How the NHS works
The structure of the NHS can be baffling for anyone on the outside.
To ensure that the NHS delivers high quality healthcare at a local level, it is divided into a series of trusts:
- Strategic health authorities monitor the performance of trusts within their region and develop plans to improve performance and increase capacity
- Primary care trusts (PCTs) assess local health needs and commission the services to meet them
- NHS trusts (or acute or foundation trusts) provide the hospital, out-patient and other services commissioned by PCTs to meet local population needs
- Ambulance trusts provide services responding to 999 calls, transporting patients, and providing out-of-hours care in some areas
- Mental health trusts provide specialist care for people with complex and severe mental health problems
- Care trusts co-ordinate health and social care services for individual users
- Other local primary care services are provided through GP practices, NHS Walk-in Centres, NHS Direct, dental practices, pharmacists and opticians.
There are almost 250 hospital, mental health and ambulance trusts in England, 51 primary care trust clusters (PCTs) and a growing number of clinical commissioning groups. Clinical commissioning groups are groups of GP practices working together to manage local budgets and buy services for patients direct with other NHS colleagues and other health providers.
NHS hospital trusts employ by far the largest number of people in the NHS, both as clinical staff in hospitals and across a wide range of support functions. Your local hospital may well be one of the most important employers in your town or city.
Primary care is provided in your local community via your local GP, NHS walk-in centre, dentist, pharmacist and optician. NHS Direct is also responsible for providing healthcare advice and information 24 hours a day via the internet and over the telephone.
Currently, all hospital and mental health trusts are dependent on PCTs buying services such as elective surgery, outpatient visits and other treatments from them, but PCTs also run community-based hospitals and provide services such as district nursing and health promotion. However, there are new government proposals to give GP practices much more responsibility for spending the NHS budget in England and commission services direct from hospitals and other health providers for their patients.
Strategic health authorities (SHAs) cover large areas and are responsible for overseeing other NHS organisations in their area and leading on issues such as workforce.
More information can be found on the NHS Choices website.
