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A to Z of writing

This A to Z gives detailed guidance on our written style. All writing under our identity, whether online or offline, should be consistent with this style. You can check NHS digital service manual’s content style guide for any points you don’t find here.

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abbreviations and acronyms

The first time you use an abbreviation or acronym explain it in full unless it’s well known, like NHS, GP, BBC, UK and US. Then refer to it by initials. Do not use full stops in abbreviations or acronyms: ‘BBC’, not ‘B.B.C.’ 

If readers might not see your first use, introduce the full version again.  

Do not capitalise words just because they are being used in an acronym. For example: ‘In 2022, integrated care boards (ICBs) replaced clinical commissioning groups (CCGs).’  

Try to minimise the use of abbreviations and acronyms, as block capitals are difficult for people to read.

See also capitals.

active, passive

Use the active voice. This will help us write concise, clear content. 

The subject of the sentence performs the action in a sentence using the active voice, for example, ‘The study shows a trend.’

The subject receives the action in a sentence in the passive voice, for example, ‘A trend is shown by the study.’

The passive voice is sometimes useful. However, more often than not, you can find an active form that has the same meaning and is more direct and concise.

See first person.


Punctuate addresses when you write them horizontally:

NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire, LS1 4AP.

Do not punctuate when you write them vertically:

NHS Digital
7 and 8 Wellington Place
West Yorkshire


An ampersand is the ‘&’ symbol.

Use ‘and’ instead of ‘&’ because not everybody understands what it is. We only use it as part of an organisation’s name, for example, ‘Marks & Spencer’ or in commonly accepted abbreviations such as ‘A&E’.


Used for:

  • possessives, for example: the NHS's services (see possessives)
  • missing letters, for example: it's, we're, we've, they've (see contractions)

You can also use apostrophes to:

  • mark omissions, for example: the ’90s
  • make single letters into plurals, for example: mind your p’s and q’s

We do not put apostrophes into ordinary plurals, for example: peas, CDs or the 1990s, and we do not use an apostrophe for the possessive its.


An application for a mobile device or computer. Lowercase unless referring to the official name of the ‘NHS App’ – see also NHS App.

arm’s length body

Use an apostrophe but no hyphen.


blog post

Use two words when talking about an article published on a blog. A blog is the site on which a blog post is published.


Lower case unless it’s part of a proper title or you are referring to our Board, 'the Board'. For example, ‘board minutes and papers are published after the Board meets'.

See also capitals.


In technical documentation or instructions, you can use bold to explain what field a user needs to fill in on a form, or what button they need to select. See our Using Databricks in DAE page as an example. 

Use bold sparingly – using too much will make it difficult to know which parts of your content to pay the most attention to.

Avoid using bold in other situations, for example to emphasise text. This is because screen readers ignore bold and italics when they are set to default mode.

Instead, to emphasise words or phrases, you can:

  • put the most important word/s at the beginning of the sentence
  • use headings 
  • use bullet points
  • use emphasis boxes or similar elements for website content


Punctuate inside brackets where a full sentence falls inside the brackets. (This is the way to do it.)

Punctuate outside brackets where only part of the sentence falls in brackets (this is the way to do it).

Only use square brackets to indicate comments added by an editor or editorial interventions like ellipses (see full stops). Avoid putting brackets within brackets.

Britain, British

bullet points

Bullet points break text into short, digestible sections and help to highlight important points. Bulleted lists should be short and snappy. If possible, limit your list to no more than 6 items.​ Each item in the list should be roughly the same length.

Use a lead-in line that ends with a colon and make sure that:

  • each bullet point makes sense when read after the lead-in line
  • you use lower case at the start of the bullet
  • you avoid ending a bullet point with "and" and "or"
  • each bullet point has no punctuation at the end, including after the last point
  • you do not use more than 1 sentence per bullet point

Bulleted lists should be aligned left.

See also numbered lists.

byte, kilobyte, megabyte, gigabyte, terabyte

Abbreviate ‘byte’ to B (for example: ‘a 180GB hard drive’).

Use MB for anything over 1MB: 4MB not 4096KB.

Use KB for anything under 1MB: 569KB not 0.55MB.



