When discussing problems facing the NHS during an interview, such as increased waiting times, the NHS winter crisis and the NHS obesity crisis in the UK, it is essential to know about the structure of the UK healthcare system to identify which sectors may be impacted the most.
Crucially, the structure is mid-reform. In March 2025 the government announced that NHS England, long the central arms-length body, would be abolished and folded back into the Department of Health and Social Care. The legislation to do this, the NHS Modernisation Bill, was introduced to the House of Commons on 14 May 2026 and is progressing through Parliament (its second reading was on 1 June 2026), with the legal abolition of NHS England targeted for April 2027 if the Bill passes. This guide reflects the position as of mid-2026, so you can answer interview questions on the current, evolving system rather than the old one.
This article breaks down the people and organisations that influence how the NHS is run, along with an insight into how this is monitored and regulated externally.
Summary of NHS Structure in England (2026)
NHS oversight: The Secretary of State for Health and Social Care (Wes Streeting as of 2026) oversees the NHS, sets the mandate and allocates funding through the Department of Health and Social Care (DHSC).
DHSC Role: The Department of Health and Social Care develops health policies and allocates funds to NHS organisations, including NHS England and Health Education England.
NHS England (being abolished): Historically the arms-length body that managed funding to NHS trusts and Integrated Care Boards. Announced in March 2025 for abolition, it is being merged into the DHSC over roughly two years, with central and ICB running costs cut by around 50%.
Integrated Care Boards (ICBs): Local NHS bodies that plan and commission services for their populations. They replaced Clinical Commissioning Groups (CCGs) on 1 July 2022 and, from April 2026, are being merged into larger footprints (the 42 reducing towards roughly 27).
NICE: Provides evidence-based guidance and evaluates treatments to ensure high-quality, cost-effective healthcare services across the NHS.
Who is in charge of the NHS in 2026?
Commonly perceived as a single entity, the National Health Service (NHS) is in reality a combination of organisations working together, consisting of doctors, managers and other health care professionals.
The Secretary of State for Health and Social Care:
Decides how health services are organised by allocating finances
Writes the NHS mandate, a set of key aims and expectations for the NHS for the following year. This is fulfilled by NHS England.
Is able to intervene where they feel certain bodies of NHS England may be lacking, or failing to meet targets.
Develops public health initiatives by ensuring health-related legislation is recognised in parliament.
Past Holders of the Role
Wes Streeting: July 2024 onwards
Victoria Atkins: 2023-2024
Steve Barclay: 2022-2023
Thérèse Coffey: 2022
Sajid Javid: 2021-2022
Matt Hancock: 2018-2021
Jeremy Hunt: 2012-2018
The Department for Health and Social Care (DHSC):
The Department of Health and Social Care (DHSC) is the central government body responsible for health and social care policy in England, and, with NHS England being abolished, it is taking direct control of running the NHS. It is led by the Secretary of State for Health and Social Care (Wes Streeting as of 2026).
It ensures the effective functioning of the National Health Service (NHS) and other health-related bodies by setting overall health policy and allocating necessary funds. The key roles of the DHSC include:
Formulating Health Policy: Developing and implementing health and social care policies to improve the healthcare system.
Funding Allocation: Distributing financial resources to vital health organisations and bodies, such as:
NHS England: Manages the planning and delivery of NHS services.
Workforce, training and education: This function was carried out by Health Education England until April 2023, when HEE merged into NHS England; with NHS England now being abolished, workforce planning moves into the DHSC.
UK Health Security Agency (UKHSA): Handles public health protection and responses to health threats.
Local Authorities: Manage public health initiatives and services at the community level.
The DHSC plays a critical role in ensuring the NHS operates efficiently and effectively, maintaining the overall health standards of the population.
NHS England was, until its planned abolition, the arms-length body responsible for allocating funding to NHS trusts and NHS foundation trusts through direct commissioning. In March 2025 the government announced it would be abolished and merged into the DHSC, ending the split that had existed since the Health and Social Care Act 2012.
It operates under the NHS mandate set out by the Secretary of State for Health and Social Care, which targets funding to relieve specific pressures such as waiting lists.
