What has NHSE ever done for me?

Over the last few weeks the rockfalls in health and care policy that signalled changes to NHS England (NHSE) became a full-scale landslide with the announcement that it was to be abolished. NHS England is the arm’s-length body that manages how health services up and down the country are run, while the Department of Health and Social Care (DHSC) is responsible for overall health policy. The changes to NHSE were framed by the Prime Minister and the Secretary of State as key to busting ‘bloated bureaucracy’, saving money and taking control of the health service back into ministerial hands. But what does this mean and how will it impact day-to-day delivery of services?

I have been trying to work through some of this in my head, particularly given that NHS England has been a feature of the NHS landscape during my career in health policy so far. I think focusing on general practice helps illustrate the huge range of things NHSE actually does.

If you start at the front door of your GP practice, how you access this service and make an appointment has been shaped by the work of NHS England. It sets the strategy for ‘modern general practice access’, which has opened up not just different routes to appointments but also how you contact your practice for routine queries – for example, NHS England sets the standards that all providers of GP IT systems must meet. It also sets out the requirements for how practices should offer online consultation tools so that patients can send in non-urgent appointment requests, medication queries and admin requests.

Once you are through the door, the work of NHS England also has an impact on who you will see in your appointment. Following its merger with Health Education England in 2023, NHSE is responsible for training, educating and hiring the professionals who work in general practice but also for planning how many of these staff the NHS will need in the future to meet people’s needs. In general practice specifically, NHS England has supported changes to the skills mix of the workforce so that you can see a range of different professionals – such as physiotherapists or paramedics. If you are having an appointment to review your medication, for example, this could now be with a pharmacist rather than a GP, as a result of the Additional Roles Reimbursement Scheme.

At this appointment, you could also be offered a vaccine to protect you against illnesses such as Covid or flu, because NHS England supports GPs to provide them as part of its responsibility for national vaccination programmes. As part of this, and their role in getting innovation into the NHS, from 2024 they’ve rolled out a new vaccine to protect older adults and pregnant women against RSV (respiratory syncytial virus), an illness that spreads all year round and affects the airways and lungs.

The GP or nurse would know if you were eligible for this new vaccine by looking at your patient records, the infrastructure for which is organised nationally by NHS England, which plays a key role in supporting the integration of digital technology into health care. This includes things such as developing the NHS app, ensuring that you can access your patient records, and that these can be shared across the different services you access, but also enabling transformation in how care is delivered. For example, as part of its work on transformation, NHS England has been supporting pilots of ambient AI, which records conversations between GPs and patients and converts them into medical notes so that your GP can talk to you face to face without having to tap on their keyboard.

These are some non-exhaustive examples of how the work of NHS England influences the day-to-day running of general practice – just one part of a much wider system. There are lots of things I haven’t covered, such as the role it plays in collecting, analysing and publishing data on different parts of the health service, which is how we know that there were 33 million general practice appointments made in January 2025. NHSE also has plays an important role in supporting patient safety across the system, for example rolling out Martha’s rule, which gives patients and their loved ones the right to request an urgent review of the person receiving hospital treatment, or through the primary care patient safety strategy.

What I come back to thinking is that NHS England currently holds a lot of really important functions. These don’t have to sit in NHSE, but they do have to sit somewhere, and so quite rightly, in the context of the reorganisation, much of the concern and questions about these changes at the centre have been around what will happen to X, Y or Z. In many of the examples above, it makes sense that lots of these things are not done by 6,000 or so separate GP practices but by specialists in technology or data, for example. Deciding which of these functions will be moved from NHS England to the DHSC, or to integrated care boards or regions or even to individual providers, will take time. And it will be complicated by the shrinking of both the centre and integrated care boards. As the dust from the past few weeks begins to settle, the number of questions, on everything from responsibilities to legislation, continues to stack up.