We do not use block capitals as they're difficult for people to read. Always use sentence case, even in page titles. The exceptions to this are: ​

  •  proper nouns ​

  •  official titles of organisations ​

  •  names of directorates – see also directorates​

  •  names of programmes – see also programme 

  •  trade names ​

  •  the first letter of a page or heading in a document (but not the following words unless they take a capital for other reasons) ​

  •  religious holidays and festivals (‘Christmas’, ‘Easter’, ‘Eid’) but use lower case for seasons (‘summer’ and ‘autumn’) 

  • job titles (but not descriptions of job roles) –  for example: ‘Melanie White, Non-Executive Director at NHS England’ but 'Melanie is a non-executive director at NHS England'

  • names of political parties

Child Protection - Information Sharing project (CP-IS)

Use a hyphen in both the full and acronym form.


Clichés bore people and get in the way of communication.

A survey by the Plain English Campaign found the most annoying cliché in the English language was ‘at the end of the day’, followed closely by phrases like ‘ballpark figure’, ‘blue sky thinking’, ‘bottom line’, and ‘value-added’.

As William Safire said: “Last, but not least, avoid clichés like the plague”.

clinical commissioning groups (CCGs)

CCGs were replaced by integrated care boards (ICBs) in July 2022.

See integrated care boards (ICBs).


Lower case.




A colon is used:

  • at the end of a lead-in line before a list or bullet points
  • directly before a direct quote (do not use a comma)
  • after a complete sentence to connect to a second clause or sentence that explains or follows from it (for example: ‘She got what she deserved: a promotion’)

Only capitalise the first word after a colon if it is a proper noun, the start of a complete sentence or the start of a quote.

Do not use a colon when introducing a quote within a quote, use a comma and single quotes.


Commas help guide readers through the meaning of a sentence.

They can be used to mark out clauses or phrases that are not integral to the meaning of the rest of the sentence. Note the difference between the meanings of ‘NHS staff who do not read our stylebook should not be communicating in public’ and ‘NHS staff, who do not read our stylebook, should not be communicating in public’.

They can also separate adjectives qualifying a noun (for example: ‘a small, profitable company’). Don’t use a comma if the last adjective before a noun is an integral part of an established noun phrase: ‘a cheap personal computer’.

Finally, commas are often used to separate elements in a series: ‘Our systems are fast, resilient and secure’. It is not always necessary to put commas before the final ‘and’ in a list, but you should do this if it makes your meaning clearer (for example, ‘Whitby is famous for vampires, Captain Cook, fish and chips, and jet’).

Don’t use too many commas. If a sentence is getting weighed down, consider using dashes.

See dashes and hyphens


A contraction is a short form of a word or combination of words.

Positive contractions such as you're, we've, we're are OK to use.

Avoid negative contractions like can't and don't. Many users find them harder to read, or misread them as the opposite of what they say. Use cannot, instead of can't.

Avoid should’ve, could’ve, would’ve, they’ve too. These can be hard to read.


Lower case.


Upper case.

Do not use:

  • ‘Covid-19’ with only the first letter capitalised
  • ‘covid-19’ lower case
  • ‘coronavirus’ as ‘COVID-19’ is the specific condition



Dashes (‘–’) and hyphens (‘-’) are not interchangeable. In Microsoft Word, a dash can be achieved by typing a space, two hyphens and a space (‘ – ‘).

Use dashes in place of pairs of commas or brackets when you want to draw the reader’s attention to something interesting or unusual.

They can also be used in place of commas or colons to provide a change of thought, continuity and pace: ‘Our job is supporting better health, better care and a more effective system – not computerising or going paperless for their own sake.’

Spaces should be inserted before and after each dash. We use the en dash (‘–’) but not the longer em dash (‘—‘).

See hyphens.


We treat ‘data’ as a singular noun (for example, ‘the data is stored on a secure server’) rather than a plural noun (‘The data are stored on a secure server’) when talking to the public and to non-specialist audiences.

Understanding Patient Data researched the public’s comprehension of these terms and recommended using the singular. This is consistent with the Government Digital Service’s advice.

But take a flexible and practical approach. The Oxford Dictionaries website says both usages are acceptable in standard English and notes that some technical audiences still prefer the plural. If you are talking to a group of specialists and feel that using the singular will get in the way of communication, use the plural.

Data Access Request Service (DARS)

Data Processing Services (DPS)

data set

Should always be two words.


