Healthcare in England

4 mins read

Finding your way around the NHS can seem confusing, especially if your child needs to be seen by lots of different health professionals and 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.

In this article

Understanding the NHS

As you navigate the NHS, it can be useful to know how the system’s structure 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 involved in the NHS. 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

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)

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 services).

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 one.

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 quality.

NHS providers

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 (NICE).

NHS services are often provided by NHS trusts, which include:

  • Acute trusts – manage hospitals and community services, for example through health centres, clinics or in people’s homes
  • Mental health trusts – provide health and social care services for people with mental health services
  • Ambulance trusts – provide emergency access to healthcare

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.

NHS services and how to access them

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.