Skip to content

Reference guide to the NHS

An updated guide on the structure and function of the NHS, which reflects changes introduced by the Health and Social Care Act 2012.

What is this guide for?

The Health and Social Care Act 2012, which came into effect in April 2013, significantly changed the NHS landscape in England. New organisations were created, existing ones abolished and functions moved from one organisation to another. It remains a complex and evolving picture.

This guide sets out in brief the main elements of the changed structure and the funding, commissioning and accountability arrangements of the NHS in England and provides links to further information as required.

Who is it for?

Local voluntary and community organisations and patient and public representative groups have important strategic and commissioning relationships with local NHS bodies, many of which changed as a result of the reforms.

In order to maintain existing relationships and build new ones, it is important for these groups to have a good understanding of the NHS in all its forms and how it operates at a local, regional and national level.

The information in the guide is correct as at March 2015. The guide will be updated in response to any major changes and otherwise on an annual basis. As such, we cannot guarantee this is always up-to-date.

Get the full guide

You can read the guide in full (PDF, 641KB).

However, this is quite a long document so you may want to download individual sections, details of which are below.

Skip to relevant section

The key players of the NHS (PDF, 174KB)

This section outlines the main decision-making bodies involved in planning and delivering healthcare. This ranges from the people in government responsible for setting the priorities for the NHS down to the local organisations that plan and purchase care.


Objectives, plans and frameworks (PDF, 104KB)

In this section we outline the mechanisms used by the NHS and government to set national and local level objectives for care and to measure how well the health service is performing. These mechanisms also allow the public to see what the NHS should be achieving. There should usually be scope to involve the public in their development.


Funding and accountability (PDF, 117KB)

This section provides a brief overview of the funding and accountability mechanisms in the NHS. This includes information on where the funding for NHS care comes from and the process used to allocate it to services, and details on accountability relationships.


Commissioning responsibilities (PDF, 153KB)

Commissioning typically refers to the process of planning and buying health services, as well as ensuring that the quality of services is maintained. This section provides more detail on where commissioning responsibilities lie across different parts of the system.


Procurement, levers and incentives (PDF, 105KB)

This section highlights the main mechanisms through which NHS organisations may be contracted to supply services, and incentivised to transform local services and improve the quality of care and/or health outcomes.


Engagement, regulation and inspection (PDF, 104KB)

The NHS has a number of national and local organisations responsible for ensuring services are safe and effective. This section outlines who these organisations are as well as organisations that are responsible for engaging the public.

Other resources

Appendix A - Sources and further information (PDF, 124KB)

Appendix B - Table of local structures (PDF, 73KB)

Appendix C - Glossary of terms (PDF, 172KB)

Further information

For more information: Call Age UK 0800 169 8787

This page was last updated:

Was this helpful?