Dates are written ‘day month year’ with no punctuation: ‘22 April 2018’.

Avoid using ‘nd’ ‘st’ ‘th’ and ‘rd’ except when referring to centuries, anniversaries or positions.

In general, use ‘to’ for date ranges, not hyphens or dashes (for example: ‘10 November to 21 December’). However, to refer to a financial year, use a hyphen (for example: ‘2017-18’).

See times.


Be direct wherever possible. Say ‘death’ or ‘died’ instead of:

  • fatality
  • passing
  • passed away
  • deceased


Capitalise the official names of directorates (for example: 'Product Delivery') but lowercase for 'directorate' (for example: 'the Data Services directorate').

Directory of Services (DoS)

Use lowercase ‘o’ in acronym.


Use positive and active language that respects people living with a disability or condition.

The NHS digital service manual’s guidance on disabilities and conditions gives more information. 

double quotes

Use double quotes in body text for direct quotations.

Where the speaker’s name comes before the quote, use a colon: ‘Melanie White said: “More people are using our services.”’

Where the speaker’s name follows the quote, insert a comma before the closing quotation marks: ‘“More people are using our services,” said Mrs White.’

Use open quotation marks at the start of each paragraph of a quote. Only use closing quotation marks at the end of the quote, not at the end of every paragraph within it.

See single quotes.



Try to avoid synthetic words that use ‘e’ in place of ‘electronic’. Their meaning is often vague.

When you do need to refer to them, use hyphens (‘e-commerce’, ‘e-bulletin’) apart from in ‘email’. At the beginning of a sentence, capitalise the first letter of the word that follows the ‘e’, rather than the ‘e’ itself (for example: ‘e-Business’).

e.g., etc and i.e.

‘E.g.’ can sometimes be read aloud as “egg” by screen reading software. Instead, use ‘for example’, ‘such as’, ‘like’ or ‘including’.

‘Etc.’ can usually be avoided. Try using ‘for example’, ‘such as’, ‘like’ or ‘including’.

‘I.e.’ isn’t always well understood. Try writing sentences to avoid the need to use it. If that isn’t possible, use an alternative such as ‘meaning’ or ‘that is’.

Electronic Prescription Service (EPS)

Not to be referred to as ‘ETP’ or ‘Electronic Transfer of Prescriptions’.


Not ‘e-mail’.

email addresses

Write email addresses in full, in lower case and as active links.



Use ‘ethnicity’, not ‘race’. Use ‘ethnic minorities’, not ‘BAME’ or ‘BME’. 

The NHS digital service manual’s guidance on ethnicity, religion and nationality provides more information.

exclamation marks

Take Howard Mittelmark’s advice: “In almost all situations that do not involve immediate physical danger or great surprise, you should think twice before using an exclamation mark. If you have thought twice and the exclamation mark is still there, think about it three times, or however many times it takes until you delete it.”

Never use multiple exclamation marks.



Upper case. Facebook is a trademarked name.

first person

Our success relies on the strength of our staff and our relationships. 

Although not appropriate in all contexts, we prefer to talk in the first person when describing what we do and to address our readers directly: ‘we’, ‘us’ and ‘you’.

See active, passive


Spell out and use hyphens for common fractions: ‘one-half’.

Do not compare fractions with decimals (‘one-third of men and two-thirds of women’ rather than ‘one-third of men and 66% of women’).

See numbers 

full stops

A full stop:

  • ends a sentence
  • does not appear in headings
  • does not appear in formal abbreviations such as BBC

Three dots with no spaces between them (‘…’) are sometimes used to indicate the intentional omission of a word, sentence, or whole section from text. For example, a writer may choose to shorten a quote in this way. This is called an ellipsis. Spaces should be placed either side of the dots (for example: ‘David Vine said: “I am speaking from a deserted … Crucible Theatre.”’)

There is no need to insert an extra full stop if the omission is at the end of a sentence. Square brackets either side of the ellipsis can be used if it is important to highlight that material has been omitted.



Use gender- neutral language wherever possible, such as ‘you’, ‘them’, ‘their’ or ‘they’ where possible.

The NHS digital service manual’s guidance on sex, gender and sexuality has more information.

general practitioner, GP and general practice

‘GP’ can be used interchangeably with ‘general practitioner’. Don’t capitalise the spelled-out version. It is not necessary to spell out the abbreviation on first use if the meaning is clear.

