The concerto is in four movements. Following an opening nobilmente flourish on the cello, the violas introduce the haunting 9/8 lament, the theme that most readily identifies the concerto’s pervasive feeling of autumnal regret. It is this melody that Elgar hummed on his death-bed to his friend and said: "If ever after I'm dead you hear someone whistling this tune on the Malvern Hills, don't be alarmed. It's only me". The movement has the character of a melancholy soliloquy, fading gently away into the shadowy second movement scherzo by way of the soloist’s guitar-like pizzicato version of the introductory flourish.

Following the Scherzo, the short and serene Adagio third movement is an elegiac song without words, perfectly suited to the cello at its most nobly eloquent. Without a real break, the orchestra then suggests the final rondo theme, but the soloist instigates another recitative-like cadenza before launching into the last movement. Near the end Elgar recalls the second phrase of the Adagio melody from the second movement, and rarely has music conveyed such anguish and despair. But the soloist’s introductory flourish returns, and the work ends with a few hurried bars in which cellist and full orchestra combine for the only time in the concerto.

Elgar himself conducted the first performance at the Queen’s Hall on 26th October 1919 with Felix Salmond as soloist.