A basic(ish) guide to how the NHS is set up

NHS care

The NHS is a fundamentally simple idea. You feel sick, you head to a GP, and a week later you’re back up on your feet. However, sometimes it can feel a little like a maze, especially when you find yourself at the heart of it. Any healthcare news nowadays seems to involve an endless range of stern-looking politicians spouting a stream of meaningless acronyms. DHSC, PHE, CCG – there’s just one question. What does it all mean?


A slight Caveat

Okay, to keep things simple this article focuses on the NHS in England. Despite it being called the National Health service, there are actually different versions of the NHS in each of the four kingdoms; England, Scotland, Wales and Northern Ireland. While all of these share many similarities and regularly co-operate, NHS England is by far the largest, both in terms of the number of people it sees and its hefty budget.


Working from the top down

The NHS is run for the people, by the people. Ultimately this is through the power of parliament,  making the running of the NHS one of the most important issues when it comes to any general election. After much deliberation by the government, the budget for the year will be set. In 2018 this was set at £124.7 billion, or 21 million hip replacements if you’d prefer.

This money is passed to the Department of Health and Social Care (the DHSC), the arm of government responsible for ensuring everyone is looked after physically and mentally. The DHSC then decide how much money goes to NHS England (most of it) and how much is needed to fund other organisations that look after national health.


Healthcare outside the NHS

While the NHS swallows most the budget, a small amount is reserved for Public Health England (PHE), an organisation that, unsurprisingly, looks after public health. These include things such as healthy eating and dealing with emergencies such as the resurgence of the plague.

There are also organisations that act outside the NHS to ensure everything runs smoothly. The foremost of these is the Care Quality Commission (CQC) which ensures that the high standards of care required are being met. They’re a little like an exam invigilator pacing up and down the hall; needless to say, it’s best when they don’t need to get involved.


NHS England & Clinical Commissioning Groups

Of all the money the DHSC doles out, over 85% goes into the pockets of NHS England. This is the body that oversees the whole NHS system in the country. Some money is allocated straight to primary care (medicine that takes place in the community, mainly through GPs), while another lump goes to funding specialised services to take care of people with rare conditions.

Since it’s GPs, nurses and consultants that have the most exposure to patients in the community, it’s thought that they’re the ones who know where the money needs to be spent. A retirement community will require more old age care than an area full of young professionals for example. The result are a number of groups called clinical commissioning groups (CCGs) lead by local GPs.

Responsible for around two-thirds of the NHS budget, CCGs decide how much spending is needed in areas such as community services, mental health, hospitals and the ambulance service. They choose what particular services to buy (or commission) from a range of organisations, including NHS hospitals, community health services and the private sector. They can also enlist the services of volunteer services where available. They don’t tend to commision primary care, as this would involve GPs buying services from themselves – awkward to say the least. Instead, NHS England deals with this.


Supporting Organisations

On the surface, giving control to the medical profession sounds like a good thing. However, doctors and nurses don’t tend to be trained in business, meaning that the ins and outs of negotiations and securing contracts aren’t exactly their forte. With this in mind, groups called commissioning support units (CSUs) have been set up to provide advice and support to CCGs, giving them the resources to go ahead and get the services they want. Following a number of mergers there are now five CSUs currently active in England.  

The other main kind of supporting group are called Clinical Senates. Although they sound like something out of Star Wars they are actually formed by a number of hospital doctors, specialising in advanced care. Since some of the conditions they treat fall outside of the expertise of GPs, it’s difficult for CCGs to accurately commision the right kind of care for their patients. The clinical senate provides advice to CCGs about these cases, allowing them to make the best decisions for their community.


There are others too

The organisations mentioned are just the tip of the iceberg. Within the NHS umbrella there are hundreds of bodies, all focusing on something different. The most prominent one is rather ironically called NICE (The National Institute for Health and Care Excellence) and provides the guidelines for new treatments as well as deciding which treatments should, and shouldn’t, be available on the NHS. This is a rather unenviable task but a necessary one, especially when the NHS has a limited budget and a growing demand – largely the result of an ageing population.

As a patient, you might come into contact with a number of different services. However at the heart of all of them is the goal of providing the best quality treatment for your needs. At Qured, we believe that the quality of care is second to none, proudly providing NHS healthcare at home within two hours. It may be look complicated behind the scenes but that doesn’t mean getting hold of care has to be. If you’d like to find out more, or have any questions, get in touch today. We’d love to hear from you.