The number of health professionals that are involved in the primary care aspects of the health service are vast. You have health visitors, midwives, practice nurses, environmental health officers, health promotion specialists and school nurses. They all prevent ill health on a number of different levels. All health workers work at promoting good health.

Health promotion is about raising the health status of individuals and communities to enable people to increase control over and improve their health.

Health gain, health development and health improvement are the terms that professionals often use while describing the process of working to improve people’s health. There are three levels of health promotion.

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* Primary prevention

* Secondary prevention

* Tertiary prevention

Primary prevention is to try and eliminate the possibility of getting a disease one way of primary prevention is to give childhood immunisations the primary care sector they immunise children against diseases such as polio, small pox, flu and MMR this is usually done by a nurse at a health centre or the individuals GP surgery. This is to prevent the disease manifesting not only in that one child but throughout the country taking the number of cases of fatal childhood dieses down dramatically.

This is the UK annual notifications of death between the years of 1940 and 2006

Other ways for primary prevention is to educate young people on smoking as part of personal social health education (PSHE) within schools. Another example is that the school nurse as a part of her role would educate the young people about sexual awareness and what the long and short term effects of having sex are, from sexually transmitted diseases, to the conceiving of a child and how to use different preventatives such as condoms and the pill. This is giving patients the knowledge and understanding in hope that they will act upon the advice that you have given them.

Secondary prevention is about noticing and acting on a disease as early as possible. Ways to do this are by screening as this picks things up that even the patient may not even be aware of for example at woman have cervical screening every four to five years, this is normally done at their GP surgery as is secondary prevention as if anything abnormal was noticed in the screening then treatment could begin, the earlier that a disease is found and identified the more chance there is on stopping it totally or from progressing further and controlling it. Midwives do a diabetes check (glucose) during the 24th and the 28th weeks into a pregnancy to make sure that the mother’s sugar levels are correct and if it is not then provide her with the treatment necessary this would be both medically and mentally.

Also another factor of secondary prevention is to try and eliminate further symptoms after a disease has been found this often takes place in hospitals and clinics. Action focusing on underlying causes this may include action to address and rectify high blood pressure this would be done by a doctor probably as part of a routine check up.

Secondary prevention may also include support groups so the medical and social models are working together to improve health.

Tertiary prevention is to stop clients getting worse they do this by containing the illness and trying to make sure that it doesn’t get any worse. For example people with asthma get provided with inhalers. At times tertiary prevention is provided in specialist units, it does not normally involve actual medication. One of the most common but not noticeable would be to make sure that people that have had to have the teeth removed will be provided with dentures.

There are a number of professionals promoting health within the health service however in this I shall be concentrating two professionals they are midwifes and health visitors.


Midwifes aim to provide services that will support woman and their families throughout the pregnancy, child birth and the postnatal care. Also they will help care for the newborn after birth and the first few weeks of its life until the health visitor takes over. The midwife is the primary carer of both woman and their infants. Also all midwives throughout the country have to make sure that they are meeting the government’s recommendations.

To become a midwife you will need certain types of skills such as being able to communicate well with people, this will ensure that the mothers emotional wellbeing will be catered for as well as physical as if she knows what exactly is going on then she will feel happy within herself and her situation. You also need to be caring, calm, sympathetic, able to give advice without seeming to patronise. These will all make sure that you have the mothers trust. You also have to except people as individuals and not discriminate. If you do this or do not meet all of the patients needs then it may result in her not turning up to her appointments which could be dangerous for both her and the baby. On average 700.000 babies are born in the UK per year and 95% are born healthy this is due to midwives and the input that they give. You also have to be fully qualified before you can start practicing.

The qualifications that are required to become a registered qualified midwife are that you need to have one of the following

> Diploma of higher education in midwifery

> Degree in midwifery

> Diploma of higher education in nursing (adult branch) followed by 78 week midwifery conversion course

However if anybody wishing to become a midwife and start training on or after September 2008 will need to complete a degree in midwifery as the diploma is not being run after the courses final students in spring 2008

To get approved onto these courses an the canidate will have to provide evidence of Literacy and Numeracy, the minimum age is 17.5 years to take the course and you have to submit to a CRB check

Course providers can set their own academic entry requirements the norm for the midwife diploma or degree is 5 GCSE’s A-C grade plus 2 A Levels. Biology is a good course to take. For a nursing diploma you need 5 GCSE’s grade A-C you have to have English and maths and science based courses are preferred.

