Structure of the NHS

Overview

NHS services operate across England, Scotland, Wales and Northern Ireland; the organisational detail in the supplied evidence relates principally to England Adamou & Jones SL 2026Tomlinson et al. 2026.

England: national direction, local coordination and service delivery

• National level: the Department of Health and Social Care and NHS England shape national policy, standards and programmes, including information-sharing requirements across health and care organisations Tomlinson et al. 2026.
• System level: Integrated Care Systems (ICSs) are geographical partnerships coordinating health and care organisations to improve population health, reduce inequalities and integrate services Tomlinson et al. 2026.
• Commissioning: Integrated Care Boards (ICBs) commission services, specifying what providers should deliver and the associated quality and governance expectations Adamou & Jones SL 2026.
• Place and neighbourhood level: local partnerships and Primary Care Networks (PCNs) support collaboration closer to communities, with GP practices organised into networks Elston et al. 2026.
• Providers: care is delivered across GP practices, hospital trusts, community organisations, mental health services and ambulance trusts, rather than through a single provider organisation Tomlinson et al. 2026.

How services are organised clinically

• Primary care: first-contact services for most health needs, including general practice and dentistry Tomlinson et al. 2026.
• Secondary care: specialist assessment and treatment, usually following referral, including diagnostics and planned surgery Tomlinson et al. 2026.
• Tertiary care: highly specialised services for complex or rare conditions, such as transplantation and neurosurgery Tomlinson et al. 2026.
• Community and mental health care: services delivered at or near home, alongside specialist psychiatric and psychological services Tomlinson et al. 2026.
• Urgent and emergency care: ambulance services, emergency departments and NHS 111 form part of the wider care landscape Tomlinson et al. 2026.

For a primary-care paramedic: the relevant working interfaces are the GP practice and PCN, community and mental health teams, hospital services and ambulance providers, with ICS-level coordination intended to connect these organisations Elston et al. 2026Tomlinson et al. 2026.