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The NHS in England

The NHS structure explained

In 2013 the NHS underwent a major transformation. The information below explains the new NHS and its core structure. 

Download the leaflet Understanding the new NHS (PDF, 1.23Mb)

Overview of organisations and their role

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

The Department of Health (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 improve health outcomes for people in England. It:

  • provides national leadership for improving outcomes and driving up the quality of care
  • oversees the operation of clinical commissioning groups (CCGs)
  • allocates resources to CCGs
  • commissions primary care and specialist services

Find out more about NHS England, its vision and business plan for the NHS.

Clinical commissioning groups (CCGs)

Clinical commissioning groups 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. CCGs members include GPs and other clinicians such as nurses and consultants. They are responsible for about 60% of the NHS budget and commission most secondary care services such as:

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 leaflet Commissioning - What's the big deal? (PDF, 297kb).

Health and wellbeing boards

Every "upper tier" local authority has established a health and wellbeing board to act as a forum for local commissioners across the NHS, social care, public health and other services. The boards are 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, read:

Public Health England

Public Health England (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 visit the GOV.UK website.


Regulation - safeguarding people’s interests

Since April 2013, some elements of the regulation system have changed. 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. 

The Care Quality Commission (CQC)

The CQC continues to regulate all health and adult social care services in England, including those provided by the NHS, local authorities, private companies and voluntary organisations.

Read more about the CQC.


Monitor expanded its role to regulate all providers of health and adult social care services. Monitor aims to promote competition, regulate prices and ensure the continuity of services for NHS foundation trusts.

Under the new system, most NHS providers will need to be registered with both the CQC and Monitor to be able to legally provide services.

Note: all service providers are required to hold a licence issued jointly by the CQC and Monitor. To get a licence, providers will need to meet essential standards of quality and safety. They’ll also have to follow certain behaviours relating to price setting, integrated care and competition. More importantly, providers will have to ensure services don't stop in the event of financial difficulties. If a provider does not fulfil the terms and conditions of the licence, both Monitor and CQC can take independent action, such as issuing warning notices or financial penalties.

Find out more about Monitor


Healthwatch is a new organisation and functions as an independent consumer champion, gathering and representing the views of the public about health and social care services in England.

It operates both at a national and local level and ensures the views of the public and people who use services are taken into account.

Locally, Healthwatch will give patients and communities a voice in decisions that affect them, reporting their views, experiences and concerns to Healthwatch England. Healthwatch England will work as part of the CQC.

Read more about Healthwatch England.

Other changes to the regulation system

Following the abolition of strategic health authorities (SHAs), the NHS Trust Development Authority (NHS TDA) is now responsible for overseeing the performance, management and governance of NHS Trusts, including clinical quality, and also managing their progress towards foundation trust status. The TDA has a range of powers, from appointing chairs and non-executive directors, to requiring a trust to seek external advice.

For more information visit the TDA website

Page last reviewed: 07/01/2015

Next review due: 07/01/2017

Other parts of the UK

For information on the health service in other parts of the UK, please visit:

The Isle of Man and the Channel Islands have their own independent health service structures. For more information, please visit:


NHS England logo

The NHS Five Year Forward View

NHS England has published a long-term vision for the NHS, explaining why change is needed and how it could be achieved

NHS Change Day

Take part in this year's Change Day. Make or join a pledge and help improve patient care

MyNHS - better data for transparency

See how NHS services perform on a set of different indicators and challenge them to improve

Equality and diversity in the NHS

Find out about the Equality Act 2010. The new laws give the NHS opportunities to work towards eliminating discrimination and reducing inequalities in care