An alternative guide to the new NHS in England

This content relates to the following topics:

Part of The King's Fund animationsThe NHS at 65

Article information

  • Posted:Monday 15 July 2013

This animation was created in 2013.  Please watch our updated version, How does the NHS in England work? An alternative guide, which was published in October 2017. 

In recent years, our health system has undergone profound change, with the 2012 Health and Social Care Act introducing the most wide-ranging reforms since the NHS was founded in 1948.

Watch and listen to our animation, which gives a whistle-stop tour of the NHS – how the organisations work and fit together – and explains that our system is as much a product of politics and circumstance as design.

This animation was created in 2013.

Updates as of April 2016

This animation was created in June 2013. Since then, there have been some changes to the way the system works:


The budget for the NHS in England in 2016/17 is £120.4 billion.

Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces.

In April 2015, NHS England’s 13 local area teams were integrated into the four existing regional teams: London, Midlands and East, North and South, each maintaining a local presence.

In 2016/17, NHS England will transfer £71.9 billion to 209 clinical commissioning groups, responsible for commissioning a range of routine services (eg, urgent and emergency care services, elective hospital care, community health services, maternity and mental health services) for their local populations.

While NHS England initially commissioned general practice, CCGs are increasingly taking on responsibility for commissioning general practice in their area. In 2016/17 a total of 115 CCGs will have assumed full responsibility for the commissioning of primary medical care services under delegated commissioning arrangements. A further third will hold the responsibilities jointly with NHS England. Nearly all CCGs are expected to have taken on delegated arrangements by 2017/18.

Work is also ongoing to change the way in which specialised services are commissioned, including more collaborative commissioning between CCGs and NHS England.

Some CCGs are supported in their work by six (down from 19 when CCGs formally launched in April 2013) commissioning support units (CSUs) – although some also commission support from independent sector providers. Clinical senates and strategic clinical networks also provide expert clinical advice on issues that go beyond the remit of an individual CCG. There are also fifteen Academic Health Sciences Networks, intended to promote and encourage the adoption of innovation in health services. The remit of AHSNs is being considered as part of the Accelerated Access Review.

Local government

In 2016/17, there will be a mandatory minimum of £3.9 billion of pooled NHS funding to be spent jointly with local authorities as part of the Better Care Fund’s integration programme. Areas also have the flexibility to pool more than the mandatory amount.

From 1 October 2015 the responsibility for commissioning public health services for children aged 0-5 transferred from NHS England to local authorities. This marked the final part of the overall public health transfer which saw some wider public health functions (eg, services aimed at reducing drug and alcohol misuse) transfer to local government on 1 April 2013.


From 1 April 2016, leaders in Greater Manchester will start to have greater control over the region’s health and social care budget. This includes taking on delegated responsibility for several commissioning budgets currently controlled by NHS England, including for a number of specialised services and some public health services. These services will continue to be commissioned by NHS England, but decisions about service changes, finances, and quality and performance will be made through the newly appointed Chief Officer of Greater Manchester Health and Social Care, working with the 37 NHS organisations and local authorities in the region. Other areas are also pursuing ‘devolved’ arrangements.


From 1 April 2016, Monitor and the NHS Trust Development Authority will be brought together under a new umbrella organisation, NHS Improvement. The new body in charge of improvement in the NHS will also incorporate groups from three other organisations: NHS England’s Patient Safety Team and NHS Improving Quality’s Advancing Change Team; NHS Interim Management and Support’s two Intensive Support Teams; and the National Reporting and Learning System. NHS Improvement will oversee foundation trusts, NHS trusts and independent providers.

New models of care

The NHS five year forward view was published in October 2014, describing a range of changes, including new models of service delivery such as:

  • primary and acute care systems, to join up GP, hospital, community and mental health services
  • multi-specialty community service providers, to move specialist care out of hospitals into the community
  • enhanced health in care homes, to offer older people better, joined up health, care and rehabilitation services.

