The NHS in the UK

Changes to the NHS April 2013

There are four publicly funded health systems in the UK, each operating independently and under different management rules:

  • NHS England
  • NHS Scotland
  • NHS Wales
  • Health and Social Care in Northern Ireland

NHS England
Under the changes to the NHS that came into effect in April 2013, the 10 Strategic Health Authorities1 and the 152 Primary Care Trusts2 were replaced by NHS England with more than 200+ Clinical Commissioning Groups (CCGs) and 27 Local Area Teams (LATs). The CCGs and LATs share the responsibilities of commissioning services for their local communities.

All GP practices now belong to a CCG which will commission most services on behalf of patients, including emergency care, community care, planned hospital care, and mental health and learning disability services in their local areas.

The 27 LATs across England have taken on direct commissioning responsibilities for GP services, dental services, pharmacy and certain aspects of optical services, while ten LATs will lead on specialised commissioning across England. A smaller number of LATs will carry out the direct commissioning of other services, such as military and prison health.

Scotland, Wales, and Northern Ireland run their local NHS services separately.

The following 3 visuals show how some of these reforms work in NHS England – who or what group is responsible for what, and how each area links.

The new NHS England, and how it is now structured April 2013

1. The new NHS England, and how it is now structured (as at April 2013)

The Cancer Care Pathway Key Stages following the NHS reforms

2. The Cancer Care Pathway Key Stages following the NHS reforms (as at April 2013)


Commissioning Groups, Clinical Networks, etc, following the NHS reforms

3. The New Regions, Commissioning Groups, Clinical Networks, etc, following the NHS reforms (as at April 2013)


Many thanks to The Teenage Cancer Trust for allowing the use of these charts.

1Strategic Health Authorities (SHAs) – were responsible for developing and improving health services in their local area, ensuring quality, measuring performance and making sure that national priorities were integrated into local plans.

2 Primary Care Trusts (PCTs) – looked after services at a local level.

For a list of all Clinical Commissioning Groups (CCGs) go to:

To find your local Clinical Commissioning Group (CCG) go to:

For further information on the NHS in England, go to:

NHS Scotland
In Scotland 14 geographically based NHS boards are responsible for both planning and delivering services and Scotland’s 32 local authorities provide social care.

Link to the official website of NHS Scotland (National Health Service for Scotland)

Scotland has three Cancer Networks:
For links to each of the national cancer network websites – for North of Scotland, South East Scotland and West of Scotland – visit:



The Scottish HepatoPancreatoBiliary Network (SHPBN)

The SHPBN’s aim is to ensure equity of care for all patients throughout Scotland with cancer of the liver, pancreas, gallbladder or biliary tree.   Also, to measure the quality of care and improve clinical outcomes for and quality of life of patients.

SHPBN’s Manager: Lindsay Campbell
First Floor, St Mungo Building, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF
Tel: 0141 232 1034 or 07951 273920

SHPBN’s Clinical Lead: Professor Steve Wigmore
Consultant Surgeon, Edinburgh Royal Infirmary

SHPBN’s website:

The Scottish referral guidelines have been updated for all cancers (August 2014), including a second update on HPB cancers, see:

Scottish Palliative Care

Palliative Care

NHS inform is the new national health information service for Scotland – a co-ordinated, single source of quality assured health and care information, which also provides generic information on bile duct, gallbladder, liver and pancreas cancers:

Scottish Palliative Care

Palliative Care


Palliative Care: The Scottish Palliative Care Guidelines, providing practical, evidence-based or best-practice guidance on a range of common clinical issues, are accessible by using this link:



NHS Wales

In Wales there are 7 local health boards, responsible for both hospital and community services.

Health and Social Care in Northern Ireland

There are five geographically based health and social care trusts in Northern Ireland, responsible for providing secondary, tertiary and social care while also managing the GPs’ contract for primary care.


November 2015