A new study published today by the Journal of the Royal Society of Medicine has found that alternative providers of primary care in the NHS, including private sector companies, do not perform as well as traditional GP practices.
Alternative providers have been contracted to offer primary care in the NHS since 2004 under reforms designed to increase competition.
The study, by researchers at Imperial College London, found that 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.
"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."
Notes to editors
Performance of new alternative providers of primary care services in England: an observational study (DOI: 10.1177/0141076815583303) by Felix Greaves, Anthony Laverty, Utz Pape, Anenta Ratneswaren, Azeem Majeed and Christopher Millett will be published by the Journal of the Royal Society of Medicine at 00:05hrs (UK time) on Friday 24 April 2015.
For further information or a copy of the paper please contact:
Media Office, Royal Society of Medicine
DL +44 (0) 1580 764713
M +44 (0) 7785 182732
Research Media Officer, Imperial College London
DL: +44 (0) 20 7594 2198
Out of hours duty press officer: +44(0)7803 886 248
The JRSM is the flagship journal of the Royal Society of Medicine and is published by SAGE. It has full editorial independence from the RSM. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. An independent company, SAGE has principal offices in Los Angeles, London, New Delhi, Singapore and Washington DC. http://www.
Imperial College London is one of the world's leading universities. The College's 14,000 students and 7,500 staff are expanding the frontiers of knowledge in science, medicine, engineering and business, and translating their discoveries into benefits for society.
Founded in 1907, Imperial builds on a distinguished past - having pioneered penicillin, holography and fibre optics - to shape the future. Imperial researchers work across disciplines to improve global health, tackle climate change, develop sustainable energy technology and address security challenges. This blend of academic excellence and its real-world application feeds into Imperial's exceptional learning environment, where students participate in research to push the limits of their degrees.
Imperial nurtures a dynamic enterprise culture, where collaborations with industrial, healthcare and international partners are the norm. In 2007, Imperial College London and Imperial College Healthcare NHS Trust formed the UK's first Academic Health Science