Could someone explain the structure of the NHS for me please?

[wendywednesday]

Or guide me to a website that explains it? I've realised I've completely misunderstood!

I thought the NHS was, well, the NHS, but it seems it's lots of different organisations that operate under a NHS banner?

So a GP practice is NHS but it can also be partner owned, and they can refer you to other places - do they choose where to refer you? Do they have contracts to refer patients to certain places? How does it work?

And there are CCG's and PCT's and I just have no idea what fits where!

Anyone care to enlighten me?

Google?

Ccgs commission services which nhs trusts and private companies can bid to run. Contracts are reviewed every 7 years or more frequently meaning you have to keep promising to run it for cheaper and cheaper while also proving your effectiveness and promising more.

Best resource is www.kingsfund.org.uk/audio-video/how-is-nhs-structured-funding-flow
They have a few videos and diagrams but it is very complicated.

Second the Kings Fund link - it's a really good resource

Thank you!

Also worth remembering that providing nhs services does not make you an nhs body (e.g.GPs are private organisations who make profits for their owners, but provide nhs services, but also have some of their supporting services like IT provided and paid for by NHSE). No wonder you’re confused, it confuses even those of us involved in it!

I work at a relatively senior post in an NHS Trust and it confuses me sometimes so good luck

Happy to start
GPs - they are contracted by the NHS (CCGs - see below) to provide services. They receive payment for each patient registered at their practice + for specific services they undertake that is over an above standard + for meeting targets around health promotion & monitoring.
GP practices are in effect private companies - some owned by the GPs who work their (the partners), others are run by companies who tend to run a number of practices and employ salaried Drs
CCGs - Clinical Commissioning Groups - over time CCGs have changed, now rather than @ 110 - 130 CCGs across the county, each managing the health provision for their local area (population varied between 200 - 400,000 patients), many have merged over past 1 - 2 years into much larger organizations managing (commissioning) health services for +1 - 1.5 million people
CCGs negotiate contracts with organizations (Hospitals (acute services), Mental Health Trusts, Community services providers and voluntary organizations,
CCGs monitor the quality of services that patients receive (as set out in the contract) , support staff education and development and manage payments (to GPs for additional services as well as for acute Trust, Mental Health Trusts, Community Services from whom they commission services for their population,
Local Authorities (councils) involved as they commission (pay for, monitor quality & decide what the service should look like) services - these include Sexual Health Services & School Nurses

Add to that Integrated Care Systems ICSs and Provider networks, central bodies (NHS E/I ,NHS Digital etc) and rather a lot of people involved on top of the Drs, Nurses and Allied Health Professionals who provide direct patient care.

There are many layers of managers. No one knows what they do.

@Egghead68

There are many layers of managers. No one knows what they do.

When a manager gets the hang of what they're doing, and becomes genuinely useful, it is compulsory that they are moved to another department, where they don't know anything about the system.

I think of it more as a confederation of corner shops than a series of branches of Tesco....