Following the Health and Care Act 2022, NHS England also allocates funds to Integrated Care Boards (ICBs). These boards, like NHS England, direct funding to NHS Trusts to ensure patient care across the country is adequately funded and managed.
As NHS England is wound down, the aim is to remove duplication between it and the DHSC, cut administrative costs by around 50% and bring strategic control of the NHS back into central government. The NHS Modernisation Bill, introduced to the Commons on 14 May 2026 and, as of mid-2026, at committee stage in Parliament, gives this legal effect, with full abolition targeted for April 2027 if it passes. For interviews, the key point is that this is a major structural change still in progress, not a finished reform, so it is worth checking the latest position before you go in.
Health Education England (HEE)
Health Education England (HEE) used to be the body dedicated to the training and education of future healthcare professionals. As of 2026 HEE no longer exists as a standalone organisation: it merged into NHS England in April 2023, and its workforce functions are now being absorbed into the DHSC as NHS England is abolished.
It ensures that the healthcare workforce is well-prepared and equipped with the necessary skills to deliver high-quality patient care. HEE collaborates with universities, NHS organisations, and other educational bodies to create comprehensive training programmes and continuous professional development opportunities.
This ensures that healthcare professionals, including doctors, nurses, and allied health professionals, receive the best possible education and training to meet the evolving needs of the healthcare sector.
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Integrated Care Boards (ICBs) play a crucial role in the NHS by directing funding to NHS Trusts to ensure high-quality patient care across the country.
They were established as part of the Health and Care Act 2022, replacing Clinical Commissioning Groups (CCGs) to enhance local healthcare delivery and integration.
Unlike NHS England, which operates on a national level, ICBs focus on the specific healthcare needs of their local regions. They collaborate closely with the community, charities, and local government to tailor healthcare services to meet local demands effectively.
This localised approach allows ICBs to address unique health challenges within their areas, ensuring that resources are allocated efficiently and that healthcare delivery is responsive to the needs of the population.
By fostering partnerships and community involvement, ICBs enhance the integration and coordination of health services, ultimately improving patient outcomes and overall health system performance.
The remainder of the budget that does not go towards the NHS Trusts or Integrated Care Boards distributes money to bodies such as:
Central admin and programme
Elective services such as diagnostic scans
Prison and Youth Offender healthcare services
Military and veteran healthcare
What is the Difference Between NHS England and ICBs?
NHS England and Integrated Care Boards (ICBs) have distinct roles within the NHS framework. NHS England operates at a national level through its seven regional teams, focusing on improving the overall standards of NHS Trusts and implementing national health policies via the NHS workforce.
In contrast, ICBs operate at a local level, addressing specific healthcare needs within their regions. Formed under the Health and Care Act 2022, ICBs work closely with integrated care partnerships that include community members, charities, and local government.
NHS Foundation Trusts
NHS Foundation Trusts are semi-independent organisations within the NHS, offering the flexibility to manage their budgets and customise services to address local needs effectively.
Unlike standard NHS Trusts, Foundation Trusts have greater autonomy, allowing them to innovate and respond swiftly to the unique healthcare requirements of their communities.
They operate hospitals and community health services, ensuring that high standards of care are maintained. Foundation Trusts are accountable to local communities, with governance structures that include members and governors drawn from patients, staff, and the public.
Their performance and finances were historically overseen by NHS Improvement, which merged into NHS England in 2022; with NHS England now being abolished, that oversight is moving into the DHSC. The Care Quality Commission (CQC) remains the independent regulator of quality and safety.
How NHS Foundation Trusts Differ from Integrated Care Boards (ICBs)
While NHS Foundation Trusts focus on the operational management of hospitals and community health services, Integrated Care Boards (ICBs) have a broader, strategic role in the NHS. ICBs are responsible for planning and commissioning healthcare services to meet the needs of their local populations.
They allocate funding to various healthcare providers, including NHS Trusts and Foundation Trusts, to ensure resources are used effectively and healthcare delivery is coordinated across their regions.
