Patient and public England Wales

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How the NHS works

How the NHS is run

The responsibility for deciding how local hospital and community health services are provided falls to local organisations called clinical commissioning groups (CCGs).

There are currently just over 200 CCGs. All GP practices must be a member of their local CCG.

CCGs are overseen by NHS England. In turn, it is accountable to the Health Secretary.  The government sets NHS England a mandate every three years, outlining what it is expected to achieve and prioritise.

Theoretically, this system gives more say to doctors and other clinical staff about how health services are planned and delivered locally. In practice, the level of involvement of local doctors is mixed.


CCGs and your GP

Involvement in CCGs

Your GP may have a senior role within your CCG, such as a position on the governing body, and so will be closely involved in the decisions being made.  Alternatively, she or he may have little involvement in your CCG’s decision-making.

If your doctor needs to take time away from the practice for CCG work, the practice should receive some funding to ensure that patient services are not affected, for example to provide a locum GP to hold a surgery.

Doctors who take on a lead role in their CCG, which may be a full-time commitment, will be paid to undertake this role.

Your treatment

When you visit your doctor, his or her first priority is to make sure you receive the most appropriate treatment. This is a professional and ethical obligation.  

Doctors active in their CCG will be involved in decisions about what services are needed for all local people. This will involve decisions about how best to use the CCG’s budget. This may mean that new services are commissioned, that some services change or that some services are no longer required.

This is very different level of decision-making to the recommendations your doctor will make about your treatment.

When making decisions about the care of individual patients, a doctor must make the decision based only on the individual’s clinical need. This means, for example, that your doctor cannot decide not to give you treatment in order to save money.

Conflict of interests?

GPs must always refer patients to the most appropriate service, based on the clinical needs, wishes and choices of the patient. 

The General Medical Council requires that a doctor “must not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients.”

Where the most appropriate service to which the patient is to be referred happens to be one in which the GP has a financial interest, then the GP must inform the patient of this fact. Any unavoidable conflict of interest should be recorded in the patient record.

If a GP is referring you to an organisation in which they, or a close family member, have a financial interest, they must inform you.

Furthermore, doctors must not accept any financial inducement to change their prescribing, referral or treatment of patients without an evidence base. Their decisions about what treatment you need must be based on your clinical need alone.

The BMA recommends that doctors are as open as possible about their involvement in the commissioning process.  We take concerns about conflicts of interest very seriously and are monitoring the situation.


More information

If you would like more information about the NHS, here are some additional resources for you:

The King's Fund have produced an animation about the NHS in England, and include information about the latest changes to the system

Health Watch - a body set up to give the public a stronger voice in the NHS

Citizens Advice Bureau - provides advice on a range of issues relating to NHS care