other personnel with the relevant business and technical skills. The range of services provided by the DMS includes primary healthcare, dental care, rehabilitation, occupational medicine, community mental healthcare and specialist medical care.

The DMS has:

  • Regional Rehabilitation Units (RRUs) across the UK and Germany
  • Ministry of Joint Hospital Group (JHG) Units embedded within NHS Trusts
  • The Royal Centre for Defence Medicine (RCDM) in Birmingham
  • The Defence Medical Rehabilitation Centre (DMRC) Stanford Hall near Loughborough
  • mental health services are delivered through a network of Departments of Community Mental Health (DCMHs), Mental Health Teams (MHTs), and some additional locations have a dedicated permanent Community Mental Health Nurse
  • deployable healthcare capability for military and humanitarian operations

The Director General (DG) DMS is the professional head of the DMS and the Defence Authority for end to end Defence healthcare and medical operational capability. The DG DMS is accountable to the Defence Board, reporting routinely through the Defence Audit Committee and Defence People and Training Board.

The DG DMS tasks are to:

  • generate, deliver and assure medical operational capability for operations and fixed tasks
  • provide and commission a safe, effective and efficient healthcare service for all armed forces personnel
  • provide policy and advice on health, healthcare and medical operational policy

Recruitment

The DMS offers a wide range of career opportunities both in the UK and overseas. Armed forces personnel, civilians and contractors work side-by-side in a variety of clinical and administration roles. You can find out more about these roles here:

UK armed forces

You can browse regular and reservist roles here:

Civil Service

The MOD employs civilians in clinical and other relevant business and technical roles:

Latest news

Joint Medical Group (JMG)

The JMG has an annual budget of circa £500m and supports the delivery of the DG DMS tasks. It provides an occupationally focused primary healthcare service, encompassing primary medical and dental care, occupational health, public health, force preparation, travel medicine, mental health and rehabilitation, and some outsourced services. Secondary healthcare is provided by the NHS with JMG input to their commissioning policy to ensure it meets specific defence requirements.

The Royal Naval Medical Service

The Royal Navy Medical Service (RNMS) 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, it provides deployable hospital care. It provides specialist advice in fields of radiation protection, diving medicine and environmental medicine through the Institute of Naval Medicine. It also includes the Queen Alexandra’s Royal Naval Nursing Service.

The RNMS 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.

The Army Medical Service

The Army Medical Service (AMS) provides Army medical and veterinary policy, operational capability, healthcare advice and assurance, to enhance and sustain the operational effectiveness of the Army. Army operational healthcare is provided through regular and reserve army medical regiments that provide primary and pre-hospital emergency care and regular and reserve field hospitals. The AMS is made up of the following:

  • Royal Army Medical Corps
  • Royal Army Veterinary Corps
  • Royal Army Dental Corps
  • Queen Alexandra’s Army Nursing Corps

The Royal Air Force Medical Service

The Royal Air Force Medical Service (RAFMS) provides direct medical support to the deployed force and delivers medical expertise including aviation medicine, training and support to RAF personnel and the wider armed forces.

The RAF Centre of Aviation Medicine conducts a wide range of activities delivering aircrew and aircraft integration, aviation medical training and specialist support through research and medical boards.

Tactical Medical Wing (TMW) provides operational outputs including aeromedical evacuation, deployed primary care, pre-hospital and hospital capabilities. TMW are supported by two medical Reserve squadrons: No 612 and No 4626.

Primary healthcare

Provision of general practice and occupational health services is the responsibility of Defence Primary Healthcare (DPHC). DPHC’s purpose is to sustainably deliver and commission safe and effective healthcare, which meets the needs of patients and the chain of command. It provides primary healthcare, dentistry, rehabilitation and mental healthcare in the UK and overseas to service personnel and, where appropriate, their dependants.

DPHC supports medical force preparation of service personnel deploying on operations and exercises through the provision of health advice, preventative medicine, vaccinations, chemoprophylaxis and medical risk assessments. Responsibility for the day-to-day management of primary healthcare rests with six regional teams in the UK and a separate team embedded in HQ DPHC for overseas medical treatment facilities. UK based medical facilities are inspected by the Care Quality Commission.

Occupational health service

The 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.

Rehabilitation services

Rehabilitation services are provided through a tiered network of Primary Care Rehabilitation Facilities (PCRF) and RRUs across the UK and Germany. PCRFs are unit/station based outpatient departments offering physiotherapy and exercise rehabilitation therapy. Patients with injuries that cannot be cared for at this level are referred to RRUs, to allow rapid access to imaging services, podiatry and residential rehabilitation. This intermediate level of treatment nests between the PCRF and the DMRC at Stanford Hall.

The DMRC provides a key element of the tiered Defence Medical Rehabilitation Programme, delivering concentrated residential rehabilitation for complex musculoskeletal disorders and injuries (MSKI) including complex trauma, rehabilitation following neurological injury or illness, and in-patient care for joint and soft tissue disease. It also provides education and training in military rehabilitation and is the home of the Academic Centre for Rehabilitation Research.

