A beginner’s guide to the NHS structure for healthcare professionals

A beginner's guide to the NHS structure for healthcare professionals

It is almost 70 years since health secretary Aneurin Bevan walked into Trafford General Hospital, Manchester (formerly Park Hospital) and, with a visit to a young patient, launched an ambitious, controversial free healthcare plan, a National Health Service (NHS).

Prior to its birth, healthcare for the poorer classes was something bestowed by charity, if at all.

Since that day in 1948, the NHS’s founding principles of a health service available to all, paid for from general taxation and free at the point of use, remain mostly intact. Although, it has undergone many changes since then.

This handy guide is a helpful insight into how the NHS is structured in England. (Devolution of powers within the UK has meant Scotland, Wales and Northern Ireland have their own healthcare models.)


In charge of the purse strings, the Department of Health funds the NHS in England and helps to lead and shape the service.

The Secretary of State for Health has ultimate responsibility for ensuring a cohesive, workable service.

NHS England

NHS England was established in 2013 as an independent body, separate from Government, to lead the NHS in England.

The NHS distributes the billions of pounds of tax payers’ money through the various NHS organisations, commissions the contracts for GPs, dentists and pharmacists (via Clinical Commissioning Groups) and monitors the spending of those funds to ensure accountability and effective use of public money.

The main role of NHS England is to set properties and lead the direction of the service to improve health and care outcomes for people living in England.

NHS England also plays a lead role in pushing discussion on future management of the health service.

Clinical Commissioning Groups (CCGs)

These groups are responsible for specific areas and decide what hospital and community health services are needed, ensuring their provision.

Although NHS England is responsible for GPs, many now are co-commissioned with CCGs.

The CCGs also commission most planned hospital care, rehab, community health services and mental health services.

Health and wellbeing boards

The boards bring together the NHS, public health, adult social care and children’s services, including elected representatives and Local Healthwatch, to work out how to meet the community’s health needs.

The boards also aim to boost independent involvement in strategic decisions about health and wellbeing services, reinforce relationships between health and social care, and foster integrated appointments of health and social care services.

Public Health England (PHE)

Also established in 2013, Public Health England (PHE) provides national leadership on health and wellbeing services. It also works with local government and the NHS to respond to emergencies.

PHE provides government, local government, the NHS, parliament, industry and the public with professional, scientific expertise and support.

PHE is mostly comprised of scientists, researchers and public healthcare professionals. It brings together public health specialists from more than 70 different organisations into a single service.


Between January and September 2015, as part of the NHS Five Year Forward View, 50 vanguards were selected to develop new models that would streamline the disparate services.

The blueprint for future care is a rethink of how care is provided with the aim of easing access for patients and reducing trips to hospital.

The vanguards are also joining up the range of out-of-hours GPs, Accident and Emergency (A&E), ambulance services and injury clinics to create accessible and effective medical help available seven days a week.

Integrated Care Systems (ICSs)

The NHS Five Year Forward View also outlines plans for sustainability and transformation partnerships (STPs) to develop into integrated care systems (ICSs).

The term ‘integrated care’ has been adopted to describe the NHS’s developing system that supports a more collaborative working relationship between organisations across the healthcare sector.

While there is no fixed definition of an ICS, the organisation usually receives an annual, capitated budget to deliver contractually agreed health outcomes.

NHS England’s Five Year Forward View agenda mainly focuses on the wider integration of healthcare providers to offer a more cohesive service for patients.


Regulation exists to ensure the quality and improvement of healthcare and financial oversight.

The regulation of the care given by providers is done by the Care Quality Commission, an independent regulator of health and social care in England.

NHS Improvement, an umbrella body comprised of various support organisations, also shares the responsibility of regulation, as well as a collection of nursing, dental and medical groups.

For further details about the NHS structure, visit nhs.uk

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