Here we explain the structure of the NHS in England, by providing an overview of the core organisations and their roles.
The Secretary of State for Health
The Secretary of State has overall responsibility for the work of the Department of Health (DH). DH provides strategic leadership for public health, the NHS and social care in England.
The Department of Health (DH)
The DH is responsible for strategic leadership and funding for both health and social care in England. The DH is a ministerial department, supported by 23 agencies and public bodies. For detailed information, visit the DH website.
NHS England
NHS England is an independent body, at arm’s length to the government. It's main role is to set the priorities and direction of the NHS and to improve health and care outcomes for people in England. See NHS England’s Five Year Forward View, which sets out the future vision for the NHS.
NHS England is the commissioner for primary care services such as GPs, pharmacists and dentists, including military health services and some specialised services.
As part of the NHS Five Year Forward View, primary care co-commissioning was introduced. An example of this is NHS England inviting clinical commissioning groups (CCGs) to take on an increased role in the commissioning of GP services. You can read more about co-commissioning and the benefits on NHS England's website.
NHS England manages around £100 billion of the overall NHS budget and ensures that organisations are spending the allocated funds effectively. Resources are allocated to CCGs.
Clinical commissioning groups (CCGs)
CCGs replaced primary care trusts (PCTs) on April 1 2013. CCGs are clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. CCG members include GPs and other clinicians, such as nurses and consultants. They are responsible for about 60% of the NHS budget, commission most secondary care services, and play a part in the commissioning of GP services. The secondary care services commissioned by CCGs are:
CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities or private sector providers. However, they must be assured of the quality of services they commission, taking into account both National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality Commission's (CQC) data about service providers.
Both NHS England and CCGs have a duty to involve their patients, carers and the public in decisions about the services they commission.
If you want to learn more about how commissioning in England works, download the 2015 leaflet Commissioning - What's the big deal? (PDF, 297kb). Note: some of the statistics in this document are now out of date.
Health and wellbeing boards
Health and wellbeing boards were established by local authorities to act as a forum for local commissioners across the NHS, social care, public health and other services. The boards intended to:
- increase democratic input into strategic decisions about health and wellbeing services
- strengthen working relationships between health and social care
- encourage integrated commissioning of health and social care services
For more information, see:
Public Health England (PHE)
PHE provides national leadership and expert services to support public health, and also works with local government and the NHS to respond to emergencies. PHE:
- co-ordinates a national public health service and delivers some elements of this
- builds an evidence base to support local public health services
- supports the public to make healthier choices
- provides leadership to the public health delivery system
- supports the development of the public health workforce
For more information on PHE, visit the GOV.UK website.
Vanguards
Vanguards were introduced in 2015 as part of the NHS Five Year Forward View. The 50 chosen vanguards are tasked to develop new care models and potentially redesign the health and care system. It is envisaged that this could lead to better patient care, service access and a more simplified system. Find out more about vanguards on NHS England’s website or download the document New care models: Vanguards – developing a blueprint for the future of NHS and care services (PDF, 1.51Mb).
Regulation – safeguarding people’s interests
Responsibility for regulating particular aspects of care is now shared across a number of different bodies, such as:
For more information about individual regulators, see our Health watchdogs and authorities section.
Your health, your choices