The healthcare ecosystem

The NHS in England is an ecosystem of care providers, each with a specific purpose or specialism. They can be grouped into four broad categories:

• primary care
• secondary care
• tertiary care
• community health

Primary care is usually a patient's first point of contact, and includes:

• general practice
• community pharmacy
• dentistry
• eyecare

Secondary care includes:

• planned or elective care - usually in a hospital
• urgent and emergency care, including 999 and 111 services, ambulance services, hospital emergency departments, and out-of-hours GP services
• mental health care

Tertiary care is highly specialist treatment, such as:

• neurosurgery
• transplants
• plastic surgery
• secure forensic mental health services

Community health services include:

• district nursing
• health visiting
• child health services
• sexual health services
• and many others

Care providers do not operate in isolation. Primary, secondary, tertiary and community care are intended to act as a single, integrated care system. Patients are passed from one provider to another as appropriate, for example when a GP refers a patient to a specialist in secondary care.

Ensuring continuity of care when a patient is transferred between providers is an important part of the overall patient experience.

Underpinning the above care providers are a number of supporting organisations, including:

• Integrated Care Systems (ICSs), which grew out of Sustainability and Transformation Partnerships (STPs) will replace Clinical Commissioning Groups (CCGs) in April 2022. ICSs will fund NHS care providers at a local level. This change is intended to bring together healthcare providers, commissioners and local authorities at a local level to improve the level of integrated care
• NHS Digital (NHSD) provides digital healthcare services at a national level
• the Department of Health (DoH) and NHS England (NHSE), who fund and oversee healthcare at a national level

To find out more about how these supporting organisations work, see How does the NHS in England work?.