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The structure of the new NHS

On 1 April 2013, the Health and Social Care Act 2012 came into force, bringing with it many new structures and arrangements for the NHS in England.

Primary care trusts (PCTs) and strategic health authorities (SHAs) have been abolished.

NHS England (formerly the NHS Commissioning Board) and clinical commissioning groups (CCGs) are now responsible for commissioning the vast majority of NHS services, with local authorities taking on new public health commissioning responsibilities.

Monitor has assumed the role of system regulator for all NHS-funded services and all remaining NHS trusts are expected to become NHS foundation trusts within the next few years.

NHS organisations and boards

NHS Trust Development Authority

Following the scrapping of strategic health authorities, this body is responsible for overseeing the performance management and governance of NHS trusts that have not yet achieved foundation status. This includes clinical quality and managing trusts' progress towards foundation trust status. Ministers want all trusts to achieve foundation status.

Find out more about foundation trusts 



Monitor is the sector regulator for healthcare, responsible for licensing healthcare providers, regulating prices for NHS services and addressing restrictions on competition that act against patients' interests.

Find out more about Monitor


NHS England

NHS England (formerly The NHS Commissioning Board) is charged with improving the health outcomes for people in England, in line with the NHS mandate set by the government. It oversees the work of clinical commissioning groups (CCGs) and holds them to account, allocates resources, and commissions certain services such as primary care and highly specialised services that can be organised better and more efficiently at a regional or national level. It is accountable to the health secretary.

Find out more about NHS England 


Health Education England

Health Education England (HEE) leads education, training and workforce development nationally. It promotes high-quality education and training that is responsive to the changing needs of patients and local communities. Professional regulators are still responsible for setting and upholding standards. HEE has six professional boards. Its medical board is responsible for ensuring that training posts are filled by high-quality candidates, that curriculum-based training is delivered, that academic medicine's needs are recognised, and that there is enough capacity in the health service to deliver high-quality training.

Find out more about Health Education England 


Local authorities

Local government has a new set of duties to protect and improve public health. These include commissioning and providing public health services. The BMA has lobbied to ensure councils have adequate funding and that the independence of directors of public health, and public health doctors, in speaking out is protected. The BMA has also been working to ensure a smooth transition for public health doctors from primary care trusts, and ensured that Public Health England's code of conduct did not restrict their ability to raise issues of concern.


Local education and training boards

Local education and training boards (LETBs) are now responsible for workforce planning, education and training at a local level. They bring together all healthcare and public health providers of NHS-funded services, education providers, professional bodies and local government and universities or research centres. They are accountable to Health Education England and will host postgraduate deaneries and their functions.

Find out more about LETBs


Public Health England

Public Health England is responsible for leading and managing an integrated public health delivery service. It has taken over the roles of organisations including the Health Protection Agency, National Treatment Agency, public health observatories and cancer registries. It has 15 centres across England, each of which provides leadership and support across all three domains of public health - health protection, health improvement and healthcare public health.

This includes:

  • supporting local government in its leadership of the local public health system
  • supporting directors of public health
  • working with the NHS England on commissioning key specialist services and national public health programmes
  • providing leadership in responding to emergencies.



New patient and public bodies, known as local Healthwatch have been established. Local Healthwatch acts as a point of contact for individuals, community groups and voluntary organisations when dealing with health and social care and has a representative seat on the health and wellbeing board.

See more about Healthwatch


Health and wellbeing boards

Health and wellbeing boards have been established in each upper tier local authority to promote integrated working across health and social care. With representatives from local authorities, health and social care, public health and patient groups, health and wellbeing boards produce the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JHWS) identifying local priorities for commissioners.

Find out more about health and wellbeing boards 


Clinical commissioning groups

England's 211 clinical commissioning groups (CCGs) are taking over from primary care trusts and are responsible for £65bn of the £95bn NHS commissioning budget. They now plan and commission hospital care and community and mental health services. All GP practices have to be members of a CCG, and every CCG board must include at least one hospital doctor, nurse and member of the public.

Find out more about clinical commissioning groups


Commissioning support units

GPs and other clinicians involved in clinical commissioning groups (CCGs) need support to commission effectively. Commissioning support encompasses a range of functions, from transactional services such as payroll and IT services, to equipping CCGs with the complex population level data required to inform commissioning decisions.

Primary care trust (PCT) clusters are currently developing commissioning support organisations, to be hosted by the NHS England until 2016. CCGs may choose to host their own, internal support services, or contract from the PCT-cluster developed bodies, private or third sector organisations.

Find out more about commissioning support units


Clinical networks

The networks are hosted and funded by NHS England, and advise on specific conditions or patient groups where improvements can be made through an integrated, whole-system approach. The networks advise local commissioners, help reduce variation in services, and encourage innovation.

Find out more about clinical networks


Clinical senates

These are led by clinicians to provide multidisciplinary input to strategic clinical decision-making. The groups, 12 of which are due to be established, should help ensure that clinical commissioning groups, local authorities and the NHS England (formerly the NHS Commissioning Board) have access to a broad range of clinical input to inform their decisions. Senates include medical, nursing and allied healthcare professional representation as well as patients, volunteers and other groups.

Find out more about clinical senates


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