The general day to day role of a midwife is to prevent ill health and to promote wellbeing of a healthy lifestyle.

She does this by setting up or organising an antenatal group where she and maybe one or two of her colleges will discuss the right kind of diet and what type of exercise they could do and how much you should try to do. Also they will talk to you about not drinking alcohol and smoking as babies that are born to smokers tend to weigh less then the average baby. As the group progresses with the expecting mothers topics will change they may start talking about birthing plans also they may discuss breathing techniques along with what you should take into hospital for when you are having/had the baby. They might also talk about the kind of complications that may occur wile in labour and what may happen if the do. For example if the baby is in distress they may have to perform an emergency C section.

On a one to one basis what she will do is similar to within the group she will talk you through your labour step by step and discus any concerns that you have. As well as this she will take your blood pressure this is to try and avert Pre-Eclampsia wile pregnant and to make sure there are no signs of haemorrhaging after she has had the baby. They will also take blood samples and weigh you to make sure that you are gaining the right amount of weight.

Screening of the blood, this is a secondary prevention as it can identify if there is anything wrong at an early stage, so it will enable the midwife/GP to take the necessary action as soon as it is identified. Screening test will assess the baby’s risk of having spina bifida and downs syndrome the risk of this is 1 in every 250 however it can not always say for certain.

Depending on where you are from will depend on what you get tested for. Some women from Africa, Asia, middle eat and the Mediterranean suffers from a genetic abnormality of the blood, the midwife will offer to test to see if their baby carries the Thalassaemia disease.

She will also organise for the expecting mother to have her glucose tolerance test this is done by the patient fasting for 6 hours coming into the surgery and having their blood taken then they will be given a glucose drink and more blood will then be taken the blood sugar should rise then quickly go back to normal.

An AFP test is also offered to woman by their midwife during pregnancy the test measures the amount of alpha fetoprotein. AFP is a protean that is created by all unborn babies low levels of alpha fetoprotein can mean that the baby has a higher chance of having downs syndrome whereas high levels of AFP can mean they have a higher chance of having spina bifida

A midwife does not only take blood on every appointment that you have with either her, the hospital midwifes (when you go for your scan) or your GP you have to take a urine specimen this is to test to see if you have the right amount of protean in you urine and not an excessive amount as this could lead to pre-eclampsia.

Once you have had your baby the midwife will do home visits to see if you are recovering okay both mentally and psycially, to help you with advice or anything else that you will need.

When the baby is four days old they do the Guthrie test more communally know as “the heel prick test” they take blood out of the baby’s heel and put it on a specially prepared card the disease called phenylicetonuria is so rare that you only get the results back if they are positive.

The midwives job is also to educate you in all areas of health that will affect you and your child the key things that they educate you on is how to follow a healthy diet and lifestyle.

They do this by making you aware of the risks of smoking wile pregnant. She may do this simply by giving you leaflets or maybe explaining to you (in either the antenatal classes or on one to one) how smoking can effect your baby not just wile your carrying her but for the rest of its life. Smoking raises the levels of carbon monoxide in your blood by doing this it deprives you baby of oxygen this can result in your baby not growing as much as it should and being an underweight baby at birth and this could make a significant difference to its health at birth, the midwife would also advise that this is not the only damaging thing that you are doing to you unborn child by smoking. Smoking can also affect brain development and the general health of your baby. After the midwife has told you all this and advised you to stop smoking and you carry on you are making an informed choice.

Your midwife will also educated you on the type of diet that you need to try and follow as when you are pregant you baby needs percific things to help it grow all of these are avilible within your body and the baby will take it whether you have enough for both you and your baby. For example eating things that have allot of iron in them can prevent you becoming anemic they types of food that have folic acid in them are spinach and broccoli if you do not like these however then you can buy folic acid supplements over the counter. By doing this you can reduce health problems like spina bifida in babies. Your midwife should also advise you to go out and get fresh air whenever possible but also because the suns natural rays give off a good source of vitamin D wile you do this you are doing this you will be also exercising. Your midwife will also explain that you need to drink a pint of milk every day so you can supply your baby with a good source of calcium this helps its bones develop to be stronger.