In summary, NHS Foundation Trusts deliver direct patient care and manage health services, enjoying a degree of financial and operational independence.
In contrast, ICBs oversee the strategic distribution of resources and coordination of services across multiple providers to address local health needs comprehensively.
Public Health: UKHSA and OHID (Replacing Public Health England)
Public Health England (PHE) used to lead on protecting and improving the nation's health. It is worth knowing for interviews that PHE was abolished in 2021: its functions were split between the UK Health Security Agency (UKHSA), which handles health protection and outbreaks, and the Office for Health Improvement and Disparities (OHID) within the DHSC, which leads on prevention and health inequalities.
Those functions are now delivered by UKHSA and OHID, working with the NHS to coordinate responses to public health challenges such as pandemics, seasonal flu and lifestyle-related disease. The 'sickness to prevention' shift in the 2025 10-Year Health Plan puts this work at the centre of NHS policy.
Public health initiatives such as vaccination programmes, smoking cessation and nutritional guidance, all aimed at reducing health inequalities, are now led by UKHSA and OHID rather than PHE. By analysing health data and research, they provide evidence-based recommendations that shape health policy across England.
How Has the Structure of the NHS Changed Over Time?
The structure of the NHS has changed significantly since its creation in 1948. But fundamentally, it remains a system that provides health care free at the point of delivery.
Here is a timeline of those changes - showing how the funding that used to be allocated by GPs is now distributed by Integrated Care Boards, reflecting the specific needs of the local population to enhance community-based care.
1991-1997
Primary-care-led commissioning = GPs were given budgets to buy a range of services on behalf of their patients.
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Policies were introduced allowing patients greater autonomy, such as the ability to choose where they received hospital treatment.
2012
The Health and Social Care Act 2012 introduces Clinical Commissioning Groups (CCGs). Following their introduction, there is greater scope for change in the NHS on a national level. In addition to this increased autonomy, CCGs are also a response to the 2013 Francis report into the Mid Staffordshire Failings.
The introduction of the Sustainability and Transformation Plans (STPs) sees the move towards a triple integration system.
This integrates primary care services with mental health, community and social care. There is a large and significant shift towards considering the patient holistically, through the integration of services.
2014
The Five Year Forward View is published, emphasising cohesion between primary care and social care. The STPs are renamed Sustainability and Transformation Partnerships, and 42 are established nationwide (the footprint that later became the 42 Integrated Care Systems).
2019
The NHS Long Term Plan is published. Included is a detailed list of ways that the NHS will integrate its services by maximising and directing funding to areas that need it, such as maternity and mental health services as well as technology and innovation. The LTP formalises the transition from 42 STPs to 42 Integrated Care Systems.
2022
The introduction of the Health and Care Act 2022 abolished CCGs, replacing them with ICBs.
This allowed cohesion between local and national governments in an effort to make healthcare provision specific to the population it serves. ICBs focus on fulfilling values of the NHS Constitution: reducing health inequalities, and promoting doctor-patient collaboration and innovation.
2025
In March 2025 the government announced that NHS England would be abolished and merged into the DHSC over roughly two years, with ICB and central running costs cut by around 50%.
In July 2025 the government also published the 10-Year Health Plan for England, setting out three big shifts: hospital to community, analogue to digital, and sickness to prevention. Read on to find out how the current system fits together.
What are Integrated Care Systems (ICS) in Health and Social Care?
Primary Care Networks (PCNs) and Primary, Secondary and Tertiary Care
Below ICBs, the front door to the NHS is primary care: GP practices, community pharmacy, dentistry and optometry. Since 2019, GP practices have grouped together into Primary Care Networks (PCNs), typically covering 30,000 to 50,000 patients. PCNs let practices share staff such as clinical pharmacists, physiotherapists, social prescribers and paramedics through the Additional Roles Reimbursement Scheme, so patients can be seen by the right professional rather than always the GP.
It helps to know the three tiers of care for interviews. Primary care is your first point of contact (your GP or pharmacist). Secondary care is hospital-based services you are usually referred into, such as A and E, general surgery or outpatient clinics. Tertiary care is highly specialised treatment in regional or national centres, for example cancer care, neurosurgery, transplants or specialist children's hospitals.
