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English Health Geography

New health structure as at 1st April 2013

New health structure as at 1st April 2013

On 1 April 2013, a new structure of health geographies in England came into force. The new structure consists of clinical commissioning groups (CCG), NHS area teams (NHSAT) and NHS commissioning regions (NHSCR).

  • There are four NHSCRs in England.

  • There are 25 NHSATs in England. The NHSATs are responsible for GP and dental services, pharmacy services and certain aspects of optical services. Ten of the teams lead on specialised commissioning across England and a smaller number of NHSATs carry out the direct commissioning of prison and military health.

  • The 211 CCGs are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. They are clinically led groups that include all of the general practice groups in their geographical area. The aim of this is to give GPs and other clinicians the power to influence commissioning decisions for their patients. CCGs are overseen by NHS England (including its regional offices and area teams). These structures manage primary care commissioning, including holding the NHS contracts for GP practices. CCGs have boundaries that are coterminous with those of lower layer super output areas (LSOA).

This new structure has replaced the strategic health authorities (SHA) and primary care organisations (PCO) that had been in operation since July 2006.

July 2006 to March 2013

Current Health Administration

Health administration in England was significantly restructured in 2006.

On 1 July 2006 the number of SHAs was reduced from 28 to 10.

The boundaries of the new SHAs were coterminous with regions (former government office regions (GOR)), with the exception of the South East GOR, which comprises two SHAs (which were constituted from groups of local authority districts (LAD)).

SHAs reported to the Department of Health.

On 1 October 2006 the number of PCOs was reduced from 303 to 152.

The PCOs were made up of 148 primary care trusts (PCT) and four care trusts (CT).

CTs had similar duties to PCTs, except that CTs had responsibilities for social care as well as health care.

The majority of the new PCOs were defined in terms of LADs.

Of the 152 PCOs:

  • 130 comprised of one or more whole LADs.

  • 16 comprised of one or more whole LADs plus whole wards.

  • three comprised of only whole wards within a single LAD.

  • two comprised of one or more whole LADs and part wards (that is, whole parishes).

  • one comprised of whole and part wards (that is, whole parishes) within a single LAD.

As at 15 April 2011 there were 146 PCTs and five CTs in England, after Solihull CT reverted to a PCT.

There were also minimal changes on 1 April 2010, when two PCTs were merged into one and another PCT converted to a CT.

PCOs reported to the SHAs.

July 2003 to June 2006

This structure for health administration in England came into effect on 1 July 2003.

There were 28 SHAs, which were constituted by groups of LADs and managed the performance of the PCOs.

As at 1 October 2005 there were 303 PCOs, including 299 PCTs and four CTs based on the PCT model (this meant that they fulfilled all PCT functions and also delivered the health services usually provided by local authorities).

The PCOs were (mostly) aligned with the administrative boundaries existing at the time of the last major health reorganisation on 1 May 2002.

April 2002 to June 2003

Health Administration April 2002 - June 2003

During this period the directorates of health and social care (DHSC) formed an additional top layer to the structure.

There were four DHSCs, each covering one or more GORs.

DHSCs were part of the Department of Health rather than the NHS.

April 1999 to March 2002

Health Administration April 1999 - March 2002

A major reorganisation of English health geography occurred on 1 April 2002.

Before this there were eight health regional offices (HRO), which were part of the Department of Health.

These were divided into approximately 100 health authorities (HA), which in turn were split into PCOs.

When PCOs were first established in 1999, there were 481 primary care groups (PCG). However, by 2002, a significant number had converted to PCTs.

The numbers of both HAs and PCOs varied slightly through this period.


Content from the Office for National Statistics.
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