For any military medical enquiries email DMRC-PSSMailbox@mod.gov.uk or call 01509 251500, ext: 4804.

For all other DMRC enquiries email DMRC-PSSMailbox@mod.gov.uk or call 01509 856277.

On operations, assessment and treatment for MSKI is provided by specialist multidisciplinary teams: rheumatology and rehabilitation; sport and exercise medicine; physiotherapy and exercise rehabilitation. Within deployed hospital facilities, military physiotherapists also provide advice and treatment across the spectrum of clinical specialties including: critical care, medical and surgical, chests, burns, trauma orthopedics and MSKI.

Mental healthcare

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 a network of 20 permanent locations, comprising 11 Departments of Community Mental Health (DCMHs); 6 Mental Health Teams (MHTs); and 3 locations with a permanent Community Mental Health Nurse. 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 and UK National Health Services, where necessary, the following mental health services are available to members of the armed forces, and veterans where appropriate:

  • The VRMHP
  • NHS England Transition, Intervention and Liaison Service (TILS) and Complex Treatment Service (CTS)
  • structured mental health assessments at discharge
  • specialist follow on treatment for up to 6 months after discharge
  • Combat Stress 24 hour Mental Health helpline 0800 323 4444
  • 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).

Secondary healthcare

The provision of secondary healthcare for service personnel is the responsibility of the NHS. The majority of DMS secondary healthcare personnel work in clinical placements within the NHS to maintain and develop their clinical skills when they are not deployed on operations or other commitments. DMS staff treat both military and civilian patients within the various NHS Hospital Trusts that host military personnel. There are five centres that have a military presence including the RCDM based at the Queen Elizabeth Hospital, Birmingham (QEHB).

Deployed hospital care

Deployed hospital care is delivered on a joint basis, with each service 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) 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.

Medical Force Protection (Med FP)

NATO defines Medical Force Protection (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 promotes health, prevents disease and minimises risk: this is a command responsibility, using advice from relevant subject matter experts, as the leadership, 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 input from medical intelligence and may require specific medical countermeasures to be put in place to mitigate the risks generated by the threat
  • input to the operational equipment programme to avoid or mitigate injuries
  • input into the development of collective protection systems for deployed force elements

Programme Cortisone

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.

Defence Medical Services training courses

This is the official list of Defence Medical Services training courses and fellowships, including face to face courses, eLearning packages and conferences/symposia for regular and reserve personnel.

Defence Primary Healthcare overseas

The main objective of DPHC overseas is to bring coherence to governance and assurance of healthcare delivery to be service personnel, dependants and entitled civilians. Read more about Defence Primary Healthcare overseas.

Mefloquine signposting service

The Mefloquine Single Point of Contact launched on 5 September 2016 and is for current and former service personnel who have concerns about their experience of mefloquine (commercially known as Lariam).

The MOD takes the health and wellbeing of its personnel seriously and acknowledges its duty of care to provide the best possible support to them. This service provides information and signposting to a range of services to address their concerns.

Programme Cortisone

www.healthline.healix.com

Other DMS news

*[JMG] Joint Medical Group *[DDS]: Defence Dental Services *[SG]: Surgeon General *[RRUs]: Regional Rehabilitation Units *[MDHUs]: Ministry of Defence Hospital Units *[RCDM]: Royal Centre for Defence Medicine *[DCMH]: Departments of Community Mental Health *[NHS]: National Health Service *[BNP]: Brain Naturetic Peptide *[ECG]: Electrocardiogram *[DMRC]: Defence Medical Rehabilitation Centre *[RCDM]: Royal Centre of Defence Medicine *[GMC]: General Medical Council *[DMS(W)]: Defence Medical Services (Whittington) *[DPHC]: Defence Primary Healthcare *[RAF]: Royal Air Force *[CGOs]: Clinical Guidelines for Operations *[MOD]: Ministry of Defence *[JSP]: Joint Service Publication *[MAG]: Medical Appraisal Guide *[RST]: Revalidation Support Team *[iEHR]: integrated Electronic Health Record *[EBC]: Everest Base Camp *[JSAT]: Joint Services Adventurous Training *[NGAL]: Neutrophil gelatinase-associated lipocalin *[RNMS]: Royal Naval Medical Service *[AMS]: Army Medical Services *[RAFMS]: Royal Air Force Medical Services *[TMW]: Tactical Medical Wing *[PCRF]: Primary Care Rehabilitation Facilities *[PCRFs]: Primary Care Rehabilitation Facilities *[MSKI]: musculoskeletal injuries *[VRMHP]: Veterans and Reserves Mental Health Programme *[DMG]: Defence Medical Group *[QEHB]: Queen Elizabeth Hospital Birmingham *[NATO]: North Atlantic Treaty Organization *[Med FP]: Medical Force Protection *[OH]: occupational health