The 2025 10-Year Health Plan's 'hospital to community' shift is designed to move more activity from secondary care back into primary and community settings, including new neighbourhood health centres that bring GPs, nurses, mental health staff and other professionals together under one roof, open at least 12 hours a day, six days a week. In my experience as a GP, this is the change students should follow most closely, because it directly reshapes where and how patients are seen.
On 1 July 2022, the Integrated Care System (ICS) model became statutory, with Integrated Care Boards (ICBs) replacing Clinical Commissioning Groups (CCGs). There are 42 ICSs in England, each covering a region. From April 2026 ICBs are being merged into fewer, larger bodies (the 42 reducing towards roughly 27 by 2027/28) as part of the wider reforms.
The Integrated Care Systems (ICSs) split into Integrated Care Boards (ICBs) and Integrated Care Partnerships (ICPs)
ICBs = responsible for the provision of NHS services in the specific area.
ICPs = collaborate with the local population, authorities and other organisations to ensure that ICBs fulfil their targets.
There are 42 ICSs in England, each serving its region (the devolved nations of Scotland, Wales and Northern Ireland run separate systems). The number reflects population: London is covered by 5 ICSs, while Lincolnshire, a larger but less densely populated area, has just 1. From April 2026 these are being consolidated into fewer, larger ICBs.
A common point of confusion, and a frequent search, is the difference between 'the NHS' and 'NHS England'. The NHS (National Health Service) is the whole publicly funded healthcare system, made up of thousands of organisations: GP practices, hospitals, ambulance services, mental health and community trusts, and the bodies that plan and fund them.
NHS England, by contrast, was a single national arms-length body created in 2013 to oversee and fund the NHS at arm's length from ministers. It is not the same as 'the NHS'. As of 2026, NHS England is being abolished and merged into the Department of Health and Social Care, so its planning and funding role is moving back into central government. Note that NHS England only ever covered England: Scotland, Wales and Northern Ireland have their own separate health systems.
The NHS is funded by the taxpayer, mainly through general taxation and National Insurance Contributions, with a small share from charges such as prescriptions and some car parking. The NHS in England has a budget of well over £190 billion a year (2025/26), the large majority of the DHSC's spending.
General taxation: This refers to Income tax, a deduction that goes towards services in society. Local governments decide how much of this will be directed towards healthcare spending to improve the health and well-being of a population.
National Insurance Contributions (NICs): This is money that contributes to State Pensions and NHS Services.
The flow of funding is a relatively simple pathway to follow, starting with the Secretary of State for Health and Social Care and ending with the NHS providers that fund the treatment we see in our local A&E in secondary care.
If we reverse the flow of funding we see who is accountable. NHS providers report to their Integrated Care Boards, which have until now answered to NHS England. As NHS England is abolished, this accountability line is moving directly to the DHSC.
A variety of forms of assessment are in place. We will now delve into each of these.
Care Quality Commission (CQC)
Established in April 2009, the Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England. The CQC's primary role is to ensure that health and social care services provide people with safe, effective, compassionate, and high-quality care.
What Does the CQC Do?
The CQC carries out inspections and monitors a wide range of services, including hospitals, care homes, GP practices, dental surgeries, and other care services. During these inspections, they assess the quality of care provided and ensure that services meet fundamental standards of quality and safety.
After an inspection, the CQC rates each service provider using four ratings: Outstanding, Good, Requires Improvement, and Inadequate. These ratings help the public make informed choices about their care and encourage service providers to improve their services.
Local Authorities In Healthcare
Local authorities play a vital role in maintaining and improving public health services. They are responsible for:
Health Assessments: Local authorities assess the health needs of their communities to ensure that local health services are meeting those needs effectively.
Public Health Promotion: They work on promoting healthy lifestyles and preventing illness through various public health campaigns and initiatives.
Service Coordination: Local authorities coordinate with the NHS and other health service providers to ensure that services are delivered efficiently and effectively.
