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GPs buried under trusts' workload dump

20% of patients treated by private firms

Almost one in five NHS patients seen in secondary care is now treated by a private firm, after Labour’s ‘patient choice’ reforms led to an expansion in the independent healthcare market, a report by the Nuffield Trust and the Institute of Fiscal Studies concludes.

Private firms are now a ‘significant’ provider of NHS-funded operations, carrying out 17% of hip replacements, 17% of hernia repairs and 6% of gall bladder removals each year in England, said the report.

The number of ‘independent sector treatment centres’- private providers that carry out treatment funded by the NHS - expanded rapidly between 2006/07 and 2010/11.

GPs and patients were given a more explicit choice over where to book their first outpatient appointment by the Labour Party, which has vehemently criticised the Coalition Government’s plans to increase competition in the NHS.

By 2010, GPs referred patients to an average of 18 providers, compared with 12 – mainly NHS – providers in 2010/11.

In 2010/11 private firms carried out 8% of patients’ first orthopaedics and trauma appointments, 4.8% of gastroenterology appointments and 2.3% of ophthalmology appointments, compared with  less than 1% prior to 2008.

The report also found a decline in the percentage of patients attending their nearest trust, although they are still in the majority.

The closer a patient lived to a private provider, the more likely they were to attend, the report found. However, private firms treat a ‘significant’ amount of patients who were travelling more than 15km further than their nearest trust, the report said.

It found that patients are travelling further for care, with the average distance travelled for orthopaedics, trauma and gastroenterology treatment increasing by 0.8km from 2006/07 to 2010/11.  

Although patients are travelling further, they were not exercising choice between hospitals, as there was no statistically significant change in the proportion of patients attending an NHS trust that is not near to them, in any year and for any specialty.

The report concludes: ‘The analysis here has not demonstrated the extent to which the shift in treatment location represents a shift from lower- to higher- quality providers.’

It added: ‘While there has been some shift away from the treatment at the nearest NHS trust, the majority of patients with the conditions examined in this study are still treated by their nearest NHS provider.’

‘This suggests that while some patients may have exploited the reforms, others may not. Exploring which patients have been affected will be important in understanding how different types of individuals have been, and will be, affected by increasing choice and competition.’

Readers' comments (2)

  • These figures are evidence of private sector expansion but need to be treated with caution: they only relate to elective treatment – and in fact the study only looks in detail at three elective treatments (hip replacement, gall bladder removal & hernia), with a grand total ISTC provision of 24,000 episodes between them.
    By contrast the NHS dealt with 9.8 million elective admissions and 5.2 million emergencies. ISTCs did 12,000 hip operations: the NHS handles 856,000 operations on "bones & joints" each year.
    0% of emergencies are seen by the private sector, and on none of the categories of elective treatment analysed do the figures go above 17%: gall bladder ops are just 6%.
    The percentage of outpatient activity in the private sector is even smaller: so to claim that 20% of NHS patients are "now treated by private firms" is just grossly inaccurate and misleading.

    All this use of private providers is expensive, wasteful and undermines the proper provision of a comprehensive health service. It is a terrible legacy from a Labour government that could have spent the money and the time to strengthen public sector provision and protecting it against the ravages of this government.

    But let's not allow the false, defeatist picture to be generated that suggests the NHS is already largely privatised. This does not help us defend what are still vital public services, few of which would be offered by private providers unless they could squeeze additional funding from government over and above the NHS tariff.

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  • Never mind the ISTC's or other NHS hospitals (although the last post makes some excellent points).

    What should happen is this. All GP's in the UK should be paid a fair civil servants wage and be signed up to NHS employment contracts with a shift pattern for out of hours. There should be no more private practices (businesses) from GP's. Then they can all stop whining about the Private Sector andy show real believe in the NHS. I think patients would agree too.

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