How the NHS in England is now structured

What we call ‘the National Health Service’ is actually made up of a complex range of organisations with different functions and responsibilities. Understanding how these organisations inter-relate and work together is a complicated business.

In 2012, the Health and Social Care Act made major changes to the structure of health services in England.

The Act tried to achieve a greater separation between the Secretary of State and the Department of Health on the one side and the day-to-day running of the NHS on the other. The Department of Health transfers around £95 billion a year to NHS England, an arms-length body that the Secretary of State holds to account through an annual mandate. NHS England allocates most of its money to around 200 clinical commissioning groups (CCGs), which commission or ‘buy’ care for their populations from providers (which may be run directly by the NHS, or by private or third sector organisations). NHS England also directly commissions specialist services and primary care including GP practices – though there are plans to move more of this to CCGs.

Most providers of NHS care have to be registered with the economic regulator, Monitor, and with the quality regulator, the Care Quality Commission. Since the NHS reforms, an organisation called Public Health England has overview of the nation’s health and another new body, HealthWatch England, was created to strengthen the voice of patients.

At a local level, health and wellbeing boards bring together bodies from the NHS, public health and local government to plan how best to meet local health and care needs.

In addition there is a range of organisations and bodies that provide guidance, advisory services, training and other functions, all under the umbrella of the NHS.

Alternative guide to the new NHS in England

Confused and want to find out more? Our ‘Alternative guide to the new NHS in England’ animation provides a whistle-stop tour of how the NHS fits together.

Download the final animation image.

More NHS in a nutshell