Structure of the NHS

Version 1, 9 November 2022

This guidance is part of the NHS organisations with an impact on digital general practice section of the Good practice guidelines for GP electronic patient records.

Structures, funding flows and other aspects of the National Health Service (NHS) vary between the UK home countries.  This overview looks at the NHS in England only.

The NHS in England is not one single organisation.  It is made up of hundreds of different organisations of differing sizes, at central, national, regional, and local levels with different roles and responsibilities.

The NHS is said to be the largest employer in Europe.  Staff can be directly employed by the NHS, employed by a service provider, self-employed, or provide services under a contract with another, non-NHS organisation. 

The NHS is constantly evolving with major changes seen since the introduction of the Five Year Forward View in 2014 and the current NHS Long Term Plan published in 2019.  The structure is, therefore, unsurprisingly complicated, and difficult to describe simply.

In this article we provide a very simplified overview of both the structure and the funding flow of the NHS in England.   Please explore the links for further detail.

The King’s Fund has produced this video giving an overview of the key organisations that make up the NHS and how they collaborate with partners in the health and care system to deliver joined-up care.

Roles, responsibilities, and funding

The role, responsibility, and funding of each part of the NHS is complex. The King’s Fund has published a summary of NHS funding in ‘The NHS in a nutshell‘.

The table below provides a broad overview of the structure, function of the main departments and organisations involved, whether at national or local level, with links to further detail provided.  Links to other articles in this series are also included where appropriate.

Governing Body/ Responsible officer

Place (national regional local)



Government/Prime Minister


National Decides how much money it gives to the NHS. The Government also decides on top- level priority setting Funding for the NHS comes from:
·  taxation
·  a percentage of National Insurance contributions
·  prescription charges
·  dental service charges
·  local income which can be generated and then introduced by local activities such as car parking charges, selling of property, private provision of services, etc.
Secretary of State for Health and Social Care(SoS H&SC)/Department of Health and Social Care (DHSC) and Department for Education (DfE)


The Secretary of State is responsible for the work of the Department of Health and Social Care, including:
·  overall financial control and oversight of NHS delivery and performance ·  oversight of health and social care policy DHSC sets out the direction of future healthcare and helps to deliver the Government’s health objectives (for example cancer targets, disease monitoring and prevention, excess winter deaths, etc.). Healthcare is provided for both adults and children, however social care is an adults only service.

The DfE is responsible for children’s services and education, including early years, schools, higher and further education policy, apprenticeships, and wider skills in England
Majority of money is passed on, though a small amount is used for public health, training and development of NHS staff and regulating the quality of Care (by the Care, Quality Commission or CQC)
Care Quality Commission (CQC) National
Independent regulatory body for all health and social care service providers reporting to the SoS H&SC



CQC purpose and role is to register care providers and monitor, inspect and rate their services in order to protect users.  CQC also publishes independent views on major quality issues in health and social care

NHS England (NHSE)

Responsible for providing unified, national leadership for the NHS. NHS England is a single regulatory body responsible for overseeing the funding, planning, delivery, transformation, and performance of NHS healthcare in England. The Health and Care Act formalised the mergers of a number of NHS organisations including NHS England, NHS Improvement, Health Education England, and NHS Digital

Oversees the commissioning, planning, and buying of services.  Commissions some services itself nationally but passes on the majority of its money to ICSs.  The King’s Fund has summarised the main changes brought about by the Health and Care Act 2022
NHS Digital National NHS Digital develops and operates the national IT and data services that support clinicians at work, help patients get the best care, and use data to improve health and care
NHS Digital collaborates closely with the Transformation Directorate at NHS England to focus on the most important priorities for the health and social care system
NHS England Regional Teams Regional – 7 regional teams Responsible for the quality, financial, and operational performance of all NHS organisations in their region, working with integrated care systems (ICSs) to oversee performance and support their development


Transformation Directorate at NHS England National/Regional Driving the digital transformation of the NHS and social care, is a joint unit of NHS England and DHSC. NHSX previously supported the digital transformation of health and social care and has now been mostly integrated into the Transformation Directorate (and other parts of NHS England
Academic Health Science Network (AHSN) 15 Regional networks Goal is to improve patient and population health by aligning education, clinical research, informatics, innovation, training, and education in healthcare


Innovation Pathway – AHSN Network
Integrated care systems (ICSs) Regional Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.

Following several years of locally led development, recommendations of NHS England and passage of the Health and Care Act (2022) 42 ICSs were established across England on a statutory basis on 1 July 2022

Included in an ICS are the following:
·  integrated care partnership (ICP) ·       integrated care board (ICB)
·   local authorities
·   place-based partnerships
·   provider collaboratives


Integrated Care Partnerships (ICPs) Regional and Local A statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. The ICP will bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area


Primary Care Networks (PCNs) Local Groups of GP practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services to provide care closer to home and to deliver economies of scale.

PCNs are not legal entities under current arrangements.

Each of the 1,250 PCNs across England are based on GP registered patient lists, typically serving natural communities of between 30,000 to 50,000 people (with some flexibility). They are small enough to provide the personal care valued by both people and GPs, but large enough to have impact and time and cost savings through better collaboration between GP practices and others in the local health and social care system
Service providers such as primary care, secondary care trusts,  voluntary and community sector and private sector Local Providers include, hospital services, general practice, ambulance services, district nursing, health visiting, mental health providers, combined mental health, learning disability and community providers, specialist providers such as cancer treatment, integrated providers such as organisations providing acute and community care


General practice Local Providing pro-active, preventative health care, education, advice, and treatment for people who are ill or who believe themselves to be ill. Funded by the GP contract held with NHSE as well as additional funding through PCNs and locally commissioned services
Local authorities


Responsible for improving the health of their local population and for public health services including most sexual health services and services aimed at reducing drug and alcohol misuse.  The Secretary of State continues to have overall responsibility for improving health – with national public health functions delegated to the UK Health Security Agency (UKHSA) (previously Public Health England (PHE)).



Whilst the structure at the top of the NHS is unlikely to change significantly, the greatest and most recent reforms will be seen at ICS level and below.  Recent (2022) major structural changes (the abolition of CCGs, the move to ICSs, and ICBs for commissioning of regional services) are impacting on digital first primary care, in relation particularly, but not exclusively to:

  • improving access
  • primary care networks
  • improving GP appointment data
  • the continued evolution of the GP contract
  • GP workforce issues

The NHS will continue to evolve based on the challenges it faces at any one time. Some of the current key challenges that have been taken into consideration during the most recent structural changes are:

  • an aging population
  • a growing population
  • an increase in levels of obesity, diabetes and antibiotic resistance leading to evolving healthcare needs
  • medical advancements which save lives but push up costs (it has been estimated that medical technology in the NHS costs an extra £10bn per year)
  • closure of local services due to centralisation drives
  • an increase in the reliance on privatised services
  • unexpected events such as the COVID-19 pandemic

Other helpful resources