What is the NHS and what does it do?

The National Health Service (NHS) is a complex and expansive healthcare system that has been providing quality care to the people of the United Kingdom since its establishment in 1948. With over 1 million patients being treated every 36 hours, the NHS has grown to become the largest publicly funded health service in the world. Its core principle is that good healthcare should be accessible to all, regardless of wealth. Health services in England are centrally funded by the Department of Health and Social Care, based on a set tariff per patient and type of treatment. Let us dive into what the NHS is and how it functions.

The birth of the NHS

The NHS was founded on the idea that healthcare should be available to everyone, regardless of their financial situation. It was a revolutionary concept that aimed to provide equal access to healthcare for all UK residents. Except for certain charges, such as prescriptions and dental services, the NHS remains free at the point of use.

The structure of the NHS in England

In England, the NHS is organized into various entities responsible for strategic healthcare planning and service provision. Clinical Commissioning Groups (CCGs) are responsible for the commissioning of secondary care services, while hospitals are run by NHS trusts or foundation trusts. Primary care services, such as general practitioner (GP) practices, are mostly commissioned by NHS England.

Funding of the NHS

The NHS itself is funded by taxpayer money through general taxation and National Insurance contributions. While the majority of healthcare services provided by the NHS are free at the point of use, there are some instances where patients may have to pay for certain treatments or services. For example, outpatient prescription drugs are subject to payment, and dental care services also require payment. However, there are safety nets in place to exempt certain groups, such as children, low-income individuals, and people with specific medical conditions, from these charges.

NHS supporting organisations

Underpinning the delivery of healthcare services in the NHS are various supporting organizations. These organizations play a crucial role in funding, overseeing, and providing essential services to the healthcare system. Some of these supporting organisations include:

• Integrated Care Systems (ICSs): ICSs, which have replaced Clinical Commissioning Groups (CCGs), fund NHS care providers at a local level. They aim to bring together healthcare providers, commissioners, and local authorities to improve the integration of care
• NHS Digital (NHSD): NHSD provides digital healthcare services at a national level. It supports the development and implementation of technology in healthcare, facilitating data collection, analysis, and information sharing to improve patient outcomes
• The Department of Health (DoH) and NHS England (NHSE): These organizations have national oversight and are responsible for the funding and strategic direction of healthcare services in England. They work together to ensure the delivery of high-quality care and promote the health and well-being of the population
• NHS England: Monitors the performance of the NHS nationally and supports local commissioning
• CCGs: Approximately 190 CCGs assess local health needs and commission services to meet them
• NHS acute or foundation trusts: Around 220 trusts run NHS hospitals and other services commissioned by CCGs
• Ambulance trusts: Respond to emergency calls, transport patients, and provide out-of-hours care
• Mental health trusts: Focus on providing mental health services
• Care trusts: Coordinate health and social care services for individual users
• Other local primary care services: Include walk-in centres, NHS 111 24-hour information and triage phone line, dental practices, pharmacies, and opticians

NHS Services

The NHS provides a comprehensive range of healthcare services to all residents of England. These services are aimed at promoting public health, preventing illnesses, and providing necessary medical treatments. Some of the key services provided by the NHS include:

• Visiting a Doctor or a Nurse at a GP practice: The NHS ensures that everyone has access to primary care services through general practitioners (GPs) and nurses. Patients can visit their local doctor’s surgery for diagnosis, treatment, and ongoing management of their health conditions
• Hospital Care: The NHS provides hospital care to individuals who are unwell or injured and require specialised medical attention. This includes inpatient care, outpatient consultations, surgical procedures, and emergency care
• Maternity Care: Pregnant women have access to midwifery services through the NHS. The NHS provides support and care throughout the entire pregnancy, including prenatal check-ups, delivery, and postnatal care
• Emergency Care: The NHS operates ambulance services that provide urgent help to individuals with serious or life-threatening injuries or health problems. These services ensure that individuals receive timely medical attention and are transported to the appropriate healthcare facilities, such as hospitals
• Preventive Services: The NHS offers a range of preventive services to promote public health and early detection of illnesses. This includes screenings, immunisations, and vaccination programs aimed at preventing diseases and reducing the burden on healthcare services
• Mental Health Care: Mental health services are an integral part of the NHS. The NHS provides support and treatment for individuals with mental health problems, ranging from mild depressive and anxiety disorders to more severe illnesses. This includes access to counselling, therapy, and psychiatric care
• Dental Care: The NHS offers clinically necessary dental care services to patients. This includes routine check-ups, fillings, extractions, and other necessary dental treatments by a dentist. Charges may apply for certain dental services
• Eye Care: The NHS provides some eye care services, including vision tests, to ensure the overall health of individuals’ eyes. Certain groups, such as young people, those over 60, and people with low incomes, may be eligible for free eye care services
• Rehabilitation Services: The NHS offers rehabilitation services, including physiotherapy, to individuals recovering from injuries or illnesses. These services aim to improve mobility, function, and overall well-being
• Palliative Care: The NHS provides palliative care services to individuals with life-limiting illnesses. This includes pain management, symptom relief, and emotional support to improve the quality of life for patients and their families
• Long-Term Care: The NHS supports individuals who require long-term care, such as those with chronic illnesses or disabilities. This includes access to community-based services, residential care, and support for independent living
• Medical Devices and Assistive Devices: The NHS provides necessary medical devices, such as wheelchairs and hearing aids, to individuals assessed as needing them. This ensures that individuals have access to assistive devices that improve their quality of life

