Military veterans number approximately 2.6 million people in Great Britain with about 50% aged over 75. In many cases their health needs are no different from other members of society; the recently published Office for National Statistics indicated that veterans and non-veterans aged 16-64 years reported very good or good health (74% and 77% respectively). However, this overall figure masks the physical and mental health issues, such as trauma, specific to some veterans and particularly those who have served in areas of combat or humanitarian operations. It is important to note that whilst there has been emphasis on Post Traumatic Stress Disorder (PTSD), the actual rates for veterans are not high (around 4-5%), which is broadly equivalent to the incidence amongst civilians. More common issues include other mental health difficulties, for example anxiety, depression and substance misuse, such as alcohol. If GPs are aware of this it will allow them to help treat these patients more effectively, and give them access to services specifically available to veterans.
The UK Government has published the Armed Forces Covenant, which is a promise from the nation that those who serve or have served and their families are treated fairly (‘no disadvantage’). All veterans are entitled to priority access to NHS care (including hospital, primary or community care) for conditions associated to their time within the armed forces (‘service-related’, but based on the clinical need of others). It is important for all GPs to identify and register members of the armed forces (including reservists), veterans and their families (the armed forces community). This is highlighted in the recently published NHS England engagement report on NHS veterans’ mental health services.
Another resource that could be useful for GPs treating veterans is a free Health Education England CPD accredited e-learning package for NHS staff, especially primary care, that looks at the similarities and differences between military patients and their civilian counterparts.
Although NHS England commissions specific services for veterans who have suffered physical or mental injury as a consequence of their time in uniform, CCGs are responsible for the wider commissioning of health services in their area and as part of this, must understand and consider the health needs of veterans and their families in commissioning plans.
Top tips for GPs treating veterans:
1. When a patient registers with your surgery, ask if they are a veteran and Read code them as “Military veteran” on your computer system. There are also Read codes for ‘Member of Military Family’.
2. Consider whether a patient who attends with a health problem, especially mental health, might be a veteran (or family member) and ask them.
3. If a patient’s problem appears attributable to their time in uniform, there are often different referral pathways available which may be more suitable.
4. When referring a veteran to secondary care, ensure that this status is written in your referral letter and that if the problem is attributable to their time in uniform, they may be entitled to priority treatment.
Dr Jonathan Leach is a GP in Bromsgrove, Worcestershire and Chair of the NHS England Armed Forces and their Families Clinical Reference Group. He served in the Army for 25 years returning to the NHS in 2008.