WHAT IS A VETERAN? WHY DOES IT MATTER?
A military veteran is anyone who has served in the regular or reserve UK Armed Forces for a minimum of 1 day.1 There are an estimated 2.4 million veterans in the UK, accounting for 5% of the UK population over the age of 18 years.2 The veteran population is a diverse group in terms of age, gender, ethnicity, socioeconomic group, length of service, and exposure to various things including combat, military training exercises, foreign travel, and separation from family while in the military. Regarded as a potentially vulnerable patient group, 52% of veterans have a long-term disability or illness, which is higher than the general population (32%).3 Some veterans have complex needs and their needs may go unrecognised or unmet.
GPs are duty bound by the Armed Forces Covenant to ensure that veterans receive effective and timely access to appropriate health care.4 Raising awareness and improving access to health care for military veterans are also key commitments of the NHS Long Term Plan.5
HOW TO IDENTIFY WHICH PATIENTS ARE VETERANS
A GP should ask the question, ‘Have you ever served in the Armed Forces?’ This question is included as part of the new Patient Registration Questionnaire and can be asked opportunistically during the consultation or at the point of referral, particularly for conditions that may be related to military service such as musculoskeletal, hearing, or mental health problems. Veterans can also be asked to self-identify through publicity on the practice website, visual screens, or posters in waiting rooms. GPs should appropriately code ‘military veteran’ in the patient records and acknowledge this information when relevant, during consultations.
WHAT CAN GPS DO TO IMPROVE CARE FOR VETERANS?
Awareness of veteran status can help to build rapport and understanding. Serving in the military is an all-encompassing vocation and a way of life like no other for both the veteran and their family. Military persons relinquish civil liberties and are exposed to a much higher risk of death and serious injury.3 With this comes career structure, security, support, adventure, and camaraderie.
Leaving the military ‘introduces a rupture across all levels’ .6 It is a major life event that brings a multitude of challenges practically and psychosocially.6 Improved recognition and understanding of this in primary care can make a difference to this potentially vulnerable group and their families.
There are a number of conditions that may be partially or wholly attributable to military service including physical problems (musculoskeletal and hearing problems) and mental health problems. Veterans are entitled to priority treatment for conditions related to their military service in line with the Armed Forces Covenant4 and it is therefore important to highlight this at the point of referral.
There are also dedicated services specifically tailored to the needs of veterans including Op COURAGE: the Veterans’ Mental Health and Wellbeing Service (https://www.nhs.uk/nhs-services/armed-forces-community/mental-health/veterans-reservists/) and the Veterans Trauma Network for those physically injured during their time in the Armed Forces.1
The Veterans’ Gateway (https://www.veteransgateway.org.uk/) provides welfare information, advice, and support for veterans and their families.
ACCREDITATION AS AN RCGP VETERAN-FRIENDLY PRACTICE
The NHS in collaboration with the Royal College of General Practitioners (RCGP) is working towards approving NHS GP practices in England as veteran-friendly accredited. To date, in excess of 1000 practices are now veteran-friendly accredited, accounting for 14% of all practices in England.
Becoming a veteran-friendly accredited practice is a simple online process and helps to raise awareness, improve understanding, and better equip and facilitate GPs in their duty of care to veterans. Accredited practices are required to nominate a clinical lead, who might be a GP or other staff member such as the practice manager or allied healthcare professional, and provide evidence that they are veteran friendly. Once successfully accredited, the practice receives an accreditation pack and regular updates and newsletters from the RCGP. The programme is recommended by the Care Quality Commission for evidence on the care of ‘people whose circumstances may make them vulnerable’.7 Veterans’ health is also embedded in the RCGP curriculum. Further information and an application form can be found at www.rcgp.org.uk/veterans.
Feedback from practices already accredited is overwhelmingly positive with high levels of satisfaction reported. Ninety-nine per cent of practices recommend the programme and 84% felt they have a better understanding of the needs of veterans by signing up to the RCGP veteran-friendly accreditation programme.8
CASE STUDY
Sergeant X joined the army, leaving school with few qualifications. He joined an infantry regiment, where he excelled and was promoted through the ranks. His 15-year exemplary service included front-line combat roles in Iraq and Afghanistan. With frequent relocations and long periods of separation from his young family, Sergeant X made the difficult decision to leave the army.
The new-found freedom of ‘Civvy Street’ was initially exciting but rapidly turned to boredom and monotony. Sergeant X missed the structure of the military and struggled to fit in at work and find his place in society. He became withdrawn from family life and stopped his regular exercise regime, replacing this with alcohol. He registered with a GP but felt unable to disclose his true feelings through shame and embarrassment, and instead consulted about treatment for a fungal nail infection.
News reports of recent events in Afghanistan coincided with the anniversary of the deaths of close military friends killed in Afghanistan. His mental health rapidly deteriorated, reaching rock bottom. He left home and was reported missing. After a period of sleeping rough and heavy drinking he reached out to a fellow veteran friend who accompanied him to see a local GP urgently as a temporary resident at a veteran-friendly accredited practice.
Sergeant X was asked, ‘Have you ever served in the Armed Forces?’ It was apparent that recurring flashbacks and nightmares had been a feature for years, with alcohol used as a maladaptive coping strategy. Sergeant X was referred to Op COURAGE through which he received urgent mental health support. He was diagnosed with delayed-onset complex post-traumatic stress disorder (PTSD) and referred to the Complex Treatment Service through which he is receiving specialist trauma-based therapy. He was also provided with support for housing and finances through Armed Forces charities and is now getting his life back on track.
CONCLUSION
The RCGP veteran-friendly practice accreditation programme enables practices to deliver best care for patients who have served in the Armed Forces. To access further information and training materials including podcasts, and to sign up for the programme, readers should visit www.rcgp.org.uk/veterans.
Notes
Provenance
Freely submitted; externally peer reviewed.
Competing interests
Veronica B Grant is an RCGP Veterans Champion. Robin G Simpson is Chair of the RCGP Midlands Faculty, an RCGP Veterans Champion, and Professor of Military Primary Healthcare and Veterans’ Health, University of Chester.
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- Received October 17, 2021.
- Revision requested October 26, 2021.
- Accepted November 15, 2021.
- © British Journal of General Practice 2022