Is there one NHS?
Not exactly. The NHS was founded in 1948 on the principle that care should be based on clinical need, not ability to pay, and most care is free at the point of use and funded through general taxation. Health is devolved, so England, Scotland, Wales and Northern Ireland each run their own health service with their own structures, policies and sometimes their own staff contracts.
What stays the same across the UK is professional regulation. The GMC, NMC and HCPC cover the whole UK, and the GPhC covers Great Britain (Northern Ireland has its own pharmacy regulator). When you read guidance, check which nation it applies to.
How is the NHS in England organised?
Think in three layers: national government sets policy and money, local systems plan care for a population, and front-line organisations deliver it.
| Layer | Organisation | What it does |
|---|---|---|
| National | Department of Health and Social Care (DHSC) | Government department for health and care policy and the NHS budget, led by the Secretary of State |
| National | NHS England | Has overseen commissioning, performance and national programmes; being abolished, with functions moving to DHSC |
| Local system | Integrated care boards (ICBs) | Statutory bodies created by the Health and Care Act 2022; hold most of the local NHS budget and plan and commission services. Many have merged since 2025 |
| Local system | Integrated care systems and partnerships | Partnerships of the NHS, local authorities and others planning health and care for an area; the Health Bill proposes changes to some of these arrangements |
| Delivery | NHS trusts and foundation trusts | Run hospitals, mental health, community and ambulance services |
| Delivery | GP practices, pharmacies, dentists, optometrists | Mostly independent contractors providing NHS services under national contracts |
| Delivery | Local authorities | Adult social care and public health |
Bilal, 67, needs a hip replacement. His GP practice, an independent contractor, refers him to orthopaedics. The ICB for his area commissions the service from his local acute trust, or another provider he chooses, sometimes in the independent sector. The provider is paid from the ICB's budget, which comes from national NHS funding. After surgery, a community physiotherapy service, also commissioned by the ICB, supports his rehabilitation at home.
What is the difference between a trust and a foundation trust?
Trusts are the NHS bodies that employ most hospital and community staff. They come in several types, and some combine more than one role.
- Acute trusts run hospitals: emergency care, surgery, inpatient medicine, maternity and outpatients.
- Mental health trusts provide inpatient and community mental health care, and some learning disability services.
- Community trusts provide district nursing, community rehabilitation and community hospitals.
- Ambulance trusts run 999 services and often NHS 111.
Foundation trusts have had more financial and operational independence than other trusts. The Health Bill proposes wider powers for the Secretary of State over foundation trusts, so this distinction may change. Each trust has a board with a chair, chief executive, medical director, chief nurse and finance director. Below the board, services are grouped into divisions or care groups such as medicine, surgery or women's and children's services, each with clinical and managerial leads. Knowing this helps you understand who decides things about your department.
How do Scotland, Wales and Northern Ireland differ?
The devolved nations generally have more integrated systems, where one body both plans and delivers care for an area.
| Nation | Main structure | Notes |
|---|---|---|
| Scotland | NHS Scotland; territorial health boards plan and deliver care, with national boards such as the Scottish Ambulance Service | Health and social care partnerships integrate services locally |
| Wales | NHS Wales; local health boards plan and deliver care, plus trusts such as the Welsh Ambulance Service and Velindre | Health Education and Improvement Wales leads education |
| Northern Ireland | Health and Social Care (HSC); trusts deliver both health and social care | Health and social care have long been integrated |
Contracts, pay scales, prescription charges and organisation names differ. Prescriptions are free in Scotland, Wales and Northern Ireland, while most adults in England pay a charge unless exempt.
