How is the NHS structured?

The size and scale of the NHS means that for many people the structure of the organisation can seem confusing.

To help, the internationally renowned think-tank The Kings Fund have made a series of diagrams explaining how the NHS in England is now structured, including how providers are regulated, who can influence the commissioning of services and how the money flows.

How providers are regulated and commissioned


Who can influence commissioning of services


  • It’s worth noting that Brent Healthwatch also attends Brent CCG’s Governing Body meetings.
  • Shared services operate in-house within North West London CCGs, rather than through a Commissioning support unit (CSU).
  • In 2016/17 a total of 114 CCGs will have assumed full responsibility for the commissioning of primary medical care services under delegated commissioning arrangements. Nearly all CCGs are expected to have taken on delegated arrangements by 2017/18.

How the money flows


  • Brent CCG’s allocated budget in 2016/17 is approximately £410m.