The NHS Digital Service Manual provides more guidance on 'GP'.



Use lower case when referring to government, for example: ‘the government’s announcement’. Only capitalise if using the full title of the government, for example: ‘Her Majesty’s Government of the United Kingdom of Great Britain and Northern Ireland’. ​

government departments

Use lower case for ‘the minister’, ‘the cabinet’ or ‘the secretary of state’. However, capitalise when talking about: ​

  • a specific department (‘the Department of Health and Social Care’) ​
  •  a specific body’s name (‘the Public Administration Select Committee’) ​

  •  a specific job title (‘the Secretary of State for Health and Social Care’) 

GP Data for Planning and Research (GPDPR)

Not be confused with GDPR (General Data Protection Regulation).

Great Britain


headlines, titles and headings

For headlines, page or section titles, we use a capital for the first word only, except where words would ordinarily take a capital letter (for example: ‘Trust leaders visit NHS England’).

Note, however, that all of the words in publication titles are capitalised except prepositions (‘on’), articles (‘the’) and conjunctions (‘and’) of fewer than four letters (for example: ‘Annual Report and Accounts’).

It is sometimes acceptable to use an acronym in a headline without first spelling it out. The full version with the acronym should be spelled out as soon as possible in the following text. This should never be done if a significant proportion of the audience will not immediately understand the acronym.


Use flexibly to support clear and respectful communication.

In general, use the full name without an honorific on first mention: ‘Theresa May’. Use an honorific with the surname on later mentions in the same text: ‘Mrs May’.

Some honorifics warrant use on first mention, including ‘Baroness’, ‘Lord’, ‘Sir’ and ‘Professor’.

But use will vary according to context. In a press release about a visit from a minister, the style outlined above would be appropriate. In a case study about a patient’s positive experience of a service, you might prefer to refer to the subject by their first name on second mention.

Do not abbreviate ‘Professor’ to ‘Prof’.

Do not use full stops in honorifics: write “Mr” not “Mr.”.



  • where two or more words are taken together and read as one (‘day-to-day’)
  • to join two words that act together like one adjective (for example: ‘five-minute presentations’)
  • when expressing fractions or numbers in text (‘two-thirds’ or ‘thirty-four’)
  • to avoid ambiguity (for example, ‘re-cover’ not ‘recover’)

It is usually best to avoid synthetic words that use ‘e’ in place of ‘electronic’. Their meaning is often vague. Where you do have to use them, the prefix ‘e’ should always be lower case with a hyphen. For example:

  • e-business
  • e-government
  • e-learning
  • e-procurement

The only exception to this is email.

At the beginning of a sentence, capitalise the first letter of the word that follows the ‘e’, rather than the ‘e’ itself. For example:

  • e-Procurement

Again, there is only one exception: ‘Email’ at the start of a sentence should have a capital ‘E’.


  • re- words starting with e (for example: “re-evaluate”)
  • co-ordinate
  • co-operate

Do not hyphenate:

  • reuse
  • reinvent
  • reorder
  • reopen
  • online

In general, use ‘to’ for time and date ranges, not hyphens. However, use a hyphen when talking about a financial year (for example: ‘2017-18’). Don’t use a forward slash. ‘2017/18’ is incorrect.

See dashes.



inclusive language

Content should be inclusive and respectful and not alienate anyone. Our inclusive language guide gives more information.

integrated care boards (ICBs)

Lower case, except when you are referring to the specific name of an ICB. For example: Anytown Integrated Care Board.

integrated care system (ICS)

Lower case, except when you are referring to the specific name of an ICS. For example: Anytown Integrated Care Board.


Lower case.


jargon and technical language

Jargon is a type of language that is used in a particular group and is difficult for others to comprehend. Try to explain things so the layperson can clearly understand what you are saying.

Technical terms are not necessarily jargon, but you should explain what they mean when you use them.

Experts sometimes say that they don’t need to use plain English because they’re writing technical or complex content for a specialist audience. This is wrong.

Research shows that people with higher literacy levels prefer plain English because it allows them to understand the information more quickly. A study of the use of specialist legal language in legal documents, for example, found that 80% of people preferred sentences written in clear English. The more educated the person and the more specialised their knowledge, the greater their preference for plain English. The more complex the issue, the more insistent this demand became.

