What does it look like?
The new structure of the NHS in England can be baffling to anyone on the outside.
There is a split between the purchaser and the provider.
There are commissioners (purchasers) who are responsible for an areas strategic healthcare planning and who purchase healthcare for a defined population from providers of healthcare services.
Within secondary care the commissioners or purchasers of care are currently known as Clinical Commissioning Groups (CCGs) and the providers of care (hospitals) are run by NHS trusts or Foundation trusts.
This set-up is commonly known as the internal market, it was designed to allow competition between providers for commissioner's money.
Primary care is commissioned mostly by NHS England (although some primary care can now be commissioned by CCGs as well) and provided by General Practitioners.
The NHS in England is divided into a series of organisations:
Monitors the performance of the NHS nationally and supports commissioning locally.
It also commissions GP services and undertakes specialist commissioning which includes buying the services for conditions which affect a relatively small number of people but can include major services such as cancer services.
Clinical commissioning groups (CCGs)
There are about 200 CCGs. They are run by GPs and other local healthcare professionals, who assess local health needs and then commission the services to meet them. They are responsible for about 60% of the NHS budget.
NHS acute or foundation trusts
These provide the hospital, out-patient and other services commissioned by CCGs to meet local population needs
These provide services responding to emergency calls, transporting patients, and providing out-of-hours care in some areas
Mental health trusts
These provide specialist care for people with complex and severe mental health problems
They co-ordinate health and social care services for individual users, there are currently very few of these organisations.
Other local primary care services
These are provided through GP practices, NHS Walk-in Centres, dental practices, pharmacists and opticians.
How big is the NHS?
Almost 1.3 million people are employed by NHS England. There are almost 250 hospital, mental health and ambulance trusts in England and over 160 CCGs.
NHS hospitals employ the largest number of people in the NHS, both as clinical staff in hospitals and across a wide range of support functions. The local hospital may well be one of the most important employers in a town or city.
How do all the pieces fit together?
Primary care is provided in the local community via a local GP, NHS walk-in centre, dentist, pharmacist and optician. The NHS 111 phone service is also responsible for providing healthcare advice and information 24 hours a day via the internet and over the telephone.
Hospital and mental health trusts are dependent on CCGs buying services such as elective surgery, outpatient visits and other treatments from them. They may also be commissioned to run community services such as district nursing and health promotion. Alternatively, CCGs may commission other providers, such as social enterprises or local charities, to run these services.
The NHS is currently going through a period of rapid change.
The NHS has had to respond to numerous challenges, such as problems associated with the aging population, increased demand, not enough money and changing patient expectations.
The NHS has developed policy initiatives to tackle these issues, and these initiatives are dramatically changing the way in which the NHS is run.
How is the NHS different now?
There is an increased emphasis on the integration of care, which involves greater coordinated working between healthcare providers, and particularly between health and social care providers and commissions.
Initiatives such as the 'Five year forward view' and the 'better care fund' have been developed to enable more integrated services to be developed. Another major change is the proposed introduction of 7 day services, this will enable a broad range of healthcare to be available on the NHS 7 days a week.
There is also a considerable focus on quality improvement and increasing the efficiency of the NHS and there are numerous ongoing programmes to ensure that the NHS is fit for purpose in the modern world.