Since then, two further models have been introduced:

  • urgent and emergency care vanguards, to improve the coordination of services and reduce pressure on A&E departments, and
  • acute care collaborations, to link local hospitals together to improve their clinical and financial viability.

To implement these new care models, the NHS invited individual organisations and partnerships to apply to become ‘vanguards’ for the new care models programme; 50 vanguards have now been established across the country.

More about this animation

The inspiration for the animation was a session delivered to groups of clinicians as part of our leadership development programmes. Clinicians told us how useful the session was – whilst being experts in their own part of the health system, they were less clear about how the whole, complex system fits together. Our animation aims to bring the essence of this session to a wider audience – an introduction to the new NHS in 6.5 minutes. Find out more about our leadership development courses.


Jo Manley

Director of Operations,
Hounslow & Richmond Communtiy Healthcare NHS Trust
Comment date
23 July 2013
This is quite simply the best guide I've seen to the new NHS...and explains to anyone why it seems to have got more complicated...certainly not simpler. I shall be using it with friends, family...not to mention all our staff to explain the challenges we are now facing and how it all seems to have got so much more let me try and work out..where do I report to?

Teresa Agin

Account Manager Medical Devices,
UK Trade & Investment - Life Science Investment Organisation
Comment date
24 July 2013
Great stuff! This is a great way of explaining such a complex arena. I spend my life explaining the NHS to the rest of the world and the only thing that would enhance this picture for me is for extra pipes leading to NHS Scotland/Wales/Northern Ireland.....but I understand that the changes only apply to the English health landscape so that's why they are not included but at that high level it would be great to see them.
Thanks for this.


Strategy and Development Manager,
Comment date
25 July 2013
A really helpful overview - love the animation. Could you let me know who did the animation for you please? I'm having problems trying to print out the pdf of the finished poster, do you have hard copy posters you can send out or a better link to email?


Lee Mellor

comms lead,
healthwatch derbyshire
Comment date
29 July 2013
Brilliant, I work for a local healthwatch and will make sure I share this with the others.

Jeanne levoir

Local government officer retired Foster Carer current,
Southend B Council lately St Christophers Fostering services Org
Comment date
01 August 2013
A few interactive gogs should be in place by now. Responsibility for a transparent, coherent working agreement between Agencies is essential. To many have fallen through the net in the past and it should not be tolerated. Contracts should be sturdy and mismanagement acted upon. We have a chance here to re-create a NHS second to none. Lets let lose the baggage we carry and employ those who will make a difference.


Nurse practioner. Primary Care,
Too funny for words.
Comment date
04 August 2013
This is excellent. My only comment is your title.

Calling it an alternative guide is is not correct. This is the definitive guide because it is clear and concise and clearly informative in a way DOH publications have failed. It is the reality as it is today.

35yrs in the NHS, mostly in general practice. 3 months ago, our surgery was taken over by another company. Informed last week that we are facing redundancy, or apply for alternative jobs in the organisation at a reduced salary.

What more evidence do people need that the NHS is facing self destruction ?

Simon Truett

LTC Programme Manager,
Medway CCG
Comment date
05 August 2013
Superb clarity, this has been shared widely within our organsiation.

Yog D

Comment date
16 August 2013
Also missing is CQC (though Monitor is shown) and national Trust Development Authority - though its tenure is limited. As someone else has said NHS Property Services Ltd is absent too. When updating the final image perhaps these can be added in?


Digital Communications Manager,
The King's Fund
Comment date
19 August 2013
Hi Yog D,

Thank you for your comments. The CQC is featured in the final image - it's one of the 'helicopters' floating around on the left of the image. As the audio explains, there are a lot of organisations that we weren't able to mention individually due to a very short timeframe, but hopefully the final picture still gives a good indication of the system.


IT sales,
Comment date
29 August 2013
Loved the animation, really helpful and simple to follow. Could I also request a Jpag of the finished poster for our office wall ? Many Thanks

Add your comment