The structure of the NHS isn't an easy topic to digest and is so broad you could even write a book about it (in fact, there are a few). Luckily, the interviewers don't expect you to know the details thoroughly but may ask you for a rough structure overview.

Here are some of the most important facts:

📝 NHS Structure: Health and Social Care Act:

Significant structural change happened in 2012 with the introduction of the Health and Social Care Act. Consequently, the NHS is currently governed by several major sub organisations:

The Department of Health: governmental body, which determines how much funding the NHS receives and comes up with policies regarding the structure of healthcare in the UK.

NHS England: an institution independent from the government, which oversees healthcare by organising the planning and buying (commissioning) of NHS Services, together with 135 Clinical Commissioning Groups (CCGs), which work on a more local level. Commissioning by CCGs is based on the needs of local areas. Hence, NHS England is a body right above the CCGs.

Clinical Commissioning Groups (CCGs): As the name suggests, CCGs are involved in the commissioning (planning, buying and monitoring) of healthcare services in the local area, in response to the needs of the population. This includes the commissioning of: “most planned hospital, rehabilitation, emergency care, community health services and mental health.” Each CCG is composed of GPs, who lead them, as well as other healthcare professionals, including nurses.

NHS Trusts: This term includes hospitals, ambulances, primary care services, charities and all other organisations and institutions, which provide care to NHS patients. They are commissioned by CCGs.

🏥 Structure of the NHS: Levels of Care

In the NHS, care is provided at different levels. The higher the level, the higher the complexity of cases or responsibilities of doctors. The NHS is divided into primary, secondary and tertiary care.

Primary Care is the first point of contact for most patients and includes Accident and Emergency Departments (A&E) and GP practices. Patients have to go through the primary care sector to be referred to higher levels.

Secondary Care: Specialists (such as cardiologists or endocrinologists) can provide secondary care in hospitals.

Tertiary Care: Tertiary level of care usually refers to specialists with a subspecialty/special interest in a less common field, such as neurosurgery or regional centres for rare diseases.

🌎 NHS Structure: Devolved NHS

Another important part of the structure of the NHS is the fact that the NHS is devolved. This means that each country, which constitutes the United Kingdom, is responsible for running its own healthcare system. Hence, the NHS is made of 4 semi-independent (they are all dependent on the UK Parliament, which allocates funding, yet it's up to each system to decide how to spend this money) healthcare systems: NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland.

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✅ Talking About the Structure of the NHS: Top Tips

💯 Quantity Over Quality: This is where you get to show off how much you know, so it's better to say more, but in less depth. Obviously, you won't be able to include all the important pieces of information in your answer. We would recommend trying to show you have a comprehensive understanding and prompt the interviewers to ask you follow-up questions.

🧠 Memorising A Few Bits Of Information Is Not Enough: You have to wrap your head around the topic to comprehend it and be prepared for similar or follow-up questions. We have gathered several insightful resources below in the Resources section which may help you understand the basics.

❌ Talking About the Structure of the NHS: Common Mistakes

🔍 Doing No Research: We know that the system is somewhat complicated, but try to at least understand the basics - this will not only help you answer questions about the NHS structure but is also important background knowledge for questions about challenges to the NHS or roles of different healthcare professionals.

🚧 Structuring Your Answer:

• Points: We would recommend you to talk about several aspects of the structure of the NHS.
  • We would recommend starting by explaining the levels of care. This is the simplest aspect to wrap your head around and will show the interviewers that you understand the basics.
  • Then move on to discussing the funding of the NHS, where the money comes from and who decides how it should be distributed. Here, describe the NHS bodies and their responsibilities.
  • If you are applying to a medical school outside of England, you can throw in a few interesting facts regarding the structural differences between NHS England and the NHS of that country.
• Introduction and Conclusion: Provide a sentence of introduction. You can mention how you learned about the complexities of the NHS (your own experience of healthcare, YouTube videos, articles etc.). By the end summarise your main points to signal to the interviewer(s) that you have finished answering their question.

🌸 Similar Interview Questions To Think About:

• What do you know about the NHS?
• How is the NHS funded?
• If you could change one thing about the NHS, what would that be?

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📚 NHS Structure: Useful Resources

If you’d like to wrap your head around the topic to better understand it, here are some excellent resources that explain how the structure of the NHS:

"How does the NHS in England work? An alternative guide" - explanatory video by the King's Fund about how the NHS works,

"The NHS explained in eight charts" - overview article by Prof. Maria Goddard