What are primary, secondary, tertiary and community care?
| Level | What it means | Examples |
|---|---|---|
| Primary care | First point of contact in the community | GP practices, community pharmacies, dentists, optometrists, NHS 111 |
| Secondary care | Specialist care after referral or in an emergency | Emergency departments, hospital wards, outpatient clinics |
| Tertiary care | Highly specialised regional services | Neurosurgery, cardiothoracic surgery, specialist cancer centres, transplant |
| Community care | Care at home or in local settings | District nursing, community physiotherapy, community mental health teams |
GPs act as gatekeepers: patients usually need a GP referral to see a specialist, except in emergencies or for some services such as sexual health. The GP holds the long-term record. Practices increasingly work in primary care networks that share staff such as clinical pharmacists, social prescribers and first contact physiotherapists.
Errors cluster at the boundaries. A vague referral delays diagnosis, and a poor discharge summary can cause medication errors or missed follow-up. Every referral should say who the patient is, why you are referring, what has been done, what question you want answered and how urgent it is.
Referral to physio: Please see. Fall.
Referral to physiotherapy: Mrs J, 86, bed 14. Admitted three days ago after a fall at home, no fracture. Medically fit for discharge. Lives alone in a first-floor flat with stairs; previously walked with a stick. Now unsteady on turning, needs one person to the toilet. Question: is she safe to go home, and what equipment or support would she need? Discharge planned within 48 hours if safe. Contact: Olumide, staff nurse, ext 4321.
How do urgent care, mental health and social care fit in?
- NHS 111 (phone and online) for urgent but non-emergency problems at any time; NHS 24 on 111 in Scotland and NHS 111 Wales.
- Urgent treatment centres and minor injury units for injuries and illnesses that are not life-threatening.
- Emergency departments and 999 for serious and life-threatening emergencies.
- Community pharmacies for advice and, in England, some prescription-only treatments for specific common conditions under national schemes.
- Out-of-hours GP services, usually reached through NHS 111.
Mental health care runs from primary care and NHS Talking Therapies in England, through community mental health and crisis teams, to liaison psychiatry in acute hospitals and inpatient units. In England and Wales, detention is governed by the Mental Health Act 1983 as amended; the Mental Health Act 2025 is being brought into force in phases, so check which provisions apply where you work. In an acute hospital, learn how to reach liaison psychiatry in your first week.
Social care (home carers, care homes, day centres) is arranged by local authorities in England and is not part of the NHS. It is usually means-tested. Some people with a primary health need receive NHS continuing healthcare instead. Waiting for social care is a common reason medically fit patients stay in hospital.
Who regulates and inspects healthcare in the UK?
| Organisation | Role |
|---|---|
| GMC | Regulates doctors, physician associates and anaesthesia associates across the UK |
| NMC | Regulates nurses, midwives and, in England, nursing associates |
| HCPC | Regulates allied health professions such as physiotherapists, paramedics, OTs, radiographers and dietitians |
| GPhC | Regulates pharmacists, pharmacy technicians and pharmacies in Great Britain |
| CQC | Inspects and rates health and social care services in England; other nations have their own inspectorates |
| NICE | Publishes clinical guidelines and technology appraisals, mainly for England |
| MHRA | Regulates medicines and devices UK-wide and runs the Yellow Card scheme |
| UKHSA | Health protection and infectious disease in England |
Regulators protect the public. Royal colleges set curricula and standards in their fields, and trade unions such as the BMA, RCN, Unison and the CSP represent members on pay and conditions. These are different jobs.
Who does what on the ward?