Your readers, even the experts, don’t have time to pick their way through dry and complicated writing.

job titles

See capitals.


less, fewer

Less refers to quantities that cannot be counted (‘there is less milk in this container than there was yesterday’). Fewer refers to quantities that can be counted (‘there are fewer trees in this garden’).

When writing a link on a web page, try to describe clearly what you are linking to.

Generic text like 'click here' or 'more' is not accessible. People using screen users will often scan through the links on a page to understand its content. That is much easier if the links make sense in isolation.

If a link allows someone to begin a task, start with a verb: 'Apply for an innovation grant'. If it provides information, describe the topic: 'About Data Services'.

The NHS Digital service manual provides more guidance on links.


Lists should be bulleted to make them easier to read.

See bullet points and numbered lists

login, log in

‘log in’ is a verb; ‘login’ is a noun or adjective

Example: ‘You log in using your password on the login page.'



Use numerals and spell out measurements the first time you use them. Abbreviating kilograms to kg is fine.

Don’t use a space between the numeral and abbreviated measurement: ‘3,500kg’ not ‘3,500 kg’.

Use Celsius for temperature: ‘37°C’.

Don’t use full stops after units: ‘10kg’ and ‘15cm’ are correct.

See also numbers



Do not use decimals unless pence are included: ‘£75.50’ but not ‘£75.00’.

Write out ‘pence’ in full: ‘Calls will cost 4 pence per minute from a landline’.

See also percentagesunits, and numbers

myself, yourself, ourselves, himself, herself

Avoid using these terms and instead write ‘me’, ‘you’, ‘us’, ‘him’ or ‘her’.


National Booking Service

Use to refer to the systems that enable people to book coronavirus vaccination appointments.

NHS 111 online

Include the word NHS and give ‘online’ a lowercase ‘o’.


With an upper case ‘A’. It's the name of a specific app. To avoid repetition of ‘NHS App’, you can use ‘the app’ where needed. When referring to something inside the NHS App, use ‘in’ the app, not ‘on or ‘with’ the app.

See also app.

NHS DigiTrials

Note camel case.

NHS e-Referral Service (e-RS)

‘e-Referral Service’ is an acceptable abbreviation.

NHS login

Use ‘login’ in lower case and as one word.

NHS Spine

Can also use ‘the Spine’, ‘the NHS Spine’, or ‘Spine’.

NHS website

When referring to the website at, use ‘the NHS website’ (lower case ‘website’) and give the url in lower case. However, if talking about NHS.UK as a programme, use capital letters.


Do not use a space between ‘NHS’ and ‘mail’ and, in general, avoid using ‘NHSmail2’. The current platform is ‘NHSmail’.

numbered lists

Use numbered lists to help guide a user through a process.

  1. You do not need a lead-in line.
  2. Each numbered point should be a full sentence and end in a full stop.
  3. Steps are better than bullets if you want to explain a process.

See bullet points

numbers (1,2,3)

We use numerals (‘1’, ’2’, ‘3’) instead of spelling out numbers (‘one’, ‘two, ‘three’) because people find it easier to scan pages for numerals.

We do spell out numbers when we are using ‘one’ to mean ‘a’ or in phrases like ‘one or the other’.

It is OK to use numerals at the start of sentences and in headings.

For ordinal numbers, spell out first to ninth. After that use 10th, 11th and so on. Use full-sized letters after the number, not superscript. In tables, use numerals throughout.

For numbers over 999, use a comma for clarity, for example, ‘1,962’.

For numbers less than 1, use 0 before the decimal point, for example, ‘0.25’.

In general, write out ‘million’ or ‘billion’, for example: ‘£14 million’. If it is necessary to abbreviate, put ‘m’ or ‘bn’ immediately after the value, for example: ‘£14m’.

See also fractionsmoney and percentages



Capitalise ‘Parliament’ but use lower case for the adjectival ‘parliamentary’.​


Always use ‘%’ with a number.

When spelling out the word, use ‘per cent’ not ‘percent’. ‘Percentage’ is one word.

A percentage increase is not the same as ‘percentage point’ increase: an increase from 10% to 15% would be a 50% rise but a rise of five percentage points.


Refer to companies and organisations in the singular.