Primary care

Primary care serves as the initial point of contact for patients seeking medical assistance. It encompasses various healthcare services, including general practice, community pharmacy, dentistry, and eye care. General practice, also known as primary care physicians or family doctors, play a crucial role in managing patients’ overall health. They provide comprehensive healthcare services, including preventive care, diagnosis, treatment, and referrals to specialized care when necessary. Community pharmacies play an essential role in dispensing medications, providing health advice, and supporting public health initiatives. Dentistry and eyecare services are also part of primary care, focusing on oral and visual health respectively.

Secondary care

Secondary care refers to the specialized medical care provided by hospitals and other healthcare facilities. It includes planned or elective care, such as surgeries and specialized treatments, as well as urgent and emergency care services. In the event of serious or life-threatening injuries or health problems, individuals can seek help from healthcare professionals in the ambulance services, hospital emergency departments, and out-of-hours GP services. Mental health care is also an integral part of secondary care, addressing the mental well-being of patients and providing specialized treatments.

Tertiary care

Tertiary care involves highly specialised and complex treatments, often provided in referral centres or specialist hospitals. Neurosurgery, transplants, plastic surgery, and secure forensic mental health services are examples of tertiary care. These services require specialised expertise, advanced technologies, and resources that are not available at the primary or secondary care level. Tertiary care providers work closely with primary and secondary care to ensure a seamless transfer of patients between different levels of care.

Community health

Community health services focus on promoting health and well-being within the community. These services may include health education, disease prevention and control, immunisation programs, and support for vulnerable populations. Community health teams often work closely with primary care providers to address the social determinants of health and improve the overall health outcomes of the population.

Integrated care

The NHS emphasises the importance of integrated care, where different care providers collaborate to ensure a coordinated and seamless experience for patients. Integrated care aims to break down the silos between primary, secondary, tertiary, and community care, allowing for better communication, care coordination, and continuity of care. The establishment of Integrated Care Systems (ICSs) within the NHS is part of this effort, bringing together healthcare providers, commissioners, and local authorities to improve the level of integrated care at a local level.

The Workforce of the NHS

The NHS boasts a large and diverse workforce, with approximately 112,000 doctors and 311,000 nurses. In total, there are around 1,093,000 individuals employed by the NHS. It is worth noting that around one in eight NHS staff members are from abroad, highlighting the global nature of the workforce.

The NHS in Scotland, Wales, and Northern Ireland

While this article primarily focuses on the NHS in England, it is important to acknowledge the healthcare systems in Scotland, Wales, and Northern Ireland. Each country has its unique structure and organisation within the broader NHS framework.

In Scotland, NHS Scotland employs around 160,000 staff across 14 territorial and seven special NHS boards. Unlike in England, there is no internal market in Scotland, and the NHS boards are responsible for both planning and delivering services.

NHS Wales, on the other hand, employs around 80,000 individuals across seven health boards and three all-Wales trusts. The majority of patient contacts in Wales occur outside of hospitals, with primary care playing a significant role in delivering healthcare services.

In Northern Ireland, the NHS employs around 62,603 staff members who work across six health and social care trusts. The healthcare system in Northern Ireland is distinct from that of England, Scotland, and Wales, with health and social care being integrated in theory.

Recent changes and future challenges

The NHS has undergone significant changes in recent years to better meet the evolving healthcare needs of the population. Integration of health and social care has been a key focus, driven by the increasing demand for healthcare services and an ageing population with complex health needs. The aim is to provide seamless and coordinated care for individuals.

The Health and Care Act of 2022 has introduced new structures and powers that enable organisations within the NHS to work more collaboratively. Integrated care systems (ICSs) have been established across England, bringing together various health and care organizations to plan and deliver joined-up services.

Funding for the NHS comes from various sources, including taxation, National Insurance contributions, prescription charges, and local income generated through activities such as car parking charges and the provision of private services.

While these changes aim to enhance the effectiveness and efficiency of the NHS, the healthcare system still faces challenges. Workforce shortages, growing waiting lists, and the impact of the COVID-19 pandemic continue to put strain on the NHS. However, the hope is that by fostering closer collaboration and integration, the NHS will be better equipped to meet the changing needs of the population in the future.

For more information on the structure and functioning of the NHS, visit the NHS website and The King’s Fund.

Sources

• How the NHS works – Toolkit for doctors new to the UK – BMA
• NHS England » Structure of the NHS
• How does the NHS in England work and how is it changing? – The King’s Fund
• NHS England – An introduction to the NHS
• England | International Health Care System Profiles – Commonwealth Fund
• What is the NHS? – Full Fact