3. NHS structure and understanding the new NHS

Self Care -

3. NHS structure and understanding the new NHS

We continue with our knowledge quest to increase our understanding of how the NHS works in order to make better judgements about our own health care moving forwards.

It’s Matt here from Health Control and I truly hope that you have had a more positive few weeks after our Covid world becomes slightly less restricted. I’m feeling pretty smug as I managed to get a haircut!  It was fabulous to see so many smiling faces walking out of the hairdressers!  

Founder of Health Control, Matt, with a new, short hair cut.

Talking of Covid, we will bring into the discussion today some of the consequences of the pandemic on the Government’s plans to improve our health care over the coming years.


A bi-plane representing taking a look back in history to how the NHS has changed over the years.

A quick history of our NHS structure

Before we discuss the now and the future, let’s have a quick review of how the structure of the NHS has evolved since its conception in 1948.  It’s been quite a journey and one which has now created the UK’s largest single employer with a staggering 1.4 million employees:

Initially our NHS was created with three focus areas:

 - Hospital Services - formed into regional Hospital Boards.

 - Primary Care - GP’s, Opticians, Dentists etc who all worked independently.

 - Community Services - Providing services such as Child Welfare, Maternity and Vaccinations.

  • In 1962 the Minister for Health at the time, Enoch Powell, created a 10 year plan, building District General Hospitals each serving around 125,000 people.
  • In the 1980’s the Conservative Government created the concept of the ‘internal market’ for health care, making regional health care more competitive. 
  • In 1990 the NHS and Community Care Act was launched.  Local Health Authorities were given budgets to buy health services, increasing this competitive market, which still remains to this day.
  • The Labour Government in 2003 introduced a targeted ‘Payment By Results’ approach, where local health budgets were created based on the number of patients.  This target style approach is still prominent today, with NHS organisations working to meet targets which are publicly available.
  • The Health and Social Care Act of 2012 structurally reformed the NHS.
  • NHS Scotland and NHS Northern Ireland devolved in 1999.
  • (Revised from the Medic Portal Website: Link to source


The NHS is a moving beast, represented here by a tiny kitten, on the prowl in the grass.

Our NHS - a moving beast!

So, the NHS evolves aligned to changes of Government.  I suppose that is natural when you live in a democracy.  It doesn’t always bode well for long term improvements though.  If an organisation changes its direction every few years, it is a consequence that most longer term plans are not fulfilled.  However, some would argue that it is the frequent change that keeps an organisation alive, dynamic and aligned to present and future needs.  It’s a concept for you to ponder.

To counteract the 'short-termism,' our current Conservative Government launched the NHS Long Term plan for England in 2019.  I guess their hope is that the plan will remain in place even if they are not there to lead the way.  You could also argue that they may hope that by having a long term plan for the NHS, voters may be persuaded to let them see it through to completion (there’s the cynic in me!)

Anyway, this NHS Long Term Plan changes the way in which our local NHS is managed and makes a huge difference to the way in which we are treated.  Get ready for plenty of TLA’s - you know... three letter acronyms!

A confused looking little girl who's gone cross-eyed.

The new structure of our NHS - it’s a little bit complex...

“As of May 2020, the seven NHS England regions have 42 STPs which are at varying stages of progression into ICS’s.”  (Taken from the Wikipaedia STP Page: Link to source).

An STP is a Sustainability and Transformation Plan.  They are organisations that provide us with our local healthcare.  The STP’s are evolving into what are called Integrated Care Systems (ICS).  “ICS’s are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners, to collectively plan and integrate care to meet the needs of their population.” (The Kings Fund Website, Link to source).  Phew!

So, this new type of organisation will bring together not just health care, but also the social care of a local area.  It will oversee the whole community with an aim of providing better care for that specific population using the full set of resources available to it, including hospitals, GP surgeries, charities, social care services, mental health services etc.  With the ageing population that we are now living within, a new approach had to happen to manage the different needs of an older generation.

A discarded pair of surgical gloves, facemask and hand sanitizer gel.

Is it a good idea to have a NHS reorganisation after the pandemic?

So, we discovered that this change has actually been going on in the background since 2019.  Different parts of England will be at different stages of progress.  But the theory sounds good right?  Connecting all of our local services together better to be matched to the needs of a particular population.  This should mean more specific and relevant care, with improved communication between different organisations that are all meant to help us.

