The Structure of NHS and the Health and Social Care Act (2012) by a Medical School Applicant

Clarence Chen

The Structure before 2012

As one of the biggest and most famous national health service systems in the world. NHS is well known by its structural comprehensiveness and perfection. As the source of funding, UK parliament acts as the foundation of the whole system and providing financial support to the Department of Health (DH), which provides strategic leadership to its subordinate institutions including Strategic Health Authorities (SHA), Monitors and Care Quality Commission (CQC). Strategic Health Authorities execute the fiscal politics determined by DH and also have commissioning responsibilities among the Primary Care Trusts (PCH), which directly provides primary care services to British citizens.

Historically, NHS has never experienced any fundamental structural reforms until 2012 since it was launched in 1948. However, along with the rapid increase of population and transformation of social environment, a decisive revolution became unavoidable to ensure the quality and timeliness of health services in this new and more complex circumstance and to sort out the problems that had come out.

On 12th July 2010, the white paper, “Equality and Excellence: Liberating the NHS” was published, which formally began this “biggest revolution in the NHS since its foundation” called by the Daily Telegram – The Health and Social Care Act (2012)

A Historical Revolution

The Health and Social Care Act brought an extensive reorganisation to the structure of NHS. The Strategic Health Authorities (SHA) and NHS Primary Care Trusts (PCT) were abolished and replaced by Clinical Commissioning Groups (CCG) led by GPs and NHS England, which acts as the commissioner of primary care services. This reform allowed CCGs to commission the majority of NHS services and gave GPs the power to influence commissioning decisions for their patients. There is no doubt that this move effectively strengthened the professionalism of the management decisions in the primary care services and  also gave the primary clinicians more rights to determine the specific arrangement and enforcement of the primary services.

Moreover, the abolition of Primary Care Trusts (PCT) also successfully reduced the administrative costs over the whole system, and to an extent, relieved the financial pressure of the UK parliament on the operation of NHS.


In general, the Health and Social Care Act 2012 effectively improved the professionalism of the service management and reduced the government intervention. Meanwhile, it offered health workers more power and gave patients more rights and initiative on choosing health services.

However, such a thorough reform also led to the difficulties on governance and administration of the system. The absence of leadership and the lack of systematic integrity also became a potential problem that might arise in the future.

Hence, although the Health and Social Care Act (2012) successfully achieved its primary objectives, it still needs to stand the test of time to prove that it is suitable, effective and stable in long-term running

The following paragraph is about how this article is written based on the writer’s personal experience

How the information is collected

The vast majority of my knowledge about the structure of NHS are learnt from internet through a range of different sources (including both authoritative and official materials, and some less professional websites). Before starting to write this article, I spent around 2 hours on primary collection of information about the structure of NHS and the Health and Social Care Act (2012) from various websites including the official website of NHS Choices, which provides lots of useful and reliable information.

How the information is filtered

The reliability of the information collected are carefully considered in order to ensure the accuracy and objectivity of this particle as high as possible. The information from authoritative sources, for instance NHS Choices, BBC, The House of Commons Library, etc., are preferentially accepted, while the information collected from other sources are further filtered based on following principles:

  1. All personal and subjective comments are ignored, because they are reckoned as not reliable
  2. The same information that present in various of different sources is taken
  3. The information which is agreed (or not mentioned) by all (or most of) sources are regarded as reliable.

How are the information analysed

The most of analyses in this article are done by myself, but some opinions from authoritative sources are also taken as reference. The analyses on the changes between the old and new structures includes both analyses on macroscopic and microscopic levels. However, considering the generality of this topic, most of analyses concentrate on the macroscopic changes brought by the reform.

What are the difficulties of learning this topic

The biggest difficulty is the complexity of the NHS structure. A large number of different organisation and institution involve in the NHS system and playing different roles. A diagram might be quite useful to understand the relationship between these organisations, but lots of researches are still required to fully understand the details about the structure of NHS and the specific roles the different organisations play in the complete system.

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