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0808 808 3555
You might come across the terms 'primary care', 'secondary care'
and 'tertiary care'. Simply, these terms refer to the different
levels of care in the NHS system.
Primary care is anything you access directly.
This includes general practitioners (GPs), health visitors,
dentists and opticians. Primary care provides the first point of
contact in the healthcare system. It is the route by which we most
commonly access other parts of the NHS, such as hospital care.
Find out more about GPs and primary care.
Secondary care describes the sort of services
you might be referred to if your child needs to be seen by someone
with more specialist knowledge. Secondary care includes hospital
services, Child and Adolescent Mental Health services (CAMHS) and
child development centres. A referral from a primary care
practitioner is required to access secondary care.
Find out more about secondary care services.
Tertiary care is the specialist end of the NHS,
and you might use these services if your child has a very complex
or rare condition. Tertiary care includes specialist hospitals,
such as Great Ormond Street, Alder Hey and Bristol Children's
hospital. A referral from a secondary practitioner is generally
required to access tertiary care.
Find out more about tertiary care services.
As you navigate the NHS, it can be useful to know how the system
is structured and which organisation is ultimately responsible for
the services your child receives.
Department of Health
The Department of Health (DH) has overall responsibility for the
NHS, including policies and legislation, improvements and funding.
There are many agencies that are involved in the NHS, but for the
purpose of receiving NHS care there are two main ones - Public
Health England and NHS England.
Public Health England
Public Health England is responsible for health protection, such
as infectious diseases and health promotion and prevention. Most
Public Health preventative work is now delegated to local
authorities, who plan and commission services such as health
visiting, school nursing and health promotion programmes (like Change4Life).
Public Health is probably better known for its healthy living
messages, such as stopping smoking and obesity, and their role in
preventing infectious diseases, but they have a
wider remit [PDF] that includes improving health and wellbeing
and reducing health inequalities.
NHS England directly 'commissions' (orders and pays for) some
NHS services, including primary care services and specialist
services that are deemed 'low incidence' - either because they are
very specialist or people do not require them very frequently. NHS
England is also responsible for the quality, support and
improvement of clinical commissioning groups (see below).
Clinical commissioning groups (CCGs) commission (order and pay
for) all local health services, but not, aside from a few
exceptions, primary care services, which are commissioned by NHS
England. The services CCGs are responsible for include emergency
care (A&E) and secondary care (hospital care and community
CCGs are formed of local GPs and other clinical professionals
who plan and commission the health services for the communities
they cover. There are 221 GGCs covering all of England; some local
authorities have one CCG, whereas large cities may have more than
Alongside the local authority, CCGs decide where in your area
money is spent. They are responsible for making sure that the right
services are available locally, and that they're of sufficient
NHS England and CCGs commission the services you use, but they
don't provide them directly. Instead, the commissioners pay 'NHS
providers' to provide services to agreed standards, such as those
set by the National Institute for Health and Clinical Excellence
NHS services are often provided by NHS trusts, which
There is generally more than one trust in a local area, and
mental health services can be separate trusts or provided by the
local hospital or community trust.
Many NHS trusts are a foundation trust, which means that they
are more independent and are accountable to their local community.
NHS Trusts and Foundation Trusts are monitored through NHS
Improvement. You can find
a list of all NHS trusts.
We also support Northern Ireland and Scotland. Give our helpline
a call on 0808 808 3555 for information and advice on any aspect of
raising a disabled child, or call your local contact. Find out our
details in the Contact in your area