Funding Allocation: They allocate funding to various health and social care services, ensuring resources are used where they are most needed.
By carrying out these functions, local authorities help ensure that health services are accessible, effective, and tailored to the needs of their communities.
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NICE (National Institute for Health and Care Excellence):
The National Institute for Health and Care Excellence (NICE) is a key player in the UK healthcare system, providing evidence-based guidance and advice to improve health and social care. Here's a closer look at what NICE does:
Evidence-Based Guidance: NICE develops comprehensive, evidence-based guidelines for health services, medications, and social care. This guidance helps ensure that patients receive the best possible care based on the latest research.
Recommending Action Plans: NICE recommends specific plans of action for treating various medical conditions. These plans are designed to standardise care across the NHS, ensuring that patients receive consistent and high-quality treatment.
Evaluating QALYs: One of the crucial roles of NICE is to evaluate the Quality Adjusted Life Years (QALYs) that a patient can gain from a specific treatment. This assessment helps determine the value and effectiveness of different treatments, guiding decisions on which treatments should be funded by the NHS.
Reviewing New Drugs: NICE reviews all new drugs launched in the UK to assess their efficacy, safety, and cost-effectiveness. This rigorous review process ensures that only the most beneficial and cost-effective medications are made available to patients.
By performing these functions, NICE plays an essential role in ensuring that healthcare resources are used effectively and that patients receive treatments that are both beneficial and cost-effective. Their work supports the NHS in delivering high-quality care to all patients across the UK.
How will the structure of the NHS change in the future?
The 10-Year Health Plan and the Three Shifts
Published on 3 July 2025, the government's 10-Year Health Plan for England (Fit for the Future) is the single most important document to understand the NHS's direction. It is built around three shifts: hospital to community, analogue to digital, and sickness to prevention. These themes come up repeatedly at interview, so it is worth being able to explain each in a sentence.
Hospital to community means delivering more care closer to home through neighbourhood health centres and stronger primary care, rather than defaulting to hospital. Analogue to digital means a more powerful NHS App, a single patient record and greater use of data and AI. Sickness to prevention means tackling the causes of ill health, such as obesity, smoking and alcohol, before people become unwell, led in part by the Office for Health Improvement and Disparities (OHID).
Alongside the plan, the abolition of NHS England and the merging and shrinking of ICBs are being delivered through the NHS Modernisation Bill, which was introduced in the King's Speech on 13 May 2026. These reforms are intended to cut bureaucracy and push money and decision-making towards the front line. A strong interview answer links the structural reforms to the three shifts: changing who runs the NHS is meant to make these shifts deliverable.
Major reforms to the NHS vary based on the political party leading the country at the time. However, there are some common issues to be tackled in the next decade. These include a focus on prevention and tackling the social determinants of health.
The Hewitt Review 2022 set out changes we might expect to see within the NHS in the next decade.
These include:
Increased collaboration between ICSs and National bodies
Promoting local leadership and initiative
A shift in resources from treatment towards health promotion strategies. By 2027, prevention funding is aimed to increase by ‘at least 1%’.
The Major Conditions Strategy 2023 aims to:
Tackle ‘major conditions’ that are most prevalent in society, therefore decreasing the burden of disease. Examples include Cancers, Dementia, and Cardiovascular diseases.
Digital and Data: NHS Digital and the Move to a Single Patient Record
NHS Digital used to lead the health service's national IT systems, patient records and data analytics. As of 2026 it no longer exists as a separate body: NHS Digital merged into NHS England in February 2023, and its digital and data functions are now part of the central NHS being absorbed into the DHSC. The 'analogue to digital' shift in the 2025 10-Year Health Plan, including a single patient record in the NHS App, builds on this work.
NHS Digital Transformation: NHS Digital leads the digital transformation of healthcare services, utilising innovative technologies to streamline operations and improve patient outcomes. By integrating electronic health records (EHRs), telehealth solutions, and digital patient portals, NHS Digital enhances healthcare accessibility and efficiency.
