A study from Imperial College London reports that alternative providers of primary care in the NHS, including private sector companies, do not perform as well as traditional GP practices when their performance is assessed using a range of measures of quality of care.
Alternative providers have been contracted to offer primary care in the NHS since 2004 under reforms designed to increase competition. These providers performed worse than traditional GP practices on 15 out of 17 indicators after adjusting for the characteristics of the practices and the populations they serve.The study was published in the Journal of the Royal Society of Medicine.
“This study provides data to inform the debate about the growing role of the private sector in the NHS,” said Dr Christopher Millett, lead author of the study, from the School of Public Health at Imperial. “New providers were allowed into the primary care market to stimulate competition, but our findings suggest that their introduction has not led to improvements in quality and may have resulted in worse care.
“The lesson is that increasing diversity does not necessarily lead to better quality. Regulators should ensure that new providers of NHS services are performing to adequate standards and at least as well as traditional providers.”
Three hundred and forty-seven general practices – 4.1 per cent of practices in England – are run by alternative providers, including private companies and voluntary organisations. These practices tend to be smaller, and serve younger, more diverse and more deprived populations than traditional providers.
The study looked at a range of performance indicators from the Health and Social Care Information Centre and the national GP Patient Survey. These included access measures such as how easily patients can get appointments, clinical measures such as how well they manage patients’ blood pressure, and efficiency measures.
Among the differences between types of practices, alternative providers had worse results for patients’ diabetes control, higher hospital admission rates for chronic conditions, and lower overall patient satisfaction.
“So far, alternative providers have not been widely contracted to delivery primary care services,” said Dr Millett. “However, private sector providers have secured a third of contracts to deliver NHS clinical services since the Health and Social Care Act was enacted in 2013. Our findings highlight the need for careful and independent evaluation of how this legislation has impacted quality of care.”