| Role | Main responsibilities |
|---|---|
| Consultant | Overall responsibility for patients; leads ward rounds and supervises doctors |
| Registrar or specialty doctor | Leads day-to-day medical decisions; SAS doctors are senior doctors outside training programmes |
| Foundation and core doctors | Assessments, prescribing, documentation and procedures under supervision |
| Physician associates | GMC-regulated, working under a named senior doctor within a defined scope; following the 2025 Leng review, titles and scope are changing, so check local policy |
| Registered nurse and nurse in charge | Assess, plan and deliver care; the nurse in charge leads the shift and is a key escalation point |
| Advanced clinical practitioner | Experienced nurses, paramedics, pharmacists or AHPs assessing, diagnosing and often prescribing |
| Nursing associate and healthcare assistant | Nursing associates are NMC-registered in England; HCAs support personal care and observations |
| Pharmacist and pharmacy technician | Medicines reconciliation, dose and interaction advice, safe discharge |
| Therapists and dietitians | Mobility, function, swallowing, communication and nutrition; key to discharge planning |
| Social worker and discharge coordinator | Care packages, placements and discharge arrangements |
Olumide, an internationally educated nurse, is in his first month on an older people's ward. The ward round entry for Mrs J, 86, says 'medically fit, home today', but he knows she is unsteady and struggling with her tablets. He asks physiotherapy and occupational therapy to assess her, the pharmacist to review her medicines and consider a compliance aid, and the discharge coordinator about a care package, and tells the doctor the plan. She goes home two days later with a frame, carers twice daily and simpler medicines, and is not readmitted.
Learning more
This guide is educational and describes the structure as of October 2026. To work through the system, the levels of care and team roles in more depth, with patient journeys and a reflective exercise for your CPD record, see the How the NHS Works: Structure and Roles course. Your First NHS Job: Induction and Expectations and Your First Week on the Ward cover the practical side of starting.
Frequently asked questions
What is an ICB in the NHS?
An integrated care board is a statutory NHS body created in England by the Health and Care Act 2022. It holds most of the NHS budget for its area, plans and commissions services from trusts, GP practices and other providers, and works with local authorities. Many ICBs have merged since 2025 to cut running costs, so check which one covers your area.
Is NHS England being abolished?
Yes. The Government announced in March 2025 that NHS England would be abolished and its functions moved into the Department of Health and Social Care. A Health Bill to do this was introduced in May 2026 and was still passing through Parliament in October 2026. Check DHSC for the latest position.
What is the difference between an NHS trust and a foundation trust?
Both provide NHS services such as hospitals, mental health, community and ambulance care. Foundation trusts were given more financial and operational freedom, with their own governance. The Health Bill proposes giving the Secretary of State more powers over foundation trusts, so the difference may narrow. For staff, day-to-day work is very similar.
What is the difference between primary and secondary care?
Primary care is the first point of contact in the community, such as GP practices, pharmacies, dentists and optometrists. Secondary care is specialist care, usually in hospital, reached by referral or in an emergency. Tertiary care is highly specialised regional care, and community care is delivered at home or locally.
Is the NHS the same in Scotland, Wales and Northern Ireland?
No. Each nation runs its own health service. Scotland and Wales use health boards that both plan and deliver care, and Northern Ireland has integrated health and social care trusts. Pay, contracts, prescription charges and some guidance differ. Professional regulators such as the GMC, NMC and HCPC cover the whole UK.
Is social care part of the NHS?
No. In England, social care such as home carers and care home places is arranged by local authorities and is usually means-tested. NHS continuing healthcare is a separate, NHS-funded package for people with a primary health need. The distinction matters for discharge planning and is a common reason for delays.
Who inspects NHS hospitals?
In England, the Care Quality Commission inspects and rates health and social care services. Scotland, Wales and Northern Ireland have their own inspectorates. Inspection of services is separate from regulation of individual professionals, which is done by bodies such as the GMC, NMC, HCPC and GPhC.
Related courses
How the NHS Works: Structure and Roles
This course explains how the NHS is organised, how primary, secondary and community care fit together, and who does what in the teams you will join.…
Your First NHS Job: Induction and Expectations
This course is a practical guide to your first weeks in an NHS job, written for newly qualified staff and for professionals who trained outside the…
Your First Week on the Ward
This course is a practical survival guide for doctors and nurses starting on a UK hospital ward. It explains how ward rounds, jobs lists, bleeps and…
Sources and further reading
- Health and Care Act 2022. UK Parliament.
- Health Bill 2026. UK Parliament.
- The NHS Constitution for England. Department of Health and Social Care.
- What's in the new Health Bill?. Nuffield Trust.
- How the NHS works: explainers. The King's Fund.
- Welcome to UK practice. General Medical Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
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