Some nouns are always plural, such as ‘police’ and ‘people’.


Singular words not ending in ‘s’ use an apostrophe before a final ‘s’, for example, ‘Peter’s pen’.

Singular words ending in ‘s’ use an apostrophe after that ‘s’, for example, ‘James’ pen’ not ‘James’s pen’.

Plural words ending in ‘s’ use an apostrophe after the final ‘s’, for example, ‘the Smiths’ house’.

Acronyms use apostrophes as they would in their spelled-out form, for example, ‘the NHS’s budget’ is correct.

See apostrophes.


Lower case: ‘Citizen Identity programme’.

public health

Lower case.

public sector

Lower case.


quotation marks


references to documents

References to documents should be easy to understand by anyone, not just specialists. They should follow the style guide.

When writing a reference:

  • do not use italics
  • use single quotation marks around titles
  • write out abbreviations in full: ‘page’ not ‘p’, ‘Nutrition Journal’ not ‘Nutr J’
  • use plain English. For example, use ‘and others’ not ‘et al’
  • do not use full stops after initials or at the end of the reference

If the reference is available online, make the title a link and include the date you accessed the online version.

For example: ‘Corallo AN and others. ‘A Systematic Review of Medical Practice Variation in OECD Countries’ Health Policy 2014: volume 114, pages 5-14 (viewed on 18 November 2014)’



Semicolons are often misread and so should be used sparingly. The Government Digital Service’s guidelines say they should not be used on web pages and suggests breaking up text into separate sentences instead.

However, semicolons can sometimes be useful in lists when each item is already comprised of words separated by commas. For example: ‘The events will be held in Guangzhou, China; Kolkata, India; and Berlin, Germany.’

Shielded Patient List (SPL)

Use ‘Patient’ in the singular, not plural.

single quotes

Use single quotes:

  • in headlines
  • for unusual terms
  • to highlight a term, word or phrase that is being discussed or defined
  • when referring to publications (for example: ‘Download the publication ‘Understanding Our Statistics’)
  • to put a quote within a direct quote

See double quotes.


Use a single space after a full stop rather than two.


The name of this programme is Spine. The infrastructure can also be referred to as ‘the Spine’ or ‘the NHS Spine’.

Summary Care Record (SCR)

Use Summary Care Record (SCR) when referring to the patient record service; Summary Care Record Additional Information (SCRai) when referring to the patient record service with extra information; and Summary Care Record application (SCRa) to refer to the product.


technical terms

telephone numbers

Use ‘telephone: 011 111 111’ or ‘mobile: 011 111 111’.

Use spaces between the city and local exchange. For example: ‘01273 800 900’, ‘07771 900 900’ or ‘+44 (0)20 7450 4000’.

When a number is memorable, group the numbers into easily remembered units: 0800 80 70 60.




  • ‘5:30pm’ (not ‘1730hrs’)
  • ‘midnight’ (not ‘00:00’)
  • ‘midday’ (not ‘12 noon’, ‘noon’ or ‘12pm’)
  • ‘6 hours 30 minutes’
  • ‘to’ in time ranges, not hyphens or dashes: ‘10am to 11am’ (not ‘10-11am’)

Midnight is the first minute of the day, not the last. You should consider using ‘11:59pm’ to avoid confusion.

For example, ‘You must register by 11:59pm on Tuesday 14 June’ can only be read one way. ‘You must register by midnight on Tuesday 14 June’ can be read in two ways (the end of Monday 13 or end of Tuesday 14).

See dates.


See headlines, titles and headings.

See honorifics for personal titles and forms of address.


Lower case unless you are referring to the full name of a foundation trust (‘NHS trusts’, ‘Bolton NHS Foundation Trust’, 'the trust').

See also capitals.

Twitter account

Upper case. Twitter is a trademarked name. However, we tweet tweets (both in lower case).


UK government

Not ‘HM government’.

United Kingdom

The United Kingdom (UK) consists of four countries: England, Scotland, Wales and Northern Ireland.

Britain is the official short form of United Kingdom.

Great Britain is the largest island of the British Isles, which also include the island of Ireland and numerous surrounding islands.

Our work is focused on the NHS in England. Take care not to refer to Britain when you mean England.




Lower case.


One word and lower case.


One word and lower case.


No hyphen.