How the NHS works

The NHS provides healthcare that is free at the point of use for people living in the UK.

In England, healthcare services are generally delivered through four main layers:

Primary care is usually the first point of contact for patients.

Examples include:

GPs act as gatekeepers to specialist services, meaning many treatments require a GP referral before you can access them.

Community services provide treatment outside hospitals.

Examples include:

Some community services allow self-referral, meaning you can contact them directly.

Secondary care includes hospital-based specialists such as:

These services typically require a referral from a GP or another clinician.

Tertiary care refers to highly specialised services provided at dedicated centres for complex or rare conditions. Examples include specialist cancer treatment centres, neurosurgery units, and paediatric intensive care. Patients are usually referred to tertiary services by a secondary care specialist rather than directly by a GP.

The NHS App is the NHS's official digital platform for accessing health services.

Patients can use the app to:

Many GP practices now encourage patients to use the NHS App as their main way to manage appointments and prescriptions.

However, the app does not currently allow patients to:

For many people, navigating the system still requires additional research.

NHS 111 is a 24-hour medical helpline designed to help patients get the right care when they are unsure where to go.

You can access NHS 111 by:

NHS 111 advisors and clinicians assess your symptoms and guide you to the most appropriate service.

Depending on the situation, they may direct you to:

In some cases, NHS 111 can book appointments directly with urgent care services.

NHS 111 should not be used for life-threatening emergencies. In those situations, you should call 999.

Many NHS services require a GP referral.

A referral means your GP sends your medical information to a specialist service so that they can assess your condition.

Common services requiring referrals include:

After a referral is sent, the receiving service will review it and typically place the patient on a waiting list. Patients will then be contacted with appointment details when capacity becomes available.

Some NHS services allow self-referral, meaning you can contact them directly without seeing a GP. This can save time and reduce pressure on GP appointments.

Common self-referral services include:

For example, NHS Talking Therapies services allow patients to refer themselves online without needing a GP appointment. However, awareness of self-referral options is still relatively low, and many patients continue to go through their GP unnecessarily.

When a referral is accepted, patients are usually placed on a waiting list.

Waiting times vary depending on several factors:

Some services operate within national targets. For example:

However, actual waiting times can vary significantly between providers and regions. This is one reason why many patients research different providers before accepting a referral.

In England, patients often have a legal right to choose which provider delivers their care.

This is known as Right to Choose.

It usually applies when:

Right to Choose is frequently used for services such as:

For example, if your GP refers you for an ADHD assessment, you may be able to choose a provider with a shorter waiting list. However, many patients are not aware this option exists.

Patients can also choose to access private healthcare.

Private services may offer:

However, private care usually requires out-of-pocket payment or insurance coverage.

Some patients combine NHS and private care. For example, a patient may receive a private diagnosis but continue treatment through NHS shared-care arrangements.

The NHS is made up of thousands of organisations delivering care across the country.

Patients often struggle to understand:

As a result, many people rely on online searches, GP advice, or recommendations from friends and family.

This article summarises publicly available information from:

Sources referenced include: