What is the NHS (National Health Service)?
In this article we will describe what is the NHS, its structure and how to access it, and its pros and cons.
So. What is the NHS?
The National Health Service – or NHS for short – is the UK’s tax-payer funded socialised healthcare system.
It aims to provide the same quality of care to everyone for ‘free’ – regardless of income. This is a worthy ambition.
The NHS was launched in 1948 following the National Health Service Act (1946) – in the wake of the Second World War – and is close to the hearts of most British people.
Note. Oddly, healthcare for people with Sexually Transmitted Disease (STD), or those in prison or the Armed Services, are outside the main structure of the NHS. This is largely historical.
Accessing NHS Services
NHS Number
All UK citizens have a 10-digit NHS number, like 485 777 3456. This is given to you at birth, and it’s quite important to know it.
Primary care (GP)
In the NHS system, the first point of contact for healthcare is a general practitioner (GP), or ‘family doctor’.
You need to have an appointment. You cannot just turn up.
Your GP will then assess your condition and may refer you to a hospital specialist (called a ‘consultant’) if needed.
Secondary care (hospital)
All hospitals in England are run by NHS ‘trusts’. This is healthcare provider set up to deliver hospital (and sometimes) community services. There are 219 trusts in the UK, some running several hospitals.
‘Mental health trusts’ tend to be separate from ‘hospital trusts’.
After GP referral, you will then be seen by a specialist doctor at the hospital, to help make a diagnosis and/or start treatment. About 1 in 20 people who consult a GP, are referred to hospital.
In the UK, you cannot refer yourself directly to a hospital specialist. In this way, your GP is the ‘gatekeeper’ of the NHS.
Urgent care
For urgent medical issues, you can also call NHS 111 to speak to an advisor. They will assess your symptoms and tell you what to do next.
This may involve going to an Accident and Emergency (A&E) Department at a nearly hospital. They are open 24 hours a day, every day. You should avoid A&E unless you are very unwell.
But. There are also health centres called Urgent Treatment Centres (UTCs) and Minor Injury/Illness Units (MIUs) where you can see a doctor without an appointment. They are usually open 8am-8pm, 7 days a week.
So they are a good choice out of hours, at the weekend or on a bank holiday (or for visitors to the UK).
Free at the point of delivery (use)
People often refer to these health services as ‘free at the point of delivery (use)’.
This means that any UK resident can, for example, go and see a doctor who will offer diagnosis or treatment for an illness – without asking the individual to pay for this service during or after the visit.
Instead, most health care services are ‘publicly funded’, which means money has been allocated by government to pay for visits to the doctor (or other health professional). Most of the money is collected through UK citizens paying tax.
NHS Care for Visitors to the UK (and Costs)
The NHS provides very comprehensive care that is free of charge to UK citizens. However, many visitors have to pay a mandatory health surcharge of GBP £776-1035 per year to get the same access to the NHS as locals.
But some visitors from EEA countries and Switzerland may be exempt from paying for NHS treatment.
Short-term visitors who did not pay the health surcharge (and do not have medical insurance), will be charged at 150% the standard NHS tariff for any care received.
As a patient, you will get access to:
- GP consultations
- Treatment at A&E
- Maternity services
- Sexual health and contraception
- If referred by your GP, consultation and treatment by a hospital specialist.
However, you will generally have to pay for:
- Prescription drugs – fixed at GBP £9.90 per item, regardless of the type of medication or quantity
- Dental care
- Eye care.
Administration of the NHS
How the NHS works is complicated. These are some key facts.
The Department of Health and Social Care (DHSC) is a ministerial department of the UK’s Government. It is responsible for government policy on health and social care.
It does not really ‘run’ the NHS.
‘Above’ the trusts (in England) – in terms of policy and finance – are three levels of administration:
- NHS England – highest level, that runs the NHS in England
- NHS Regions (7) – middle level
- Integrated Care Boards (ICBs; 42) – roughly county-sized local level.
Healthcare is devolved in the UK. So Scotland, Wales and Northern Ireland have their NHSs. They largely follow the policies of DHSC but are not obliged to do so.
However. In March 2025, Wes Streeting MP (Health Secretary) announced the abolition of NHS England; with its powers passing to the DHSC (which he leads) over the next two years. ‘DHSC’ is a misnomer as it does not run social care. Its budget is already being reduced by the new CEO of NHS England, Sir Jim Mackey.
It is not clear what will happen to ICBs and Regions in the new administrative structure.
Are the NHSs of Scotland, Wales and Northern Ireland different?
Yes. Each of the ‘NHSs’ provide health care services free at the point of delivery.
But there are differences in what is fully funded by government and what services are available across the different UK countries.
For example, NHS England asks some people to pay part of the cost of prescriptions. Whereas, in Wales, Scotland, and Northern Ireland, these costs are paid for by the government.
Pros of NHS
Free comprehensive healthcare
Founded on the principle of everyone having equal access to healthcare, the best thing about the NHS is that it provides universal coverage. This is one of the NHS’s 7 core values.
From routine consultations to specialist operations and procedures, users of the NHS are generally not required to pay out of pocket.
They do, of course, pay for the NHS through their taxes.
Cons of NHS
Long waiting times
- The NHS is notorious for having very long wait times. It is rare to get a same-day GP appointment
- Even those in A&E have to wait hours at times (often over 4 hours). Also, significant numbers of patients when admitted, spend more than 12 hours on a hospital trolley in an A&E corridor
- Key targets for cancer, hospital care and A&E are also routinely missed. This has led to the NHS being in crisis, most of the time. Currently only 20% of the UK public are satisfied with the NHS.
Little freedom in making healthcare decisions
- Patients may feel like they have very little control over their health under the NHS
- This is because they can only see a hospital specialist (usually local) if referred to one by a GP
- There is also very little choice in choosing a specialist and there might be limited treatments on offer. Hence rationing is normal in the NHS.
Summary
We have a described what is the NHS, including its pros and cons. We hope it has been helpful.
Other resources
10 interesting facts about the NHS
Bonus interesting fact
Was the NHS the first socialised healthcare system?
No. The first modern social health insurance system was established in Germany in 1883 by Chancellor Otto von Bismarck through the Sickness Insurance Law. This law mandated employers to provide sickness and injury insurance for their low-wage workers, funded by contributions from both employees and employers.
Sweden (and other Scandanavian countries), France, Japan and New Zealand created different types of socialised universal healthcare pre World War 2.
How does the NHS work?
History of NHS Timeline
NHS regions and ICBs
Jammed NHS hospitals: 5 problems and solutions
What is the structure of the NHS?