What's changing: the NHS Modernisation Bill and the abolition of NHS England (2025-2027)
This is the fastest-moving part of the whole topic, so it is worth a short recap of the timeline. In March 2025 the government announced that NHS England would be abolished and its functions brought back into the Department of Health and Social Care. That decision needed legislation, and the NHS Modernisation Bill was introduced in the King's Speech on 13 May 2026. The bill is the legal vehicle for the largest reorganisation of the NHS in more than a decade, and the legal abolition of NHS England is being targeted for April 2027. Because this is still passing through Parliament, treat the detail as provisional and check the current position before an interview.
In practical terms, the bill makes the DHSC the operational headquarters of the NHS, absorbing functions that NHS England used to run, and expands the Secretary of State's powers over commissioning, performance and resource allocation. Responsibility for commissioning most primary care services is being transferred from NHS England to Integrated Care Boards, so that local systems have more say over the services their populations need. The bill also underpins the single patient record promised in the 10-Year Health Plan.
The ICB landscape is changing at the same time. Integrated Care Boards were asked to cut their running costs by around 50%, and the 42 are being consolidated into fewer, larger organisations. The first mergers took effect on 1 April 2026, creating six new ICBs, with further mergers decided in summer 2026 and taking effect from April 2027. The end point is expected to be somewhere in the region of the mid-to-high twenties rather than 42, though the exact number is still being finalised.
In my experience preparing students for interview, you do not need to memorise every clause of the bill. What examiners want to hear is that you understand the direction of travel: fewer central bodies, more power held directly by ministers and by local ICBs, and a reform designed to make the three shifts in the 10-Year Health Plan deliverable. If you can say clearly that NHS England is being abolished, that the NHS Modernisation Bill is the legislation delivering it, and that the change is aimed at April 2027 but not yet complete, you will sound genuinely current. Because this area is mid-reform, always double-check the latest position on gov.uk or england.nhs.uk before your interview.
One national programme worth knowing alongside the structural changes is Greener NHS, which owns the health service’s climate commitments. Our guide to the greener NHS and its net zero targets explains why there are two target dates rather than one, and why most of the emissions sit in the supply chain rather than in hospital buildings.
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FAQs
Frequently asked questions
What is the structure of the NHS in England in 2026?
In 2026 the NHS in England is overseen by the Department of Health and Social Care (DHSC), led by the Secretary of State. Below it sit 42 Integrated Care Systems, each with an Integrated Care Board (ICB) and an Integrated Care Partnership, plus Primary Care Networks and NHS trusts and foundation trusts that deliver care. NHS England, the former central body, is being abolished and merged into the DHSC.
Who is in charge of the NHS?
The NHS in England is ultimately accountable to the Secretary of State for Health and Social Care (Wes Streeting as of 2026), who leads the Department of Health and Social Care, sets the NHS mandate and allocates funding. Until its abolition, NHS England ran the service day to day at arm's length; that role is now moving back into the DHSC.
Is NHS England being abolished?
Yes. In March 2025 the government announced NHS England would be abolished and merged back into the Department of Health and Social Care, ending the arms-length model created in 2013. The legislation, the NHS Modernisation Bill, was introduced in the King's Speech on 13 May 2026, with the legal abolition of NHS England targeted for April 2027. The reform also aims to cut central and Integrated Care Board running costs by around 50%.
What is the difference between the NHS and NHS England?
The NHS is the entire publicly funded health system: GP practices, hospitals, trusts and the bodies that plan and fund care. NHS England was a single national arms-length body, created in 2013, that oversaw and funded the NHS for England only. They are not the same thing, and as of 2026 NHS England is being abolished and absorbed into the Department of Health and Social Care.
What are Integrated Care Boards (ICBs)?
Integrated Care Boards are statutory NHS bodies that plan and commission most NHS services for a local population. They replaced Clinical Commissioning Groups (CCGs) on 1 July 2022 under the Health and Care Act 2022. There are currently 42, aligned to the 42 Integrated Care Systems, but from April 2026 they are being merged into fewer, larger bodies (reducing towards roughly 27 by 2027/28).
What is an Integrated Care System (ICS)?
