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English Health Geography

New health structure as at 1st April 2013

New health structure as at 1st April 2013

On the 1st April 2013, a new structure of health geographies in England came into force.  The new structure consists of clinical commissioning groups, NHS area teams and NHS commissioning regions.

  • There are four NHS commissioning regions in England.

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

  • The 211 clinical commissioning groups (CCG) 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 GP and other clinicians the power to influence commissioning decisions for their patients. CCG will be overseen by NHS England (including its Regional Offices and Area Teams). These structures will manage primary care commissioning, including holding the NHS Contracts for GP Practices NHS. Groups have boundaries that are coterminous with those of lower layer super output areas. 

This new structure has replaced the SHA and PCO that had been in operation since July 2006.

July 2006 to March 2013

Current Health Administration

The structure of health geographies in England containing strategic health authorities and primary care organisations, was abolished on the 31st March 2013. 

Health administration in England was significantly restructured in 2006.

On 1 July 2006 the number of Strategic Health Authorities (SHA) was reduced from 28 to 10.

The boundaries of the new SHA were coterminous with Government Office Regions (GOR), with the exception of the South East GOR which comprises two SHA (which were constituted from groups of local authorities).

SHA reported to the Department of Health.

On 1 October 2006 the number of Primary Care Organisations (PCO) was reduced from 303 to 152.

The PCO were made up of 148 Primary Care Trusts and 4 Care Trusts.

CT had similar duties to PCT, except that CT had responsibilities for social care as well as health care.

The majority of the new PCO were defined in terms of local authority districts.

Of the 152 PCO:

  • 130 comprised of one or more whole local authority districts

  • 16 comprised of one or more whole local authority districts plus whole wards

  • three comprised of only whole wards within a single local authority district

  • two comprised of one or more whole local authority districts and part wards (that is, whole parishes)

  • one comprised of whole and part wards (that is, whole parishes) within a single local authority district

As at 15 April 2011 there were 146 Primary Care Trusts (PCT) and five Care Trusts (CT) in England after Solihull CT reverted to a PCT.

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

PCO reported to the SHA.

July 2003 to June 2006

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

There were 28 Strategic Health Authorities (SHA), which were constituted from groups of local authorities and performance managed the Primary Care Organisations (PCO).

As of 1 October 2005 there were 303 PCO including 299 Primary Care Trusts (PCT) and four Care Trusts (CT) 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 PCO 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 present structure.

There were four DHSC, each covering one or more Government Office Regions (GOR).

DHSC 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 Regional Offices (RO), which were part of the Department of Health.

These were divided into approximately 100 Health Authorities (HA), which in turn were split into PCO.

When PCO were first established in 1999 there were 481 Primary Care Groups (PCG) but by 2002 a significant number had converted to PCT.

The numbers of both HA and PCO varied slightly through this period.


Content from the Office for National Statistics.
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