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This page was published in April 2020. For more recent work in this area, see our animation on how the NHS in England works or our diagram on integrated care systems.

We explain how funding flows in the NHS and how providers are regulated and commissioned.

How funding flows in the NHS

Download the pdf version of How funding flows in the NHS.

The NHS: how providers are regulated and commissioned

Diagram showing how providers are regulated and commissioned

Download the pdf version of The NHS: how providers are regulated and commissioned


NHS England and NHS Improvement is responsible for providing national direction on service improvement and transformation, governance and accountability, standards of best practice, and quality of data and information. NHS England and NHS Improvement came together in 2019 to act as a single organisation (maintaining separate boards). The aim of the merger is to work more effectively with commissioners and providers, making more efficient use of resources, and removing duplication.

The Care Quality Commission’s (CQC) role is to register care providers and monitor, inspect and rate their services in order to protect users. CQC publishes independent views on major quality issues in health and social care.

Regional NHS England and NHS Improvement teams are responsible for the quality, financial and operational performance of all NHS organisations in their region. Increasingly, they are working with local systems (ICSs/STPs) to oversee performance, support their development and make interventions when necessary.

Sustainability and transformation partnerships (STPs) bring together NHS providers and commissioners, local authorities and other local partners to plan services around the long-term needs of local communities. STPs cover populations of 1-3 million people.

In some areas, integrated care systems (ICSs) have evolved from STPs. ICSs are a closer collaboration in which organisations take on greater responsibility for managing local resources and improving health and care for their populations. According to the NHS long term plan, every part of England will be covered by an ICS by 2021. 

Integrated care partnerships (ICPs) are alliances of providers that work together to deliver care by agreeing to collaborate rather than compete. These providers include hospitals, community services, mental health services and GPs. Social care, independent and third sector providers may also be involved. NHS England and NHS Improvement is developing an ‘integrated care provider contract’ as an option for formalising these partnerships.  ICPs cover populations of 250–500,000 people.

Primary care networks (PCNs) bring general practices together to work at scale with other local providers from community services, social care and the voluntary sector. Together they provide primary care by using a wide range of professional skills and community services. Since 1 July 2019, all except a handful of GP practices in England have come together in around 1,300 geographical networks. PCNs cover populations of 30–50,000 people.