An Integrated Care System is a partnership of NHS, local government and other organisations that plans and delivers joined-up health and care for a defined area. Each ICS has an Integrated Care Board (responsible for NHS services and budgets) and an Integrated Care Partnership (which sets the wider health and wellbeing strategy). There are 42 ICSs in England, each covering a different population.
When did ICBs replace CCGs?
Integrated Care Boards (ICBs) replaced Clinical Commissioning Groups (CCGs) on 1 July 2022, when the Health and Care Act 2022 came into force. CCGs had been GP-led commissioning bodies introduced in 2013. ICBs took on their commissioning role but cover larger areas and work as part of Integrated Care Systems alongside local authorities and other partners.
What is a Primary Care Network (PCN)?
A Primary Care Network is a group of GP practices working together, usually covering 30,000 to 50,000 patients. Introduced in 2019, PCNs let practices share additional staff such as clinical pharmacists, physiotherapists, paramedics and social prescribers through the Additional Roles Reimbursement Scheme, so patients can see the most appropriate professional and care can be delivered closer to home.
What is the difference between primary, secondary and tertiary care?
Primary care is your first point of contact, such as your GP, pharmacist, dentist or optician. Secondary care is hospital-based care you are usually referred into, including A and E, surgery and outpatient clinics. Tertiary care is highly specialised treatment delivered in regional or national centres, for example cancer care, neurosurgery, transplants and specialist children's hospitals.
What is the difference between an NHS trust and a foundation trust?
NHS trusts and NHS foundation trusts both run hospitals and community or mental health services and deliver direct patient care. Foundation trusts have greater autonomy: they have more financial and operational freedom and are accountable to local members and governors drawn from patients, staff and the public. Both are regulated by the Care Quality Commission for quality and safety.
How is the NHS funded?
The NHS in England is funded by the taxpayer, mainly through general taxation and National Insurance Contributions, with a small share from charges such as prescriptions. The NHS budget for England is well over £190 billion a year (2025/26). Funding flows from the Treasury to the DHSC, then to Integrated Care Boards, and on to the trusts and providers that deliver care.
Which bodies regulate the NHS?
The Care Quality Commission (CQC) is the independent regulator of quality and safety, inspecting and rating hospitals, GP practices, care homes and more as Outstanding, Good, Requires Improvement or Inadequate. NICE provides evidence-based guidance on treatments and cost-effectiveness, and professional regulators such as the GMC (doctors) and NMC (nurses) oversee individual practitioners' registration and standards.
What does NICE do?
The National Institute for Health and Care Excellence (NICE) produces evidence-based guidance on treatments, medicines and care. It appraises new drugs for clinical and cost-effectiveness, often using Quality Adjusted Life Years (QALYs), to advise whether the NHS should fund them. Its aim is to standardise high-quality care across the NHS and ensure limited resources deliver the most benefit for patients.
What happened to Public Health England, HEE and NHS Digital?
All three no longer exist as standalone bodies. Public Health England was abolished in 2021 and its work split between the UK Health Security Agency (UKHSA) and the Office for Health Improvement and Disparities (OHID). NHS Digital merged into NHS England in February 2023, and Health Education England merged into NHS England in April 2023. With NHS England now being abolished, these functions are moving into the DHSC.
What is the NHS 10-Year Health Plan and what are the three shifts?
The 10-Year Health Plan for England, published on 3 July 2025, sets out the government's strategy for the NHS. It is built around three shifts: hospital to community (more care closer to home via neighbourhood health centres), analogue to digital (a stronger NHS App and a single patient record), and sickness to prevention (tackling causes of ill health before people get sick). It is a key topic for medicine interviews.
Do Scotland, Wales and Northern Ireland have the same NHS structure?
No. Health is devolved, so Scotland, Wales and Northern Ireland run their own NHS systems with different structures. NHS Scotland uses regional health boards, NHS Wales uses local health boards, and Northern Ireland integrates health and social care through trusts. Integrated Care Boards, NHS England and the 10-Year Health Plan apply to England only, so it is worth being precise about this at interview.
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