Health Visitor

A health visitor is a qualified nurse who has taken further training to be able to work as a member of the primary healthcare team. The role of a health visitor is promotion of health and the prevention of illness in all age groups. Health visitors work within a range of work these may be working with mothers and their babies – advising on such areas as feeding, saftey, physical and emotional development and other areas of health and childcare. They also work with people of any age that have cronic illness or with a disability their role in these situations would be to help themn overcome diffculities that may incure and with coping with the illness or disability that they have. A healthh visitor focuses on secondary care she is their to spot the abnormal with whoever she is working with after noticing then she can take action.

To become a health visitor you will need certain skills and qualifications. First of all to train as a health visitor you need to have been a nurse or a midwife for at least two years. Health visitors work with all socailisation classes, working with a community to ensure good health. Also they go into peoples homes, have clinics, doctors surgery and other medical centres so they have to be organisied, confindant, and to be able to cope with potenually challenging situations – such as working with a homless family or a family with children on the child protection register. Health visitors tend to do their wrok inderpendantly most of the time even though they work as a team with other health care staff.

The qualifications that anybody wanting to be a health visitor would need are for starters 2 years experience in nursing or midwifery you need this befor you can even qualify as a health visitor. You will also need to provide evidence of literacy and numeracy skills, good health and a good charator. You will also need to have a CRB check.

Also you have to take a shortened degree or pstgraduate course in public health nursing or health visiting. This can be done in 1 year as a full time course or a part time couse over a pierod of 2 years.

The general day to day role of a health visitor is to prevent ill health and to promote wellbeing of a healthy lifestyle and to monitor developments within the whole community. They particularly are involved with children under 5 and the elderly. Most of health visitors are attached to GP practices and cover this area of patients. Every family with children under 5 has an allocated health visitor they offer support and encouragement to families. Most health visitors work alongside midwifes at the beginning stages to help prepare parents for the birth of their baby.

They also help and advise with the child’s growth and development they do a six month check and a two year check to make sure that the child is meeting all necessary milestones. They have also started recently doing a hearing test in babies to check and see if they have hearing difficulties early on.

They are also there to help with behaviour difficulties, from sleeping, eating, potty training, temper tantrums and teething. Making sure that babies have a healthy diet they do this with supporting parents with breast feeding, weaning onto solids, hygiene and safety within the home, and exercise. They are also there to help and support mothers that are suffering from postnatal depression, bereavement and domestic violence this is to ensure that they are emotionally healthy.

Health visitors also organise and run baby clinics this is because health visitors make home visits less regularly as the child gets older. So opening a clinic the parent can bring the child to be weighed and checked over. They also have health promotion groups for breast feeding, parent support and parenting courses such as competent parent’s confident kids.

Health visitors also ensure that children have the correct immunisations at the right stages of their lives. This is primary prevention as they are taking actions to prevent from Diphtheria, tetanus, pertussis (whooping cough), polio, haemophilus influenzae (Hib), meningitis c, German measles, mumps and rubella; these are administrated by injections normally in the leg. These will take place at two months, three months, four months, twelve months, thirteen months, and and three to five years and thirteen to eighteen years. Children have the same jab more then once over this period of there lives. Also they ensure that the elderly have the jabs that they need such as the flu jab this is to ensure that if they catch a cold it doesn’t escalate into phenomena.

Health visitors work closley with other health professional such as speech theripists, social workers, school nurses and distric nurses. As a health visitor they know when children are not meeting the government’s recommended stages of development so they can refer children that are having trouble with speech and launage to speech theripists. If a child is on the at risk regisiter the health visitor works alongside both childrens services and the parents to ensure that the child can remain at home. When a child starts school and they are concerned with any aspect of the childs health they may liase with the health visitor about further action that needs to be taken or what has been put in place already. If they think that a child has hearing diffculities they will ferer them to the distric nurse for an additional hearing check.


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