NHS & Healthcare

How the NHS is structured

The National Health Service in England is funded through general taxation and provides healthcare free at the point of use. It is one of the largest employers in the world. Scotland, Wales and Northern Ireland each have their own health services with similar principles but separate structures and budgets.

In England, NHS England (now part of NHS England and NHS Improvement) oversees the commissioning and planning of services. Integrated Care Boards (ICBs) replaced Clinical Commissioning Groups in 2022 and now commission most services for their local areas. NHS Trusts deliver hospital services; NHS Foundation Trusts have more financial autonomy. Primary care (GP surgeries, community pharmacists, dentists) operates through contracts rather than direct employment.

How it is funded

The NHS is primarily funded through general taxation, with some revenue from National Insurance contributions. There is a small revenue stream from private patient services and prescription charges (though many groups, including under-16s, over-60s and those with certain medical conditions, are exempt).

NHS spending decisions are made by central government as part of the annual budget process. Total NHS spending in England is in the region of 180 billion pounds per year, making it one of the largest items in public expenditure. Debates about whether this is sufficient relative to an ageing population and rising treatment costs are central to current healthcare policy.

Current challenges

The NHS faces a combination of structural and operational pressures that have intensified since the pandemic. Understanding these challenges is important for medical school interviews because assessors expect applicants to have an informed view of the environment they are seeking to enter.

• Waiting lists: the elective care backlog grew significantly during the pandemic and remains very large. Long waits for treatment have consequences for patients and for overall health outcomes.
• Workforce: the NHS faces shortages across many clinical specialties. GP recruitment and retention, nursing vacancies and the supply of consultants in certain specialties are all areas of concern.
• Mental health: demand for mental health services has risen substantially, while capacity has historically lagged behind physical health provision.
• Ageing population: people are living longer, often with multiple long-term conditions that require sustained management. This increases demand at the same time as the workforce needed to provide care is itself ageing.
• Primary and secondary care integration: many patients experience the NHS as fragmented, with poor coordination between GP services, hospitals, social care and community teams. Integrated Care Systems are partly designed to address this.

NHS values

The NHS Constitution sets out the values that underpin the health service: working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives and everyone counts. These values are reflected in the behaviours expected of NHS staff and in the qualities medical schools are looking for in candidates.

Assessors often ask applicants what they think makes a good doctor or what the NHS stands for. Answers that draw on the NHS Constitution values and connect them to specific observed behaviour from a work experience placement are more convincing than abstract or clichéd responses.

What applicants need to understand

You do not need to be a healthcare policy expert. What medical schools expect is an informed, curious perspective on the system you are hoping to join. You should be able to describe broadly how the NHS is structured, name one or two current challenges and explain why you think they matter.

The most effective preparation is to read a reliable source regularly. The King's Fund publishes clear summaries of health policy issues. The BBC Health section covers NHS stories accessibly. The BMJ and The Lancet publish commentary on clinical and policy developments that is often relevant to interview questions.