Toolkit for doctors new to the UK

How the NHS works

Location: UK International
Audience: International doctors All doctors
Updated: Monday 6 June 2022
Topics: International doctors

The NHS (National Health Service) was launched in 1948 and since then it has grown to become the world's largest publicly funded health service. The NHS deals with over 1 million patients every 36 hours.

The NHS was born out of the ideal that good healthcare should be available to all, regardless of wealth - a principle that remains at its core.

With the exception of some charges, such as prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is a UK resident. That is currently more than 66.4 million people.


How the NHS works in England

There are commissioners who are responsible for an area's strategic healthcare planning.

In secondary care, the commissioners are currently known as CCGs (clinical commissioning groups) and hospitals are run by NHS trusts or foundation trusts.

Primary care is commissioned mostly by NHS England (although sometimes can be commissioned by CCGs as well) and provided by GPs.

See the King's Fund's video on how the NHS in England works.

  • NHS England - monitors the performance of the NHS nationally and supports commissioning locally.
  • CCGs - there are about 190 CCGs run by GPs and other healthcare professionals, who assess local health needs and commission services needed to meet them.
  • NHS acute or foundation trusts - there are about 220 trusts running hospital, outpatients and other services commissioned by CCGs.
  • Ambulance trusts - response to emergency calls, transporting patients and providing out-of-hours care.
  • Mental health trusts.
  • Care trusts - co-ordinate health and social care services for individual users.
  • Other local primary care services - GP practices, walk-in centres, NHS 111 24 hour information and triage phone line, dental practices, pharmacies and opticians.

Key things to know

  • There are around 112,000 doctors and 311,000 nurses working in the NHS, which has a total workforce of around 1,093,000.
  • Around one in eight staff working in the NHS are from abroad. 
  • Demand for healthcare has been rising across all services and sectors over the past decade.
  • Due to the pressures on the NHS and an ageing population with complex health needs, there is currently a big focus on integrating health and social care.


How the NHS works in Scotland

NHS Scotland employs around 160,000 staff who work across 14 territorial and seven special NHS boards.

Territorial NHS boards are responsible for the protection of their population’s health and healthcare services.

Special NHS boards support them by providing a range of important specialist and national services eg Scottish Ambulance Service, NHS24 and the Scottish Blood Transfusion Service.

Unlike in England, there is no internal market in Scotland. The NHS boards are responsible for both planning and delivering services.

  • NHS Ayrshire & Arran
  • NHS Borders
  • NHS Dumfries & Galloway
  • NHS Fife
  • NHS Forth Valley
  • NHS Grampian
  • NHS Greater Glasgow & Clyde
  • NHS Highland
  • NHS Lanarkshire
  • NHS Lothian
  • NHS Orkney
  • NHS Shetland
  • NHS Tayside
  • NHS Eileanan Siar Western Isles

How the NHS works in Wales

NHS Wales employs around 80,000 across seven health boards and three all-Wales trusts.

Patients access the NHS in Wales more than 20 million times each year, with 90% of contacts taking place outside of hospital, such as in a GP practice or through a community health service.

Unlike in England, there is no internal market in Wales. The NHS boards are responsible for both planning and delivering services.


Local health boards:

  • Aneurin Bevan Health Board
  • Abertawe Bro Morgannwg University Health Board
  • Cardiff & Vale University Health Board
  • Hywel Dda Health Board
  • Cwm Taf Health Board
  • Betsi Cadwaladr University Health Board
  • Powys Teaching Health Board

NHS trusts in Wales with an all-Wales remit:

  • Welsh Ambulance Services Trust
  • Velindre NHS Trust - offering specialist services in cancer care and a range of national support services
  • Public Health Wales

How the NHS works in Northern Ireland

The NHS in Northern Ireland employs around 62,603 staff who work across six health and social care trusts.

Northern Ireland is distinct from England, Scotland and Wales in that health and social care is, at least in theory, integrated.

Health and social care is commissioned by a regional single health and social care board supported by five local commissioning groups.


The five health and social care trusts are:

  • Belfast HSCT
  • Southern HSCT
  • South Eastern HSCT
  • Northern HSCT
  • Western HSCT

The sixth trust is the Northern Ireland Ambulance Service, which operates a Northern Ireland wide service.