Well, let’s not get carried away, it will take time.  And we’ve had a major obstacle that has fallen in the way - the Covid pandemic.  There’s plenty of skeptics about carrying on with the plan now that Covid has left its mark:

“Encouraging collaboration makes sense, but the potential benefits of the new system proposed may be overstated and the risks of reorganisation underplayed.  NHS leaders and government have a long list of policy priorities as the country recovers from the pandemic and a major structural reorganisation of the healthcare system should not be one of them.”  (Hugh Alderwick, head of policy et al, British Medical Journal 2021; 372. Link to source, Published 03 February 2021).

However, there are many that believe that the pandemic may have created some significant benefits to speeding up the adoption of the planned improvements for our NHS.  There’s a great article written by Wilmington Healthcare, experts in the field of the NHS and Health Care, which discusses the pros and cons of a post-covid long term plan: Link to source.

To begin with, let’s have a think about what you may have seen yourself.  “At the start of 2020, most GP’s work was still conducted face-to-face but since then there has been a seismic change with primary care (GP’s, Nurses etc) adopting digital triaging as its main way of working in just three weeks.”  (Oli Hudson and Paul Midgley, of Wilmington Healthcare, 03/07/2020).

Have you had a virtual GP consultation yet?  Lots of us have.  So, the wider use of technology has been forced upon us very quickly in terms of health care.  This technology uptake was a key part of the Long Term plan in England and the regional outlook for Wales, Scotland and Northern Ireland.  It makes complete sense, and we’ll do a Blog on some of the exciting new health technologies heading our way soon.  For now, check out this BBC News story and video clip which is a real eye opener to what’s coming: Drugs by Drone

So, the future outlook is indeed exciting from a technology perspective.  The coming years will ask us all to continue to improve our tech skills in order to capitalise on these supportive developments.  A ‘can-do’ attitude is required if we really want to take control of our own health and use the technology at our fingertips to self care better.

A jigsaw puzzle of a human DNA strand.

Putting the jigsaw together

But let’s take one step back, we’ll cover the future in a forthcoming blog.  Let’s get back to what is important right now.  What does the NHS structure look like for your imminent needs?  Here’s a great diagram from the Kings Fund website, which is a fantastic resource for learning about how the jigsaw of our health care system fits together: (Link to source): 

The structure of the NHS - how it all fits together diagram

From a structure perspective, I tend to think of using the NHS this way if I’m not feeling well (non-emergency):

  1. Ask your local pharmacist - remember, the person serving you may not be the actual pharmacist in a pharmacy, so ask to speak to the pharmacist. This is part of our Primary Care system.  
  2. The Pharmacist will be able to help you, or, suggest you book an appointment to see your nurse or GP.  Again, we are still within our Primary Care System.
  3. If it’s out of hours, use the 111 website (Link to 111 Website), or call 111.
  4. At your GP surgery you’ll be seen by your GP, Nurse or sometimes someone with a different title.  I was once seen by a paramedic.  All of these Health Care Professionals will have the ability to review your health holistically.  They then have the opportunity to refer you to a Specialist if needs be. 
  5. Your Specialist may no longer be a Consultant in a Hospital.  So, you may find yourself seeing a Specialist Health Care Professional in your current GP surgery, another GP surgery, a community clinic,(Community Health Services), hospital (Secondary Care) or via these services and onwards to a specialist location (Tertiary Care).  
  6. All of these facilities will be managed in England by your local STP or ICS - so they should start becoming more aligned to the other local services that are relevant in your area.  In Scotland, Wales and Northern Ireland, the localised health care is provided by a Health Board - and all of these Health Boards should be further down the line with integrated care than we find in England - but as we know health care provision can be diverse!

Let’s summarise -   In Blog 2 we discussed how the money transcends from the Government through the NHS.  This session we have focussed on the structure of the NHS and how Covid has played a role in how the structure may change in the future.  

A compassionate hand reaches out to comfort another hand.

Next time, we’ll talk about the people who care

In our next Self Care blog we’ll talk about the people who care for you in the NHS.  We’ll move away from the organisational talk and get down to the Health Care Professionals.  We’ll discuss who you should expect to be seen by, what those job titles actually mean and provide you with an overview of who’s who in the zoo!

We love questions and feedback.  Please use the comments section below to ask any questions you may have or feedback on our content so far.  

Thanks and best wishes,


The avatar of Matt, the founder of Health Control and writer of the Self Care Blog.

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